POOL-000045-2017 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: POOL-000045-2017 Date Issued: Tuesday, August 29, 2017
This is to certify that work requested to be done as shown by Permit Number POOL-000045-2017
has been completed.
Tax Map Number: 227.17-2-24
Location: 23 CHURCHILL RD
Owner: John Jarosz III
Applicant: John Jarosz III
This structure may be occupied as a: In Ground Pool 12'x 23'
Cross Ref. Area Variance Z-AV-14-2017 By order of Town Board
Pool placement in side yard approved March 29,2017 by Zoning Board of TOWN OF QUEENSBURY
Appeals
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
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
QL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000045-2017
Tax Map No: 227.17-2-24
Permission is hereby granted to: John Jarosz III
For property located at: 23 CHURCHILL 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
Tyne of Construction
Owner Name: John Jarosz III Swimming Pool $0.00
Owner Address: Total Value $0.00
Contractor or Builders Name/Address Electrical Inspection Agency
Concord Pools Ltd.
60 BIG BOOM RD
Queensbury,NY 12804
Plans&Specifications
In Ground Pool 12'x 23'
Cross Ref. Area VarianceZ-AV-14-2017
Pool placement in side yard approved Much 29,2017 by Zoning Board of Appeals
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 31,2018
(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 Town of ns Gu7• /} Friday, ch 31,2017
SIGNED BY: onw-s_sJ[// for the Town of Queensbury.
Director of Building&Code En memen
Town of Queensbury Building & Codes Office Use Only
Received:
SWIMMING POOL PERMIT APPLICATION Tax Map ID:
A permit must be obtained before beginning construction Permit No.:
Permit Fee: $ �Jr IY1V0�� I��JS
Site Pian/Variance No.:
1. Date: A 1/ L-AV I -a U
2. Tax Map ID:
40 7,y / �76G-e wte ktrzL aor7 zd>k
/ �����`` p?
3. Pool Location Address: a3 0_hWC#/L L 4A .
4. Zoning Classification: be--Ar , A f!
5. Site Plan Review,Variance or Subdivision Approvals(list) -7
6. Property Owner -Th A/ '2;440S7-- Phone: -5/f-6's6
Mailing Address: P6 BOV , /3�5_ //'77
City: C/I_Eyne4L�N l o z
7. Contractor's Name: /VVK PO 6) Phone: s�n 741 �c � C
Mailing Address: /(7 . Dom .
City: S 62AY4 A/
/J 60 > .
8. Contact Person for Building&Code Co�mplliaannc�e7 ,45n) . /J)R/UitS . Phon ._ ', —
ABOVE-GROUND OR INGROUND? AM E
SIZE OF POOL: /� X 2 3 v
MANUFACTURER: /�P�T 6DLS7MATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY): CODES
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 statement/description 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.
Print Name:
Signature: Date 6 0
ame T e
Town of Queensbury Building&Codes Swimming Pool Permit 518-761.8256
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FEB 13 2017
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227.17-2-24 POOL-000045-2017
Jarosz III, John
23 Churchill Road
In Ground Pool 12' x 23'