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2003-408 TOWN of QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256` CERTIFICATE aF COMLI CE AN Permit Number: P20030408. Date Issued: Thursday,Junes 12,2003 This is to certif -that work requested to be done as shown by Permit Number P2Q03040$ has been completed Tax Map Number 523400=302.018-0002-061-002-0000 Location: 120 COOLIDGE Ave tamer: ROBERT J SLACK Applicant: ROBERT J SLACK This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUBENSBURv Duector of Bull 'ng d nforcement L, TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518).761-8201 Community Dev' elopment-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030408 Application Number: A20030408 Tax Map No: 523400-302-018-0002-061-002-0000 Permission is hereby granted to: ROBERT J SLACK For property located at: 120 COOLIDGE Ave in the Town of Queensbuty,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and iti compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. . . Type of Construction Value Owner Address: ROBERTJSLACK Septic Alteration Residential 120 COOLIDGE Ave QUEENSBURY,NY 12804 Total Value Contractor or Builder's Name Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2003-408 SEPTIC ALTERATON AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 12,2004 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queeiisbury before the expiration date.) Dated at the T June ll,2003 SIGNED BY r on/ ;: /z4`j- S- for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit— Septic Dispos.41 System' IOivn of Queensbuty-742 Bay Xwd.Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: .......... ........................ ............. ................... ........................... Location of installation: /d--D 6- Office Use 12N File Permit No. t�,)3 Tax Map No. D Owner's Name: k ob 77 Fee Paid. ................ ....................................................... Address: 2. ANSTALLEWS NAME PHONE NO. j2C L, 3, RESIDENCE INFORMATION; (circle year of dwe6 ), indicate ff bedroont(s) and multiply' I/ of bedroonts wittiapplicable gallons per bedroom toRl N. , - 1W, i y (101 E b Year of House' No. of Bedrooms x COnputatioll_=, TQtal.Dailv Flow J LJ 114 7 J 2.00 3 1980 or older x 130 gaVbdrin = Tn Im QPZ BUR vLC Y 1980- 1991 X 130 gal/bdrin = 1991 —present X I 10 gnUbdrin, Garbage Grinder Installed yes— 1 110 V1_ Spa or Whirlpool Installed yes— I no 4. PARCEL INFORMATION: (circle applicable intortbation-& indicate measurements) T-op-gampl, 1,1.479- . d -or - -Y ly —5PU-t� __WtkkviL I k..9 3111PP4 _A9.d Plat SWU fit ithatelepill (it )vhelt cieptly Rolling Act feet Sleep slope clay if svell; ivater supply _VQ slope other from ally septic-systein depth: absorption is /0-0 other Percolation Test: (To beconipletedl)y licensee!pi-(ifo.v.viotialetiglt?eerorarcl;ifecl) Rate: minute-par Inch 5, PROPOSED SYSTEM' fopewconrjtrucllQn: All Individual sewage disposal systems inust be designed by a licensed prorcssional engineer or architect (unless installed in a Planning Boardapproved sulAivision). Add 250 gallons 10 file size or tic septic tank and leach lidd for cacti Garbage Grinder, Spa or Wifli lix)ol'I'llb. Septic Tank: 16 gallon (min. size ],000 gfil.) h trench 2- JI, Total Sy,tni Tile Field: eac' 12 1 Length: Seepage Pit(s): number of 1A 7 size ffffeach: A by Jt Size of Stolle to be iload; / depth or Bed System Size: X Altemative-System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: Size Of each: gallons ff,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 protoctioll, please note that pursuant to Section 136-29 ofthe Code ortho Town orQueetisbtiry, nay i)crallit or nivrfrovni-grailted which iik,based tilion or is St-nitted in reliance %11' material III is rej,r4bselit.1ijol, or niiii,ro to voinkoa material fact or circtimstailco any by or oil beiin'irornit appticaiit, sit-ill be void. 1 have road the regulations with resil sect to this nploication and agree to,nbido by those and nil . 1 requiretnet Town orQtic is f Satift-ary Sewage Disposal.Ordinance. gnatpre of respongible person Date F— Town of Queensbury L Fire.Marshal's Office 742 Bay Road Queensbury, NY 12804 Phone (518)761-8205 Fax(518) 745-4437 Fire Marshal's Inspection Report Request r SCHEDULE Received: Permit#- �� INSPECTION ON: Name: �t`� C T Alin PM ANYTIME Location: APPROVED V N/A YETO , COMMENTS EXITS AISLE WIDTHS EXIT SIGNS—NORMAL BATTERY EMERGENCY LIGHTING "G FIRE EXTINGUISHERS FIRE ALARM SYSTEM ir FIRE SPRINKLER SYSTEM U� � �� 64 FIRE SUPPRESSION SYSTEM ) A�) HOOD INSTALLATION • ST®RAGEFINISHES OL�J- COMPRESSED GAS t CLEARANCE TO SPRINKLERS ( HEATING (~C.C_oM UNITS 1A CLEARANCE TO ELECTRICAL r REQUIRED SIGNAGE EMERGENCY PLAN f MAXIMUM OCCUPANCY SIGN CHIMNEY MASONRY ROUGH IN f ` FINAL I j CEIIMNEY. f 1, FACTORY BUILT ROUGH IN i'/ )lLaa Oct FINALE v WOOD / STOVE' ROUG19 IN FINAL VENTED GAS APPLIANCE ROUGH IN FINAL FIREPLACE MASONRY ROUGH IN OK THIS DATE OK FORDO, NOT OK FINAL FIREPLACE - FACTORY BUILT ROUGH IN 1146PECTEE Y FINAL IT COMDEVICHRISJIWORDILETTERS20041FIREMARSHALINSPECTIONREPOR 11022001 YELLOW-OCCUPANT COPY WHITE-BUILDING DEPARTMENT COPY Town of Tue;nsbury Fire Marshai's Office 742 Bay Road Queensbury, NY 12804 7 Phone (518)761-8205 Fax(518) 745-443 1 Fire Marshal's Inspection Report Request SCHEDULE Received: --Permit# INSPECTION ON: 2- Name: X'M ) PM ANYTIME Location: APPROVtD N/A YES I NO COMMENTS EXITS AISLE WIDTHS EXIT SIGNS-NORMAL - BATTERY EMERGENCY LIGHTING FIRE EXTINGUISHERS FIRE ALARM SYSTEM FIRE SPRINKLER SYSTEM FIRE SUPPRESSION SYSTEM HOOD INSTALLATION INTERIOR FINISHES STORAGE COMPRESSED GAS CLEARANCE TO SPRINKLERS UNITS WkNeE4O HEATING CLEARANCE TO ELECTRICAL REQUIRED SIGNAGE EMERGENCY PLAN MAXIMUM OCCUPANCY SIGN CHIMNEY MASONRY ROUGH/IN FINAL,,.. CHIMNEY z FACTORY BUILT ROUGH IN FINAL WOOD STOVE- ROUGHIN FINAL VENTED GAS / APPLIANCE i ROUGH IN FINAL FIREPLACE NOT OK MASONRY ROUGH IN OK THIS DATE fF R CO NOT OK FINAL FIREPLACE V4* FACTORY BUILT ROUGH IN INSPECTED BY FINAL COM13E9//CHRISJ/WORD/LETTERS20011FIREMARSHALINSPECTIONREPORT11022001 WHITE-BUILDING DEPARTMENT COPY YELLOW OCCUPANT COPY Residential Final Inspection Office No. (518)761-8256 Date Inspection re ece Queensbury Building&Code Enforcement Arrive: a e 742 Bay Rd., Queensbury,NY 12804 Inspector's Initial NAME: t PE T#: 40Y LOCATION: aur E: TYPE OF STRUCTURE: Comments Y N N/A Chimney Ht./"B"Vent/Direct Vent Location Fresh Air Intake 3 inch Plumb Vent through roof Roof Complete Guard 30 in. or more @ stairs,decks,patios Guard at stairwell at 34 in. or more Guard at deck,porches 36 in.or more Exterior Finish Complete Interior/Exterior Railifigs 34 in.to 38 in. Platform at all exterior doors Interior Handrails stairs 2 or more risers Grade away from foundation 6 in.with 10 ft. Handrail Termination at Newell Post or Wall 8 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18"above grade Gas Furnace shut-off within 30_ft. 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 V/ Interior privacy/trim/doors/main entrance 36 in. Bathroom/Kitchen watertight Safety glazing Window in stairwells pfety glazing Interior Smoke Det tors: Every Every Be 00m: X/ Outside every bedroom ea: Inter Connected: V / Battery backu : Bathroom Fans,if no window V Carbon Monoxide detector Plumbing fixtures Foundation insulation Floor truss,draft stopping finished basement 1,000 sf �`%� Emergency egress below grade Basement stairs closed rise>4 inches 3/4hour fire door/door closer Garage fireproofing Duct work Sealed properly Attic access 30 in.x 24 in.x 30 in.(ht.)In accessible area/ Crawl Spaces 18"x 24"access, 1 sq. ft.-150 sq. ft.Aents Building No./Address visible from road Final Electrical Site Plan Wariance required Final Survey Plot Plan As Built Septic System/Sewer Dept. Inspection Sticker Flood Plain Certification,if required Okay to issue C/C(Cert. Of Compliance) Okay to issue Temporary C 0(Cert.Of Occupancy) Okay to issue Permanent C 0(Cert. Of Occupa cy) L:\SueHeniingNvay\Btiilding.Codes.Inspection.FOIMS\Res.Final Insp.form 2.doc edited January 28,2003 Residential Final Inspection 41 Office No. (518)761-8256 Date Inspection request received- Queensbury Building&Code Enforcement Arrive: V 1-0 anj4pfq D -am/ m 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia NAME: PE T#: 0409 LOCATION: TE: TYPE OF STRUCTURE' Comments Y N N/A Chimney Ht./"B"Vent/Direct Vent Location Fresh Air Intake 1 3 inch Plumb Vent through roof Roof Complete Guard 30 in.or more @ stairs,decks,patios Guard at stairwell at 34 in.or more Guard at deck,porches 36 in.or more Exterior Finish Complete Interior/Exterior Railings 34 in.to 38 in. Platform at all exterior doors -,V C> Interior Handrails stairs 2 or more risers Grade awU from foundation 61. �ft. Handrail Termination at Newell Post or Wall 8 inch clearance to sill plate Gas Valve shut-off exposed/regulator 18"above grade Gas Furnace shut-off within 30.ft. or within line of site Oil Furnace shut-off at entrance to furnace area Furnace/Hot Water Heater operating %Z �-T LSL-- \7't-- -Low water shut'-off boiler V Relief Valve(s)installed Interior privacy/trim/doors/main entrance 36 in. Bathroom/Kitchen watertight Vt9, Safety glazing Window in stairwells safety glazing 7 Interior Smoke DePectors: level: / - Eve Every Bedroom: L Every Outside every bedroom area: V Inter Connected: / Battery backup: Bathroom Fans,if no window V7,;r--- Carbon Monoxide detector ,�1\ � % Plumbing fixtures Foundation insulation Floor truss,draft stopping finished basement 1,000 sf Emergency egress below grade Basement stairs closed rise>4 inches /4hour fire door/door closer Garage fireproofing Duct work Sealed properly Attic abCess 30 in.x 24 in.x 30 in.(ht.)In accessible area Crawl Spaces 18"x 24"access, 1 sq.ft.-150 sq. ft.vents uilding No./Address visible from road Final Electrical , Site Plan Wariance required QV�Y- / .40 Final Survey Plot Plan F V As Built Septic System/Sewer Dept,Inspection Sticker Flood Plain Certification, if required Okay to issue C/C(Cert. Of Compliance) Okay to issue Temporary C/0(Cert.Of Occupancy) Okay to issue Permanent C/.0(Cert. Of Occupan y) LASueHemifi gway\Building.Codes.Itispection.FORMS\Res.Final Insp.form 2.doc edited January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection 7rrquest ived: 4UA'q Queensbury Building&Code Enforcement 'Arrive: I ;j( a in aW 742 Bay Rd., ueensb NY 12804 Inspector's Initial NAME: CJ IT NO.: LOCATION: SPECT ON: RECHECK, V , Comments and/or diagram Soil TY PeSandXoam ClaZ� Type ofQatgt1'Munici-paWell Water Waterline separation distd ft. Well separation distance Other wells: Absorption Field: Total length ft. Length of each trench Depth of trenches -_q1 ft. Size of Stone Seepage Pits: Number Size: Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Pit I'Z>� .Opening Seale Partial Location/Separations Foundation to tank Foundation to absorption ft Box e Separation of Pits Box qX-1 alen C�' .a y /P� le . Y, /I Conforms as per Plot Plan -�Ly Location of System on Property: Fro R eft Side ight ight Side as e MidAdleF- nt Middle Rear tus. S stem Use S atus: Approved Partial Approved and needs to be re-inspected,please call the'Building&Codes Office Disapproved L:\Sut Hemingway\Building.Coacs.inspection.FORMS\Septic Inspection ReporLdoc, January 28,2003 ?- v ,-�- � RECEIVED JUN 11 2003 TOWN OF QUEENSBU UlLD1NG qND G RY QDE TOIPA s ; r'"`•.:.... e.., t""'w�«T ,sav,f�"r pa REVIEWED E . DATE 01 f t � g � � a 1 Cl o ti "I have seen or observed,or believe I saw evidence of, all objects such as houses, wells,trees, fences, etc., b shown on this d cument. I also represent that I have � - ly mea ;ured tances se forth on th diagram." SIGNATu E D TE