2006-769 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060769 Application Number. a2006O769
Tax Map No: 523400-301-007-0001-064-000-0000
Permission is hereby granted to: KENNETH &MARILYN RYBA
For property located at: 28 CENTENNIAL Dr
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. Tyne of Construction Value
Owner Address: KENNETH &MARILYN RYBA
30 SARA-JEN Dr Garage-2 Cars Attached
QUEENSBURY, NY 12804-0000 Single Family Dwelling $150,000.00
Total Value $150,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
CLUTE ENTERPRISES
13 DAWN Rd
QUEENSBURY,NY 12804-0000
Plans &Specifications
2006-769
1232 sq ft single family dwelling 576 sq ft garage
$205.44 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, October 31,2007
(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 To v�i of ensb �; Ts y, October 31,2006
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
i
TOWN OF QUEENSBURY
s
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20060769 Date Issued: Tuesday, January 23, 2007
This is to certify that work requested to be done as shown by Permit Number P20060769
has been completed.
Tax Map Number. 523400-301-007-0001-064-000-0000
Location: 28 CENTENNIAL Dr
Owner. TINA M ARCURI-DE MARSH
Applicant:
This structure may be occupied as a:
Garage - 2 Cars Attached By Order of Town Board
Single Family Dwelling TOWN OF QUEENSBURY
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&Co o ent
Planning Board or Zoning Board of Appeals.
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' OFFICE USE ONLY - """ .......
TAX MAP NO. PERMIT N0. '` ' 0 '
' PERMIT FEE '
APPROVALS; ZONING % ' '
N CLERK ' 0 0
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM I , rrr:.rrr.......::...:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT T PERMI�'1.
PERMIT. O REVIEW BEFORE ISSUANCE OF A VALID
OWNER:
INSTALLER: C . v :—, ;~�, •
ADORERS: c Q6 .
�'� �yADORESS:
J
PHONE NOS._
LOCATION OF INSTALLATION: -t_, PHONE NOS.__ (�1 "7 7
YEARBUILT».N NNNO.N� »..N".. X .............."".N.N..N»""..........."."......"."... ..... .....N"...."........"".........".._
NNNN.,," »,• BE,DRQOMS COMPUTATION: : TOTAL DAILY FLOW"" " RESIDENCE INFORMATION:
1980 or older "X. .......50"..»».....""......N."................". ........_.........._...N...""____".."........
1991» " gallon per bedroom .," GARBAGE GRINDER
" 1981 "....._."..»..»»».»".. NX.. N1Ngallon per bedroom.... ..........
. " ............."......................."......"............ INSTALLED?
1992 present ».".... "•. N.NN.»»........,».". ..... .... " ".N•...
PA OR HOT
N...»»...N " ""» .".".....» ..»».....»»....NX N ....110 gallon per bedroom "'» ........".. :: »""................... INSTALLED? TUB
PARCEL INFORMATION: N ........... N�-..'."."......".................
TOPOGRAEdY FLAT OLLING STEEP SLOPE_____
� %SLOPE
✓ SOILMM C- SAND
LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
WHAT DEPTH? .BEDROCK
MPE�O11 MATEgIAL: AT
DSTIC WATER MUNICIPAL } WELL
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS
✓ P FtCOLAI T,�F T: RATE IS PER MIINUTE PER INCH (TEST TO' BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITEC
T)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be d
a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision).
Add d by
sion) Add
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub, 250
✓ SEPTIC TANK: (C-�_GALLON (MIN. SIZE IS 1,000 GAL.)
TIL--E-�4Q: EACH TRENCH aO FT,
✓ TOTAL SYSTEM L N ,TN: �-1012_FT
SEEPA f PIT(S): HOW MANY?
✓ SIZE OF EACH sFT. X--____.__FTI
✓ SIZE OF STONE TO BE USED: #
/DEPTH OR THICKNESS F7
✓ _BED SYSTEM SIZE:
✓ ALTERNATIVE SYSTEM:
LENGTH AND10R SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS:
/SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY.•
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NOTE: ALARM SYSTEM AND ASSOCIATED R •1. .J.l.1.,.J.NI.N41.1.1.J.1.l.,.,.J.,.,.,.1.,.,.J.1.1.,.1.l.41.1.1.i.;.1.1.iN.l.l.1.1.J.1.l.1.1.J.J,,,,,,,,,,,,,,,,,,,,,,
1.,.1.,.1.lN.1,J•1.1.J.1.lN.1.1.,.,.,
APPROVED ELECTRICAL INSPECTION AGENCY.
ELECTRICAL WORK MUST BE INSPECTED Bh A TOWN
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For your protection, please note that pursuant to Section 136.29 of the Cade of the Town of Queensbury, an 414
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation o
failure to make a material fact or circumstance known by:or on behalf of an applicant, shall be void; r
I have read the regulations with respect to this application and
agree to abld.a-by these And all require is of the Town of QUESTIONS? CALL 701.=6 OR EMAIL
Queensbury''Sancta wage D p al rdi ce. ccdesen,�eensb�ry net
::;
IT OUR WEBSITE FOR MORR INFORMATION
;,• ��.... w�e►.aueetlsbury net
lg ure of Person Responsible Date
Town of Queensbury • Community Development Office ■ 742 Bala Road. nuaviah,ir, rTV IIOAA
'.....r............r..r...........................rr... ..............
ZI OFFICE USE ONLY
TAX MAP NO. r r
PERMIT NO.
� %iJ v J
FEES: PERMIT2 _ '
RECREATION�_ENGINEERING
:............................... (If appRcable) S a n p
PRINCIPAL STR UCT"URE: .........
APPLICATION FOR ZONING APPROVAL & BUILDING
A PEFYMIT MUST BE OBTAINED BEFORE BEGINNING CONSTR PERMIT
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.APPLICATION IS SUBJECT TO
APPLICANT/BUILDER: ��J� I •
—...., `= OWNER: /
ADDRESS:
ADDRESS:
PHONE NOS.__
PHONE NOS,
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:
LOCATION OF PROPERTY: (' 1
--------------
. n
SUBDIVISION NAME:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT zU
APPLY TO YOUR Z p
PROJECT � � � $ v�j
d Itiri �
SINGLE FAMILY
TWO-FAMILY
---
MULTI-FAMILY
(NO.of UNITS_•__,
TOWNHOUSE
BUSINESS OFFICE
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACH
OTHER
IF COMMERCIAL OR INDUSTRIAL—NAME OF BUSINESS:
ESTIMATED CO STRUCTION COST: C c"''--o
'FUEL TYPE:
HEAT TYPE: c z, '"HOW MANY FIREPi.ACE(.$
AND/OR WOODSTOVES(S):___SC___
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? i�s
IS THIS A HISTORIC SITE?
PROPOSED USE OF BUILDING OR ADDITION:_ `
"Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
B 3-LGL 11.05
Town of Queensbury• Community Development Office • 742 Bay Road, Queenshury, NY 12804
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY?
I acknowledge no construction soul s,Shall be:Commenced prior to issuance of a valid
permit. 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 reguletions. 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 requi-red to provide an as-built survey by a licensed land surveyor of all newly
constructed faciiities prior to Issuance of a certificate of occupancy.
I have read and agree to.th ove.
Signed
Director of Buildl �Q •761-8;266 r�qusstions regarding Building Permits, construction
codes'or septic sy;ytems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
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Permission ..1
1 I I
Permission is hereby 'granted to the above ; ; This application/ proposed action described
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said
Application: 0, zoning Laws of the Town of Queensbury.
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BUILDING &CODES APPROVAL '
ZONING APPROVAL 1
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DATE 1 I, /
11 DAME
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QUESTIONS? CALL 761.825e OR EMAIL
cod_eaAam ety�bury n'st
VISIT OUR WESSITE FOR MORE INFORMATION
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70n'n of Queensbury• Community Development Office• 742 Bny Road, Queensbury, NY 12804