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2005-510 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: P20050510 Date Issued: Wednesday, August 03, 2005 This is to certify that work requested to be done as shown by Permit Number P20050510 has been completed. Tax Map Number: 523400-302-018-0003-030-000-0000 Location: 16 BROADACRES Rd Owner: JEFFREY& AMY COLLINS Applicant: AMY & JEFFREY COLLINS This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance 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 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20050510 Application Number: A20050510 Tat T\-lap No: 523400-302-018-0003-030-000-0000 Permission is hereby granted to: AMY& TF,FFRF.Y COLLINS For property located at: 16 BROADACRES 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 Value Owner Address: SANDRA L BUCHMAN 16 BROADACRES Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Ol TEENSB1 TRY SEWER JAY SWEET Plans&Specifications 2005-510 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, July 11, 2006 (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 Town of Queensbury; Monday, July 11, 2005 SIGNED BY //J for the Town of Queensbury. irector of Buildi o Enforcement Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: :......................................................................................................................................: Office Use Location of installation: l ty4o jjx,;t,ir QJcu-f/�v �/ File Permit No. Tax Map No. ��l< < ; Fee Paid j Owner's Name: Amv if Address: �G f14.-/F , *,� &d j zt4 f s < , A'y Q 6e To"A 3-3, 2. INSTALLER'S NAMEPHONE: 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply #of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 er x 150 ga1/bdrm = _ 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ L. { - 1 D5 Spa or Hot Tub Installed yes 4 /ci4 TOWN OF 00LENSgURY BUILDING AND CODE 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) ToDozranhv Soil Nature Ground Water Bedrock or Impervious Material Domestic Water So ply at what depth at what depth munici a olling loam feet feet well Steep slope clay if well; water supply �%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub. Septic Tank: gR:r_L gallon (min. size 1,000 gal) kA4t I -trr'-k-/ws --Lk-Field: each trench Total System Length: Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 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 Queensbury Sanitary Sewage Disposal Ordinance. U Z- Skjn re f responsible erson Date Town of Qum& Building & Code Enforcement Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: C � Inspected on: 7 L4 t Location: % ( � ./�.��f�C�iCi ' ? J� Arrive: a.m.I P.M. Permit No.: C% 5- — /C' Inspector's Initials: Comments and/or diagram Soil Type: Sand I Loam I Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: N ft. Well Casing Length 50'+/ Y N /A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below gi ade _Y N [provide extension collar if Ye ] _Y N _��1 Location/Separations Foundation to tank ft. Foundation to absorption Separation of Pits Conforms as per Plot Plan V Y Engineer Report and As-Built _Y_N ETU Maintenance Contract provided _Y_N Location of System on Property: Front Re Left Side Rig ide Middle Front Middle Rear System Use Stat Appro ial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/pr�I r,Depart: p 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: V�� NAME: DLL/�� PERMIT NO.: LOCATION: �.E'0�4b/.�� INSPECT ON: RECHECK: ' Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance Other wells: $. Absorption Field: Total length ft. Length of each trench ft. D th of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distrib Box Distribution B6j td 3eld/Pit Opening Seale : Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle Fro Middle Rear System Use St Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 fo f tf Septic Inspection Report 1 Office No.(518)761-8256 Date Inspection request received: "�, ./-5 Queensbury Building&Code Enforcement Arrive: am/pp�, epart: am/pm 742 Bay Rd_.,Queensbury,NY 12804 Inspector's Initials: ' NAME• A ��f �LtiL ) Cv(�� 5 PERMIT NO.: LOCAT ON: �,� _ �� INSPECT ON: 3 RECHECK: Comments and/or diagram Soil Type: San o / la Type of Wa er: unicipa /Well Water Waterline separALon d' nce ft. Well separation distance _ ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone —' L - See a e Pits: Number Size: x Stone Size: Piping SiZA.. Type Building to tank L Tank to Distributio Distribution Box to rie /Pit OpeningSealed: Y k&/kartial �-(, 'r�o End Caps Location/Separations JA Foundation to tank ft. Foundation to abso tion Separation of Pits ft. Conforms as per Plot Plan Y N En sneer Report and As-Built Y N Location of System on Property: Front ea Left Side Right Side Middle ront Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 1/6/05 Queensbury Building & Code Enforcement - Resi ti al Inspection Office No.(518)761-8256 Arrive: am/p apart: amt,( Date Inspection request received: Inspector's Inif is ` NAME: RMIT#: j LOCATION: TYPE OF STRUCTURE: Comments � Building Number/Address visible from road Yes No N/A Chimney Height/"B"Vent/Direct Vent Location 9_, jj Fresh Air Intake 3 inch Plumbing Vent through roof minimum 6 inches Roof Complete/Exterior Finish Complete Platform at all exterior doors Guards at stairs,decks,patios more than 30 inches above grade Guard at stairwell at 34 inches or more Guard at deck,porches 36 inches or more Handrail Termination at Newell Post or Wall Interior/Exterior Railings 34 inches to 38 inches Interior Handrails P,stairs 2 or more risers Grade away from foundation 6 inches with 10 feet 6 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18 inches above grade Interior privacy/trim/doors/main entrance 36 inches Bathroom/Kitchen watertight Safeglazing/Window in stairwells safety glazing Interior Smoke Detectors: Every level: Every Bedroom: Outside every bedroom area:--- Inter Connected: Battery backup: Carbon Monoxide Detector Attic access 30 inches x 22 inches x 30 inches(height)in accessible area Crawl Spaces 18 inch x 24 inch access, 1 s .ft,150 s .ft.vents Bathroom Fans,if no window Plumbing fixtures Foundation insulation Floor truss,draft stopping finished basement 1,000 s .ft. Emergency egress below grade Gas Furnace shut-off within 30 feet or within line of site Oil Furnace shut-off at entrance to furnace area Furnace/Hot Water Heater operating_ Low water shut-off boiler Relief Valve(s)installed/Heat Trap/Water Temp 110 Enclosed Stairs Sheetrock Underside minimum%z"Gypsum Basement stairs closed rise>4 inches Garage Floor Pitched Garage fireproofing/3/4 hour fire door/door closer Duct work Sealed properly Gas Logs in Sealed or Glass Enclosure Final Electrical Final Survey Plot Plan As Built Septic System/Sewer Dept.Inspection Sticker Site Plan /Variance required Flood Plain Certification, ' uired Okay to issue C/C oK/Ojqe or Permanent L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form revised 100405.doc 0 [1�C1[.f[J�[.n[.n[J'[J�[1'�[J�[1[J�C1[nirJC1�C1�[1CP[.I'C1CJ�[J'[J�Gf[J�[J�CI[ J 11, 2PE [.nC3rL3J'3PLr.n[J�[J'L3PL PLrE3 I� 5 BY THIS CERTIFICATE OF COMPLIANCE THE 0 —'S—` 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 S SBUREAU OF ELECTRICITY 5 5 40 FULTON STREET - NEW YORK, NY 10038 55 5 CERTIFIES THAT S 5 S SUpon the application of upon premises owned by 5 5 S 5 JEFF COLLINS JEFF COLLINS PO BOX 630 S GLENNS FALLS, NY 12801 GLENS FALLS, NY 12801 5 S 5 5 16 BROADACRES RD QUEENSBURY, TN, NY 12804 5 5 Application Number: 2054542 Certificate Number: 2054542 5 5 5 5 Section: Block: Lot: Building Permit: BDC. A2 39 S 5 5 Described as a Residential occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 5 Basement,Outside, 5 5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 herein, was conducted in accordance with the requirements of the applicable code and/or standard 5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other S 5 authority having jurisdiction, and found to be in compliance therewith on the 8th Day of September,2006. 5 5 Name (OTY Rate Rating Circuit Tyne 5 Panels 5 5 1 200 40 CU SService Cj 5 1 Phase 3 W Service Rating 200 Amperes 5 Service Disconnect: 1 200 cb Meters: l S 5 S S S 5 5 S 5 5 5 _ 5 seal 5 _ 5 5 1 of 1 5 5 5 SThis certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 t7 rJ'CnCnC rrrcnrJ'rJ'CPCPrJrJ�cnrJ�rrr�CPcnC rC!@nc.l�rJ�Cnr�rJ'rJ'CnCJ�cnr�r c.PJ�rrrJ�CPcPCPcPCncJ�CPrJCfrJ�CnC rcPr.Pr.J'ct-�n�J'rJ'CPcnCn�nr�rl�.rClCP 0 a i LL. M LLJ Lli 06 LL z o WNED i �. I _._.� -,; Jul. TOWN OF OU E ., BURY tE. t� I� 4