POOL-000138-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
x Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: POOL-000138-2017 Date Issued: Tuesday, September 26, 2017
This is to certify that work requested to be done as shown by Permit Number POOL-000138-2017
has been completed.
Tax Map Number: 290.-1-82.1
Location: 24 STONEHURST DR
Owner: Ray Every
Applicant: Ray Every
This structure may be occupied as a: In Ground Pool 28 x 16
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r:Dj 4 / t
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-000138-2017
Tax Map No: 290.4-82.1
Permission is hereby granted to: Ray Every
For property located at: 24 STONEHURST 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
Type of Construction
Owner Name: Ray Every Swimming Pool $0.00
Owner Address: 24 STONEHURST DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Ray Every
24 STONEHURST DR
Queensbury,NY 12804
Plans&Specifications
In Ground Pool 28 x 16
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,April 14,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of een /��/Enda , pr 1 17
SIGNED BY: -/• for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING POOL PERMIT APPLICATION office Use OnlyQt �Q
Permit#:TW I< _
Town of Quccnsbun
Permit Fee:$,')'b ;Invoice#: �
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbuy..net Notes:
Project Location: r24 5kgifbnl�1.,/_ YI� V-e,
Tax Map ID M 2010 • _ ) 's2. Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Name(s): 2A-1 Allco c--\jet-1
Mailing Address, C/S/Z: acl o✓ QJ&A �
Cell Phone: ( 5')b' ) 0132-30%44 Land Line:
Email: 1?A4 Ahf PlQm e-31,11 w `I Ah u cw-r
Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
o Installer/Builder:
Business Name:
Contact Name(s): 20-1 C�iE-R:1
Mailing Address, C/S/Z:
Cell Phone: _( 5JR ) 0132-3Ci4H Land Line: _( )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: _( ) Land Line: ( )
Email:
Town of Queensbury Building&Code Enforcement Revised February 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: C ABOVE-GROUND IN-GROUND
SIZE OF POOL:
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl_X 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 NYS Building Codes, local building
laws and ordinances and in conformance with local zoning regulations. I acknowledge that I have read the
application and plot plan requirements and I, or my agents, will obtain a certificate of compliance before use
of the pool.
PRINT NAME:
SIGNATURE: �L'�1 DATE: -71 7
Town of Queensbury Building&Code Enforcement Revised February 2017
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