1986-016 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 86-16
WARREN COUNTY, NEW YORK
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PERMISSION is hereby g ranted to Beverly Ann Close
OWNER of property located at • 15 Queensbury Avenue Street, Road or Ave.
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in the Town of Queensbury,To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is 15 Queensbury Avenue
Glens Falls, New York•
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2. CONTRACTOR or BUILDER'S Name
Ron Grimes •
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3. CONTRACTOR or BUILDER'S Address
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RR #1
Lake George, New York
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
7. PLANS and Specifications
1000 gallon tank, dist. box and 2 — 6'x8' seepage pits with r„
No. 24" #3 stone per plot and application submitted.
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8. Proposed Use CD
SEwage system for dwelling
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$ 10.00 PERMIT FEE PAID —THIS PERMIT EXPIRES January 20th 19 88
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 20th Day of January 19 86
SIGNED BY -Iiiazg a, ,O for the Town of Queensbury
Building and Zoning Inspector C
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBURY
° SEWAGE' DISPOSAL PERMIT APPLICATION D G E p V E -`
1. Owner's Name „'\,J f ( A 0 iv " l L 6 S. DEC At 198h
Ads" `�f s}c`q N v opy® 'L-� PT .r�.
Cole N c —i ( (c Telephone No.- 7(11 i
2. Property location e } ec
3. Name of person or firm responsible for installing system -
.k0 Telephone No. -
Address
4. Number of bedrooms (residential buildings only)
5. Daily flow L/50 gallons/day
6. Septic tank capacity /000 gallons
7. Topography: flat, rolling, steep
% of slope
8. Nature of soil and depth C )_ A-`P- Los -M -
9. If ground water, bedrock or impervious: material is apparent at what
depth does it begin? ft. "
10. Percolation test: A is required
. B is not required
C If required what is the rate minutes/inch
11. Water supply: municipal, well, other ///lO.U(G/ d2r4-4--
12. Type of system proposed: drywell, tile field, other N4QA.(sa-5-(2)
Any contractor, corporation, individual, etc. engaged in th4 construction
of a sanitary sewage disposal system who covers 'the same before inspection,
does-not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided for in Section 6.010 of the
Queensbury Sanitary Sewage Ordinance.
Date I - 12 �� . -� .
- signaiure of applicant
On separate sheet. of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of,
the system itself.
• Form 3-82 Dist aK. c
Sd U S rv� cDp p/
TOWN OF QUEENSBURY
Building Department
Inspectors Report Date 3/4 !/' .
Name
Location i"7 %j-
Perr it No. 9 /t, Weather
Remarks
Excatia ti on
Footing Forms
Footing & Piers
Foundation
Cement Coat
Waterproofing
Backfill
Final Survey
Framing
Sheathing
Roof Felt
Roofing
Siding
Masonry Veneer
Rough Plbg.
Relief Valves
Wall Board
Ext. Porches
Finished Floor
Interior Trim
Stairs & Railings
Cellar Dr. Tile
Concrete Floors
Plbg. Fixtures
Gar. Fireproofing
Door Closers
Chimney
Water Meter Inst. /'j 4 SY5e/;141 ei)
Septic Approval ,
Floors
Insulation Foundation
Walls
Ceiling
Building Inspector
REMARKS
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