2003-650 'SOWN OF QUEENSBURY
.742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building.&Codes (518)761-8256
COu IFI ATE
C OF COMPLIANCE .
Permit Number: P20030650 Date Issued: Friday, October 31,2003
This ris to certify that work-requested to-be-done as.shown by-Permit Number __ 120030650
has been completed.
Tax Map Number: 523400-301-013-0001-004-002.0000
Location: 579 WEST MT. Rd
Owner: JACK&FRANCES SIGNORELLI
Applicant: JACK&FRANCES SIGNORELLI
This structure may be occupied as a:
By Ordet of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Quemsbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20030650 Application Number: A20030650
Tax Map No: 523400-301-013-0001-004-002-0000
Permission is hereby granted to: JACK &FRANC.F.S SIGNORFI.T.T
For property located at 579 WEST MT. 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: JACK&FRANCES SIGNORELLI 32 HARRISON Ave Septic Alteration Residential
' Total Value
FRANKLIN SQUARE,NY 110 10
Contractor or Builder's Name Address Electrical Inspection Agency
STCTNORFT,T,l & SON
589 WEST MOUNTAIN ROAD
01JEENSBURY.NY
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Plans&Specifications
2003-650
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 13,2004
(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 of Que sbu dnesday,August 13,2003
SIGNED BY for the Town of Queensbury.
Director of Building&Col Enforcement
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury
Dept. of Community Development Permit No. -n3-
Building&Codes Office > 1,
742 Bay Road Fee Paid $
Queensbury, NY 12804
e,A
Location of property for install on:
AUG 112003
Property Owner's Name:
Property Owner's Mailing Address: TO OF QUEENSIBURY
Installer's Name: Id��4 fe 51 wwl Phone #
Number of bedrooms (if residential): Total daily flow:
(residential - compute @ 150'gal./bdrm.)
Topography: *, t, rolling, steep slope % of slope
Soil Nature: sand, _ loam, clay, other /depth:
Ground water: at what depth? feet Bedrock or Impervious Material: at what depth? feet
Percolation test: not required, _ required [rate min. per inch
Domestic water supply:. /'��municipal, _ well, other
If domestic water supply is a WELL, water supply from any septic,absorption is feet.
PROPOSED SYSTEM
Septic tank:f gallon (iminimum.size: 1,000 gal.)
Tile field: each trench feet Total system length: feet
Seepage pit(s): number of size each: ft. by
Size of stone to be used: # depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified agency.
For your protection,I 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 future to maim 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 thew and all requirements of the Town of
Queensbury Sanitary Sewage Disposal-Ordinance. Z.
Signature of responsible person: Date:
BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
S S
BUREAU OF ELECTRICITY
5 40 FULTON STREET — NEW YORK, NY 10038
�'5 CERTIFIES THAT
5 Upon the application of upon premises owned by 5
5 5c
5 NICHOLS ELECTRIC CO. JACK SIGNORELLI
5 2 JONES AVE. 579 WEST MOUNTAIN ROAD 5
5 HUDSON FALLS, NY 12839, QUEENSBURY, NY 12804 5
'AIN ROAD QUEENSBURY, N",* 1-2804��=--
.-Located-at - --5-79-VVESTMOUN-1
5 5 5 Application Number: 1175205 Certificate Number: 1175205
Section: Block: Lot: Building Permit: BDC: A239
5 Described as a Residential occupancy,wherein the premises electrical system consisting of
5 electrical devices and wiring,described below, located in/on the premises at: 5
Basement,Outside,
5 �C5
5 was inspected in accordance with the National Electrical Code and the detail of the installation,as set forth below,was 5
found to be in compliance therewith on the 26th Day of November,2003. 5
CS5 Name QTY Rate g1tin X Circuit Type
Service
1 Phase 3W Service Rating 200 Amperes
Service Disconnect: 1 200 cb, 5
5 Meters: I
5 5
5
5
seal qa'-
5 1 of
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection requ re i
Queensbury Building&Code Enforcement Arrive: pm
742 Bay Rd.,Queensbu .NY 12804 Inspector's Init' Is: 5L cj,
NAME: 3�a NO.:
LOCATION:
-- SPECT ON:
RECHECK:
Comments and/or diagram
Soil Type- Sand oar Clay
Type of Vater, unicipal/Well Water
Waterline'separation distance
Well separation distance
Other wells: ft.
-Abso�Ltion Field: Total length e7
,Length of each trench
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box R
Distribution Box j� eld Pit C—
Opening SealK. �tial
Location/Separations
Foundation to tank
Foundation to abs2Eption
Separation of Pits
Conforms as per Plot Plan Y N
Location of System,on Property:
Front Rear Left Side Right Side
Middle Fr%�id�dleRear �..
S stem Use St us:
Anproved
ar al Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:4SueHemingway\13uilding-Codes.Inspection.FORMS\Septio Inspection Report.doc January 28,2003
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SIGNORELLI PU&ZING'AND HEATING
DATE: NAM:
ADDRESS: PHONE: ( )
ES- IMATE GIVEN FOR JOB: PAID BY: CASH CHECK ( )
'TOTAL AM}IfiTT OF JOB: JOB COMPLETED:
DATE PtlkBIER TDME/PER HOUR F 114M TIME/PEP. HOUR DATE HELPER TIME/PER HOUR
MATERIAL ON OTIEt SIDE
r4vlj—
o�
r CU��:I �� .
B(JILDING&COD .�.,
Y
REVIEWED BY
� DA E
fi
have seen or observed,or believe!s '
4 all objects such as h Saw evidence of,
P houses,wells trees,
9 shown on this do
cu es,fences,etc,, i
went. I also represe?rth;thedi89ram.)'
at I have AUK
�pe�sahal easur he disfanceS s
TOWN oFOU,,' ,
BUILDINGRy
I t TUR
DATE
oS �
SIGNORELLI PLUMBING AND HEATING
DATE: NAME:
ADDRESS: PHONE: ( )
ESTIMATE GIVEN FOR JOB: PAID BY: CASH CHECK
TOTAL AM)RNT OF JOB: JOB COMPLETED: F
t
3 •pi - P
t
r ! r
1,
DATE PLUMBER TIME/PER HOUR PLUMBER TDE/PER HOUR DATE HELPER TIME/PER HOUR
i
MATERIAL ON OTHER SIDE