RC-000169-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: RC-000169-2015 Date Issued: Wednesday, June 6, 2018
This is to certify that work requested to be done as shown by Permit Number RC-000169-2015
has been completed.
Tax Map Number: 265.-1-73.1
Location: 1434 Bay RD
Owner: Michael George, Tammy George
Applicant: Tammy George
This structure may be occupied as a: SFD w/gas FP 3032 s.f.
Garage 1196 s.f By Order of Town Board
Cross ref AV 62-2013 (for 2nd garage) & SP 67-2013 & SB 14-2006 (Lot 2). TOWN OF UEENSBU
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL
1
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: RC-000169-2015 26A , 12A
Tax Map No: 265:I-73.1 REVISED
Permission is hereby granted to: Michael George
For property located at: 1434 Bay RD
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: Tammy George Single Family-New $175,000.00
Owner Address: 8039 Route 82 Total Value $175,000.00
Pine Plains,NY 12567
Contractor or Builder's Name/Address Electrical Inspection Agency
Michael George
8039 Route 82
Pine Plains,NY 12567
Plans&Specifications
SFD 3032 s.f.w/garage and fireplace
PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,May 23,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the own of ensb A"W22,2015
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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Town of Queensbury Building & Codes
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PRINCIPAL STRUCTURE APPLICATION
Per It
A permit must be obtained before beginning construction permit
Please read: 'TB resolution 86-2013(1-28-2013): $850 recreation fee for new dwelling Rec Feer_• ""$
units, including single-family dwellings,duplexes or two-family dwellings,multiple family Site Plan No.: 67-ao J a?�
dwellings, apartments, condominiums, townhouses, and/or manufactured and modular Subdivision No.2 , - -_ -
homes,but not including mobile homes. This is in addition to the permit fee. 4V (01-d-013
Date (4 )18-1)LI Applicant Nl4aa 0-1'ayhmi
Tax Map ID 06S- ! - 73. 1 Address 13
Zoning
Phone l E-mail S-3 •cias-7 +;ios�#)snc
Property Owner 6C_Q&J J0:;nn2y Contractor/Agent N t cllcw-i t?
Address 3039 MrR Address a
' P / 11-61 VS M\4k SU7 asci—,
Phone/E-mail TSWS-3�a)- g36-7 Phone I E-mail 51 -` &S-y130 416 r4iPal Qry sr�C
Building Street Address:
Subdivision Name: O k!lllLot#: Historic Site: _Yes _No
Estimated cost of construction: $ /
Type of Construction:
Check all that apply Please indicate measurements as required below:
c c
0
z v m 1st Floor 2nd Floor Other Total Height
a a
Single Family /
V �01�155Fl- �lossF-� �s � 3o3a�F1-
rTwo-Family
Multi-Family(#of
units_)
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garages(# r a(,S
q r4-
Other ✓
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
If commercial or industrial indicate name of business
Proposed use of building or addition j C
Source of heat(circle one) Gas OilPropane Solar Other
Fireplace-complete a separate application for"Fuel Burning Appliances&Chimneys" _Yes —No
Are there structures not shown on plot plan? No
Are their easements on the property? N c�
Site Information
a. Dimensions or acreage of lot
b. Is this a comer lot? rQ
c. Will the grade be changed as a result of construction: _Yes t1 No
d. Public water or Private well pt I vok
Sa
e. Sewer or Private Septic System t Va-ke
G
Value of all work to be performed(labor and materials) $ �–�L Com)
Declaration: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval. I certify that the application,plans,and supporting materials are a true and complete statement/description of the
work proposed,that all work will be performed in accordance with the NY State Building Codes, local building laws and ordinances,and
in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a
certificate of occupancy. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read an gree to the a
Sig Date:
llt
FOR OFFICE USE ONY:
Operating Permit Issued: _Yes _No
Occupancy Type:
Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
1--APR 18 2014
I I Re ised /14/2010
APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS
Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the
New York State Fire Prevention & Building Code. The applicant or owner agrees to comply with all applicable laws,
ordinances, regulations,and all conditions that are part of these requirements and also will allow all inspectors to enter
premises to perform required inspections.
Important Note To Applicant.• Rough-in and Final Inspections Are Required-
Owner:: klchr'� &N QNnw'j lly Installer/Builder: \C-1\0 .0
Address. I>c� Address: ��
Phone Nos.: :��5s-9 hS-Ll) 26O )SLIS-33a-905l'none Nos.: 51�--'9 ISS- t-I 130
Location of Property: Subdivision Name:
VEc`soljr"N)`1 B7 i�OrYl
Location of Proposed Construction and/or Installation: (1'
Contact Person for Building &Codes Compliance: A I 51 - Ci G S-u 1 30
Fuel Burning Applicance Wood :Coal Pellet Gas Oil
Information
Stove
Fireplace Insert
Fireplace, factory built'
Fireplace, Masonry
Furnace, (Garage Only)
If Factory Built, Please Provide: Manufacturer Name: Model No.
Listed By: Number:
Chimney Information BLOCK BRICK STONE
Masonry" Check One✓
TILE STEEL / SIZE IN
✓ INCHES
Flue Check One ✓
DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY
VENT LINER
Chimney Material Check One-'
" If Non-Masonry, please provide: Manufacturer Name: Model No.
ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE
PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT
AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS
Town of Queensbury` Community Development Office ` 742 Bay Road, Queensbury NY 12804
T-To\WNN [ ° � D
Revised 4/14/2010
Town of Queensbury i la LS R 18 2014
Highway Michael F. Travis
Department OF QUi= Highway Superintendent
BUILDING =
742 Bay Road, Queensbury, NY 12804 — Home (518) 798-0493
Office Phone: (518) 761-8211 Thomas R. Vanness
Fax: (518) 745-4466 Deputy Superintendent
Home (518) 745-0929
www. Queensbury.net
DRIVEWAY PERMIT
Date: L1 I Y� ) q _
Applicant Name: 1q ICne0 QnCk Imrry Veo
Address to be inspected:
Return Address: `)�I 'L I �a l Yee 1'iGl✓v5 )N\1 i dS�1
Applicant must show exact location and width of driveway(s) to be connected to the highway by placing
stakes at the specified location.
The Superintendent of Highways of the Town of Queensbury has reviewed this application. The following
action has been taken:
Step 1: ( ) Preliminary Approval
Need: ( ) Slight swale
( ) Deep swale
( ) Level with the road
( ) Level with the top of the paved wing
Size culvert pipe to be used (if necessary)
( ) 12" ( )15" ( ) 18" ( )24" ( )36"
Preliminary inspections completed by: Date:
Approved by Higway Supt: Deputy Supt.:
Upon completion, please resubmit this approved permit for a final approval.
Step 2: ( ) Final Approval
( ) Rejected
Date:
Michael F. Travis, Highway Superintendent
Thomas R. Van Ness, Deputy Highway Superintendent
Town of Queensbury' Community Development Office`742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
OFFICE USE ONLY 1 a 2Q1
TAX MAP NO. PERMIT NO.
PERt�1T FEE u,}RY
APPROVALS: ZONING TOWN CLERK 4 c
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT.
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE
ISSUANCE OFAV�ABLID PERMIT.
1 �
OWNER: v tcv\& 1 �m �J>;V INSTALLER:"
'"l 1�� UI , Tl
ADDREss �`JC4Gt GR tF�d ?P) r`e l lc lye �1 ADDRESS: c�
PHONE NOS. PHONEpNO\S.51 0
LOCATION OF INSTALLATION' I114 ) L`
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLU STEEP SLOPE_ %SLOPE_ '
✓ SOIL NATURE: SAND_ LOAM_ CLAY_ OTHER_
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCKIIMPERVIOUS MATERIAL AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL_ WELL /(If well:water supply from any septic system absorption is: ft1
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi]
(rest to be completed by a licensed professional engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: Al individual sewage disposal systems must be designed by a licensed professional engineer
or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: 101SO GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder,spa or whirlpool tub.
SYSTYPE:
U'ABSORPTION FIELD(WITH NO.2 STONE) Total length t"I-(So�{t Each trench ` X 5�
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 13629 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant,shall be void.
I have read the regulations with respect to this application and agree
to abide by these and all requirements of the Town of QueensburyCQUESTnIONSCALL 7618256 OR EMAILSanitary Sewage Disposal Ordinance. a)aueensburv.netE FOR MORE INFORMATION
ignature of Person Responsible Date clueensbury.net
Town of Queensbury' Community Development Office'742 Bay Road, Queensbury NY 12804
'R
Foundation Inspection Report
to !Z
Office No. (518)761-8256 Date Inspection request received: 91-2,`l17 CA
Queensbury Building&Code Enforcement Arrive: am/pm Depart: p Jilpm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: !T (L l
NAME: Q) /n� PERMIT#: 201 12a
LOCATION: btu Y-0OY� INSPECT ON: gI3D I2OA`J
TYPE OF STRUCTURE:
(�'
Comments
Y N N/A 'bre
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing '
for 48 hours following the placement 111 1 tom, `;
of the concrete.
Materials for this purpose on site.
Foundation/Wallpourn
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing C
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/9/2014
ENVIRONMENTAL DESIGN
Oct) PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518.371.7621 (F)518.371.9540 edplip.com
Shaping the physical environment
• at 1
TO: Town of Queensbury Building & Codes
ATTN: John O'Brien U IE C%E 0 W E
FROM: Dennis MacElroy
N8"_3 2017
RE: George Wastewater System TOWN OF QUEENSBURY
DATE: COMMUNITY DEVELOPMENT
•
COPIES DESCRIPTION DATE
1 Revised As-Built for George Residence Wastewater System 11-3-17
John ...... enclosed is a revised as-built plan which now also includes reference to the water
supply well and its horizontal separation distance to the wastewater system. Please add this to
the Town's file for this project.
DELIVERED BY: DM
COPY TO:
ENVIRONMENTAL DESIGN
Oct) PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518 371 7621 (F)518 371 9540 edpllp.com
TO: Town of Queensbury Building & Codes
ATTN: John O'Brien D 0 W
FROM: Dennis MacElroyWR 2017 D
RE: George Wastewater System TOWN OF OUEENSBURY
COMMUNITY DEVELOPMENT
DATE:
COPIES DESCRIPTION DATE
1 Revised As-Built for George Residence Wastewater System 11-3-17
G — _ 2-o V5
John ...... enclosed is a revised as-built plan which now also includes reference to the water
supply well and its horizontal separation distance to the wastewater system. Please add this to
the Town's file for this project.
DELIVERED BY: DM
COPY TO:
D ECS ' 9WE
0 3 2017
TOWN OF QUEENSBURY _
MUNITY DEVELOPMENT
SEPTIC
EXISTING WELL IS LOCATED FOUNDATION
WESTERLY AND UPGRADIENT OF CORNER D—BOX
THE HOUSE, 167.5 FT FROM
THE NOTED CORNER
POINT AT START
OF LATERAL
ID
POINT AT END
�O OF LATERAL
� ABSORPTION FIELD
167 —6
TO
WELL
„ 74
63'_10,,
63'-8,.
POINT AT END
'tedd'' OF LATERAL
WASTEWATER AS-BUILT PLAN FOR
GEORGE RESIDENCE
LOCATED AT 1434 BAY ROAD
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP.
TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK
12065
N.T.S. TAX MAP No. 265-1-73.1 900 Route 146 Clrfton Park,NY
(518)371-7621 edpllp.Com
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03 2011
TOWN OFQUEENSBURY
MUNITY DEVELOPMENT i
SEPTIC
EXISTING WELL IS LOCATED FOUNDATION
WESTERLY AND UPGRADIENT OF CORNER D—BOX
THE HOUSE, 167.5 FT FROM
THE NOTED CORNER
POINT AT START
OF LATERAL
��� �,a POINT AT END
.�O OF LATERAL
,y1
ABSORPTION FIELD
• TO WELL
67'—�6
63'—ip"
63'_8,.
POINT AT END
OF LATERAL
rk
WASTEWATER AS-BUILT PLAN FOR
GEORGE RESIDENCE
LOCATED AT 1434 BAY ROAD
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP.
TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 900
NY
N.T.S. TAX MAP No. 265-7.73.7 (518)3rte 146 Clifton P8%dpI12065
(518)371-7621 edpllp.00m
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ENVIRONMENTAL DESIGN
PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518.371.7621 (F)518.371.9540 edpllp.com
October 20, 2017
Town of Queensbury Building & Codes Department
742 Bay Road
Queensbury, NY 12804
Attn: Dave Hatin, Director
Re: George Residence Wastewater
1434 Bay Road
Dear Dave:
In compliance with application approvals granted by the Town of Queensbury I offer the following
regarding the referenced project. The design plan reviewed and approved by the Town as associated
with the wastewater system application is as follows:
Proposed Site Development For The Lands of Michael& Tammy George
Bay Road
Town of Queensbury Tax Parcel ID 265.4-73.1 1-9-2014
• Sheet S-1: Site Plan
• Sheet S-2: Details
During the course of construction I was on the job site to observe key components of the system
installation. I have attached an 'as-built' sketch of the absorption field to document the location of
the field and d-box.With my approval the Owner relocated the field location to accommodate a
potential pool in the future. As finally positioned the corner of the absorption field is approximately
14' from the house foundation. At your request we have confirmed the elevation relationship of the
basement level of the house and the absorption field. Based on field measurements I can confirm
that the absorption field depth is at and lower than the basement slab elevation.
Other than this adjustment in location the system as installed is compliant with the design plan.
Based on my inspection of the system installation it is my opinion that the wastewater system is in
compliance with the intent of the approved design plan and is ready for operation. Please contact
me should you require any further information.
Sincerely,
Dennis MacElroy, PE , [ I
Partner u OCT L �(it7
Environmental Design Partnership TOWN OF QUEENSBURYBUILDING
4 Glens Falls Technical Park, Box 5
Glens Falls, NY 12801 �� 20 IJ
(518) 376-4485
cc: Michael George
ENVIRONMENTAL DESIGN
900 Route 146 Clifton Park, NY 12065
PARTNERSHIP, LLP.
(P)518.371.7621 (F)518.371.9540 edpllp.conn
Shaping die physical en:ironmer:
October 20, 2017
Town of Queensbury Building & Codes Department
742 Bay Road
Queensbury, NY 12804
Attn: Dave Hatin, Director
Re: George Residence Wastewater
1434 Bay Road
Dear Dave:
In compliance with application approvals granted by the Town of Queensbury I offer the following
regarding the referenced project. The design plan reviewed and approved by the Town as associated
with the wastewater system application is as follows:
Proposed Site Development For The Lands of Michael& Tammy George
Bay Road
Town of Queensbury Tax Parcel ID 265.4-73.1 1-9-2014
• Sheet S-1: Site Plan
• Sheet S-2: Details
During the course of construction I was on the job site to observe key components of the system
installation. I have attached an 'as-built' sketch of the absorption field to document the location of
the field and d-box. With my approval the Owner relocated the field location to accommodate a
potential pool in the future. As finally positioned the corner of the absorption field is approximately
14' from the house foundation. At your request we have confirmed the elevation relationship of the
basement level of the house and the absorption field. Based on field measurements I can confirm
that the absorption field depth is at and lower than the basement slab elevation.
Other than this adjustment in location the system as installed is compliant with the design plan.
Based on my inspection of the system installation it is my opinion that the wastewater system is in
compliance with the intent of the approved design plan and is ready for operation. Please contact
me should you require any further information.
Sincerely,
�,"V,roc.�1� -f C C (E 0 M IE
Dennis MacElroy, PE I
Partner RL OCT 2 $ 7617 D
TOWN OF QUEENSBURY f
Environmental Design Partnership BUILDING& CGD[S _
4 Glens Falls Technical Park, Box 5
Glens Falls, NY 12801 �C� �`� • 2015
(518) 3764485
cc: Michael George
SEPTIC TANK
D—BOX
POINT AT START
OF LATERAL
'�D POINT AT END
NQ1 OF LATERAL
ABSORPTION FIELD
67'-6„� \\\
74
63'-10,, \
POINT AT END
OF LATERAL
WASTEWATER AS-BUILT PLAN FOR
GEORGE RESIDENCE
LOCATED AT 1434 BAY ROAD
ENVIRONMENTAL DESIGN
PARTNERSHIP, I.I.P.
TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 900 Route 146 Clifton Park,NY 12065
N.T.S. TAX MAP No. 265-1-73.1
(518)371-7621 edpllp.com
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i
SEPTIC TANK
D—BOX
POINT AT START
OF LATERAL
POINT AT END
�O OF LATERAL
ABSORPTION FIELD
63'_10.,
6,3'-
POINT AT END
OF LATERAL
WASTEWATER AS-BUILT PLAN FOR
GEORGE RESIDENCE
LOCATED AT 1434 BAY ROAD
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP.
TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 9O0 Route 146 CiftnPBrk NY 12066
N.T.S. TAX MAP No. 265-1-73.1
(518)371-7621 edpllp.can
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