POOL-000134-2017 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-000134-2017 Date Issued: Wednesday, September 6, 2017
This is to certify that work requested to be done as shown by Permit Number POOL-000134-2017
has been completed.
Tax Map Number: 301.20-1-43
Location: 21 LANCESTIRE DR
Owner: ADAM LANE
Applicant: ADAM LANE
This structure may be occupied as a: In Ground Pool 16 x 32
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, /eJ
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
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000134-2017
Tax Map No: 301.20.1-43
Permission is hereby granted to: ADAM LANE
For property located at: 21 LANCESTIRE DR
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
Tvoe of Construction
Owner Name: ADAM LANE Swimming Pool $0.00
Owner Address: 21 Lancestire DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Pools Plus
45 MAIN ST
Queensbury,NY 12804
Plans&Specifications
In Ground Pool 16 x 32
$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 expiration date.)
Dated at the Town ofbury; /�A Thu A y, pril ,2017
ASIGNED BY: C for the Town of Queensbury.
Director of Building&Code Enforcement
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.: Poo L_' I�>A - 7O\'-4"
Permit Fee: s
Site PlanNariance No.: I r-\V Q1 U__' l o
1. Date: March 23 2017
2. Tax Map ID: 301 .20-1-43
3. Pool Location Address: 21 Lancestire Dr.
4. Zoning Classification: Residential
5. Site Plan Review,Variance or Subdivision Approvals(list) N/A
6. Property Owner: Adam and Jennah Lane Phone: 518 636 3208
Mailing Address: 21 Lancestire Dr.
City: Queensbury NY, 12804
7. Contractor's Name: Pools Plus Phone: 518 793 2929
Mailing Address: 45 Main St.
City: Queensbury NY, 12804
8. Contact Person for Building&Code Compliance: Dave Barlow Phone 518 793 2929
ABOVE-GROUND OR INGROUND? Inground
SIZE OF POOL: 16 x 32 VBUILDING&CDES EadCMANUFACTURER: Platinum Pools SR 3 1 2017DMATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY): OF QUEENSBURY
Steel/Vinyl X Fiberglass Gunite Poured Concrete X OtherO
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 statement1description 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: Adam Lane
Signature: /Fda/��i.,. rib r Date 03/23/2017
Name/Title
Town of Queensbury9uilding&Codes Swimming Pool Permit 518-761-8256
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301.20-1-43 POOL-000134-2017
Lane, Jennah & Adam
21 Lancestire Drive
In Ground Pool 16 x 32
PFPIPT PI r.
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Qoe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
?ODL—-IN-S.Q v,-+
Permit No.'...A...........................Cert. N2 44934 Cut-in Card No.....................................
Owner..............t A ..............................................................................................................
Location..,--�- /....... ...de.................................. Y...........
Installation Consisting of.... GI 4.411 (2.,e Ala A-JOI'A.O�Dl
...............................................................................................................
....................................................................................................................................................................................
....................................................................................................................................................................................
Installed By...... ...AM/ce-4/7V.........................................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making iJ�qtions at any time, and if its
rules are violated,the Company shall have the right-to r 0 thisate.
Date..... -&.42............. INSPECTOR..........
Member N.F.P.A.,I.A.E.I.