BOTH-000122-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000122-2016 Date Issued: Friday, September 9, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000122-2016
has been completed.
Tax Map Number: 301.17-2-11
Location: 11 CHEROKEE LN
Owner: Thomas DeGroff
Applicant: Thomas DeGroff
This structure may be occupied as a: 350 s.f.Inground swimming pool
By Order of Town Board
TOWN OF QUEENNSBUARY
Issuance of this Certificate of Compliance DOES NOT relieve the �J
property owner of the responsibility for compliance with Site Plan, GGG
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 12804-5904 (518)761-8201
r
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000122-2016
Tax Map No: 301.17-2-11
Permission is hereby granted to: Thomas DeGroff
For property located at: 11 CHEROKEE LN
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
Tyne of Construction
Owner Name: Thomas DeGroff Swimming Pool $0.00
Owner Address: I I Cherokee LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name 1 Address Electrical Inspection Agency
Adirondack Pools
5 BOULEVARD
Queensbury,NY 12804
Plans&Specifications
350 s.f.Inground swimming pool
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 11,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
orthe Town of Queensbury before the expiration date.)
Dated at the Town of eensbury, j�edne ,2016
SIGNED BY: �/� for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensl4ldtng-&—ode§_y
—��,,,^ Received:
SWIMMING POOLIIT APPLICATION Tax Map ID:
A permit must be obtaineLWeojrj.Le�inning construction permit No.:f\!OF Q�JEENSSURY
BUILDIG � CODES Permit Fee: $ �5 .C:o
N
� Site PlanNariance No.:
1. Date: 3—a—�
2. Tax Map ID: , I �
3. Pool Location Address: �(� �
4. Zoning Classification:
5. Site Plan Review,Variance or Subdivision Approvals(list)
6. Property Owner; I _ '�' Phone: J:�
� 9
Mailing Address: '�� c ulc�te
City: v y
,4�
J G
7" Contractor's Name: ►^ % Phone:
Mailing Address: 15: D ,✓
City. W
8" Contact Person for Building&Code Compliance: Phone
ABOVE-GROUND OR INGROUND? j�-,d
J,q /
SIZE OF POOL: ,Y
MANUFACTURER: �l
MATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY):
Steel/Vinyl \' Fiberglass Gunite Poured Concrete Other
Declaration; I acknowledge no construction activities shall be commenced prior to issuance of a valid permit. I certify that the application,
plans, and supporting materials are a true and complete state menUdescription of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. I
acknowledge that I have read the application & plot plan requirements and I or my agents will obtain a certificate of occupancy before use
of the pool. — �'10�'1�( %��
Print Name: / , 1 MIs
Signature: Date �� l
Name/Title
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
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EM E U E
ru QUEENSBURY
NG & CODES
Attention Home Owner
Please assure you are familiar with the TOWN OF
Pool Enclosure requirements specific to QUEENSBURY
BUIL
Your pool. We will be happy to explain DlNG & CO E EPT.
what Requirements you will have to Reviewed By;
meet per Appendix G Of the Date: �� t
New York State Residential Code,