2001-617 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: P20010617 Date Issued:. Friday, August 17, 2001
This is to certify that work requested to be done as shown by Permit Number P20010617
has been completed.
Tax Map Number: 523400-302-018-0003-039-000-0000
Location: 24 BROADACRES Rd
Owner: THERESE COLLYER TRUSTEE
Applicant: THERESE COLLYER TRUSTEE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
/1411 _
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
`IA/ 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256 •
BUILDING PERMIT
Permit Number: P20010617 Application Number: A20010617
Tax Map No: 523400-302-018-0003-039-000-0000
Permission is hereby granted to: THERESE COLLYER TRUSTEE
For property located at: 24 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: THERESE COLLYER TRUSTEE Septic Alteration Residential
24 BROADACRES Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY,NY
Plans &Specifications
2001-617
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,August 14,2002
(If a longer period is requited,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 n o ueen ury, T e d ,•August 14,2001
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
Application for.Permit—Septic Disposal System r : ® iR,'. A
T otw:of Queensbui y 742 Bay Road Queeusburp, NY 12804 (518) 761 P_
1. OWNER INFORMATION:
) Office Use
It I2_Location of installation: g rO / 74 6 rs !`� ,
Tax Map No. / / Filo Permit. No61 `'' L
Owner's Nam : i '
Address: 7 /3 a!J !.1 7 yy rc f /�c� AUG 1 3 2001
TOWN OF
2. INSTALLER'S NAME : _)...?
i 5-, ccp-i 1 C
FE � �C�
3. RESIDENCE INFORMATION: (circleyear of dwelling, indicate II bedroom(~) and multiply II of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older Y x 150 gal/bdrtu = • (9O
1980— 1991 x 130 gal/bdrut =
1991 —present x 110 gal/bdriu =
Garbage Grinder Installed yes / no __ .
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information &indicate measurements)
'•••,raph a ire Gio nd Water Bedrock or Impervious Material t'r ate'. Supply
Mat scuu at I ha depth ai wl rr epth municipal
ing an feet —�L ',et veil
Steep slope clay if well; water supply
_%slope outer from any septic-system
• depth: absorption is ft.
other . •
Percolation Test: (To be completed by licensed professional engineer or architect)
• Rate: minute per inch
•1 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 lank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
• Septic Tank: 0,52_gallon (min. size 1,000 gal) _
TA/1 C7,
Tile Field: each trench O fl, Total System Leugtlr:G� �ft.
Seepage Pit(s): number of size of each: fl. by fl.
•
Sizo of Stone to be used: It / depth or thickness_____ _fret
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 Queonsbury, 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 road the regulations with respect to this application and agree to abide by these and all
requirements of the T n of Queensbur Sanitary Sewage Disposal Ordinance.
?..._ /, 0
nature of responslb a person Date
•
COMMERCIAL FINAL INSPECTION REPORT B
fBuilding& Code Enforcement Date inspection request received: l -fit''
Office No. (518)761-8256
Dept. of Community Development
Town of Queensbury Arrive (0`eam/pm Depart t3n1/pm
742 Bay Road Inspector's Initials
Queensbury, NY 12804
NAME E PERMIT# 2 /^
LOCATION } L DATE ZYri
TYPE OF STRUCTURE
N/A YES NO COMMENTS
ChimneyP'B"Vent/Direct Vent location
Plumbing Vent
Roof Complete (��, \V
Exterior finish grade comp ►J
Interior/exterior guardrail 42 .platform/decks
huerior/exterior ballasters 4 in.spacing platform/decks
Stair handrail 34 in.-38 T. \
Step risers 7 3/4 in.
Alain door 44 in. l
All others 36 in.
Lever handles
Exits at grade or platform i
•
Canopy to cover req.exit doors •
•
Gas valve shut-off exposed A regulator(18 in.)above grade
Floor bathroom watertight\
Other floors okay
Hot water relief valve
Boiler/furnace enclosure
<250,000 BTU N/R
250,000 BTU to 1,000,000 ITU's(1 hour)
>1,000,000 BTU's(2 hour)
Gas furnace shut off within 30 IL r within line of site
Oil furnace shut off at entrance to ace area
Stockroom enclosure(1 hour),3/4 h ur door
Storage/receiving/shipping room(2 our), 1 '/2 doors
1 '4 hour doors and closers
4 hour corridor doors and closers
Firewalls/fire separation,2 hour,3 our complete
Fire dampers,2 hour fire wall/sep tion or greater
Fire door/shutters 1 '/2 hour,3 hour
Ceiling fire stopping 3,000/5,000 sq.ft.
Fan shutdown,smoke vents or fan
Exit door/panic bars assembly hardware
Elevators
Elevator signage
Handicapped bathroom grab bars/sinks/t eLc
Handicapped bath/parking lot signage en t '^ ✓
Handicapped service counters 34 in.,checkout 36 in.
Handicapped ramp/handrails continuous/12 in.beyond
.Active listening system and signage assembly space
Final Electrical
Site Plan/Variance required
Final Survey,new structures
.As-built septic system layout required
Okay to issue temp.C/O(Certif.of Occupancy)
Okay to issue permanent C/O(Certif.of Occupancy)
Okay to issue C/C(Calif of Compliance)
) u'-30
TOWN OF QUEENSBURY•
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Nameee � VI(/'
Location °J)Q/)
a /-
Date -0 P rmi t #0/" 6)/ 7
SOIL TYPE• Sand-Loam- lay-
Results of P rcolation Test-
(if applicabl ) Ra e-Minute/Inch
TYPE OF SYST : ,)
ABSORPTION FI LD: otal Length) -51
Length of each tre ch i 15-0
Depth of trenc es 2-
Size of stone +c/c
SEEPAGE PITS: ber-
Size - x ft.
Stone size
PIPING: Size Type
Bldg. to Tank I f+ 5.0 %3
Tank to Dist. Box 0 it
Dist. Box to Field Pit 0 i1
Openings Sealed? No . :Partial
LOCATION/SEPARATION .
Foundation to Tank v feet •
--ii-Foundation to Absorption. __ feet . .
Separation of Pi is __ _ eet
Conforms as per Plot P1 an - No
LOCATION 0 SYSTEM ON PROPERT' .
(circle •
Front - - Left Side - Right Side i0
Middle = t - Middle Rear
COMMENTS:
•
SYSTEM.USE APPROVED: • YES NO
Arrived: /
Departed: muff
NO!_,---'
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