POOL-000103-2017 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-000103-2017 Date Issued: Tuesday, July 10, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000103-2017
has been completed.
Tax Map Number: 288.16-1-29
Location: 138 EQUINOX RD
Owner: William Bergman,Michelle Bergman
Applicant: Trademark Builders&Remodeling LLC
This structure may be occupied as a: In Ground Pool 16 x 40
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
(76 ,, ,0 4
property owner of the responsibility for compliance with Site Plan, 1r
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
Community Development-Building&Codes (518)761-8256
BUILDING PEFMT
Permit Number: POOL-000103-2017
Tax Map No: 288.16-1-29
Permission is hereby granted to: Sprague's Mermaid Pools
For property located at: 138 EQUINOX 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
Tvce of Construction
Owner Name: William Bergman Swimming Pool $0.00
Owner Address: 158 Equinox DR Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Sprague's Mermaid Pools
300 Broadway
Fort Edward,NY 12828
Plans&Specifications
In Ground Pool 16 x 40
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 13,2018
(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 expiirte/ion/date.)
Dated at the Town of Q eensbu f/ �Jiurs yKir-13,2017
SIGNED BY: 1j/ y for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Onlv
Received:
SWIMMING POOL PERMIT APPLICATION Tax Map ID:
A permit must be obtained before beginning construction
Permit No.: foot-- 10;,-
Permit Fee: $ t�j
site-RanA/arianc"o.: )Y-)VQ01
t. Date:
2. Tax Map ID: f�
3. Pool Location Address: /3� �j a /ok I/-t� Z-ake C'e-o r3�c7 Al(' /2-�4/-j
4. Zoning Classification:
5. Site Plan Review,Variance or Subdivision Approvals(list) �9 �7
6. Property Owner: fV i l�i� *2i Cede /S� Phone: 7C �d 115
Mailing Address: 23F1 Qurgok
CRY: /��e �c� NY 12!Wq '
7. Contractor's Name: Phone: �!� 7`!`7 9270
Mailing Address:
City: For+r-trwa'-d/ AlyY c
B. Contact Person for Building&Code Compliance: � Phone 7/� �O y///
ABOVE-GROUND OR INGROUND7 �r�r2r�70t
►�� x ! �f
SIZE OF POOL:
MANUFACTURER: h ..I MAR 0 1017 IJ
MATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY): Ti ' l �r CUEENSEai Y
BUILDING
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.'
Pdnt Name: r"-'a�7
Signature: I/U Date /U i /6
Name/Title
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
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150' .... ... APPARENT PROP= LINE FROM REFERENCED
= TATRW COUNTY GIS�DATA
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... ....... SUBDIVISIONMAP &
7'-'-)WN OF 0JJEE1`,4SBURY Attention Home Owner
Please assure you are familiarwith the
V-JILDING & ODES DEPT. Pool Enclosure requirements specific to
F.'.'.,viewed By Your po6l. We will be happy to explain
Late: What Requirements Y0u0u119rd*Qo
... ...... meet per Appendix n 2If
New York State Resid of 1
dto c e
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Based on our limited exanination,compliance .. ....
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........................................... PLAN Or- WILOM6 ADDITIONS,with theoBuilding Codes of
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'POOL HOUSE,'POOL 4 PATIO Now York State. . .... .......... ................
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10' P.L. SEffACk—(W,7 W)-
L = M M M M M M M M
150,
PROP,ABSORPTION TRENCH PROP.EFFLUENT SEWER PROP.HOUSE SEWER
W/22"WIDE OPEN BOTTOM
GRAVELESS CHAMBERS PROP.DISTRIBUTION BOX PROP.1000 GAL.PRECAST
(2)REQD AT 40'LONG EA. CONCRETE SEPTIC TANK
(SEE ABSORPTION TRENCH
IV
SECTION&PROFILE FOR DETAILS)
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0 M :A WASTEWATER SYSTEM PLAN
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(D 3• 0 IN FEET
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o 96 MAR 2 0 2017
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