2008-621 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080621 Date Issued: Wednesday, November 23, 2011
This is to certify that work requested to be done as shown by Permit Number P20080621
has been completed.
Tax Map Number: 523400-289-017-0001-017-000-0000
Location: 72 ASH Dr
Owner: MICHAEL MILLER
Applicant: MICHAEL MILLER
This structure may be occupied as a:
Test Pit/Perc Test Review
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibilityp for com liance with Site Plan . 1 '�� -
P tY A , .�°��
Variance, or other issues and conditions as a result of approvals by the Director of Building&Co a Enfor ement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20080621 Application Number: A20080621
Tax Map No: 523400-289-017-0001-017-000-0000
Permission is hereby granted to: MICHAEL MILLER
For property located at. 72 ASH 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. TWe of Construction Value
Owner Address: MICHAEL MILLER
Test Pit/Perc Test Review
5519 SE REEF Way
STUART, FL 34997-0000 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
2008-621
DEEP HOLE/PERC TEST
$200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 23,2012
(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.)
1
Dated at the Town ofQuee sbury / We esovember 23,2011
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Nov 06 2008 6: 24PM HP LRSERJET FRX p. 1
NOV 18 2008
Togo of Qumnnbury- Building&Codee Enforcemcnt Office,742 Bay Road- Queembury.NY 12804
DEEP HOL1E/PERC TEST
Request for Town Engineer Review
Property Owner: Michael Mil1.er �`a! 1i 1 Phona:� 02
Property owneVe
Address: 5S1 9 SE Reef Way, Stuart FL -3="W$1i ` c 2 0? 7
Location of Teat: 72 ash Drive 0 eensbUry Tax ID#: 2139-1 7--1_1 7
'ApplicarWs Engirmer: Jarrett-Martin Sncr. PLI�C _ Phona: 797-2907
Applicant's Agent Jarret:l:-Ma-tin Eng. PLLC Phone: 792-2907
Additional NOILOS;
1.Reasan far RequasYl i^l Now Septic Systemn Replacement Septic System ❑ Failed septic system
❑ Subdivlslon OX , Site Plan Review
2.Are Wetlands premnt? 1:1u YES ❑ NO a UNKNOWN
*Note: Applicant is required engage an engineer for design and testiag of the system. The Town
Engineers responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE.
a. $200 Flat free Date Paid: _
Check No.:
b. OR to be determined during To Be determined:
Site Plan I Subdivision review process
SIGNATURE:
In carrying out the provislons of Article W, the Local Board of Health or the enforcement officer may
engage the services of a qualltled professlonal consultant for expert review and recommendation arlsing
frog► the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
speclitcatfons and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole ar?d percolation tests, system installations, and any other aspect of an ontalned In this Ark
IV, and any wsia incurred in such review shall be paid to the Town by the property before
any approval can be granted under tils Art. IV shah become effective wi of presentment of an
Invoice for same, whichever is sooner. Such costs shall not exceed $1,t�Ut)wit rior written notice to
the party to be charged with same. 4 41,v4e c,'96-7—
My signature below indicates i have thoroughly'read and understand the instructions, agree to the
submission requirements and have completed the apptication. I also fully understand that additional
engineering fees may be necessary per Town of Quee.isbury Local Law i,36-14D.
S1433NATURE OF AP���_
...�. (]ate:
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SIG NATURE Or �' a �� � �`7'�`'�' _ Date: // 7 d
Ohgg nal (B &C He) Canary (Planning) -Ink(Applicant) Gold (Town Clerk)
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Map Produced by Warren County Spatial Data Vie Lwer-www.co.warren.ny.us/gis r Q¢�O['�
data sources:parcels-Warren County Real Property Tax,2003 Tentative Roll u J rtv-
aerial photography-NYSOFT,flown April,2001
IMPORTANT NOTICE AND DISCLAIMER uklt Fr-a,+ rrope-4(�
THIS MAP AND INFORMATION IS PROVIDED"AS IS"AND WARREN COUNTY MAKES NO WARRANTIES OR �( 7
MERCHANTABILITY AND THAT OPRESSED OR FA FITINESS OR A PARTICULAR PURPOSE ED,INCLUDING WARRANTIES OF TITLE, ITH S MAP AND THE T4kX#
INFORMATION CONTAINED HEREIN.USER ASSUMES ALL RISKS AND RESPONSIBILITY FOR DETERMINING
WHETHER THIS MAP IS SUFFICIENT FOR PURPOSES INTENDED.
GIS MAPS ARE NOT LAND SURVEYS!
This GIS map is computer generated using software which contains information acquired by Warren County Planning
Department from various sources and is intended only for reference,conceptual planning and presentation purposes. 0 10 20 40 60 80
While we work hard to include reliable data for the stated purposes,this map is not intended for and should not be used Feet
to establish boundaries,lines,locations of objects or to provide any other information typically needed for construction,
excavation or any other purpose when engineered drawings/plans or surveys are 1)required by law:2)required for any
legal document or 3)needed to assure accuracy and/or that certain standards are met.