POOL-000182-2017 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-000182-2017 Date Issued: Monday, April 30, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000182-2017
has been completed.
Tax Map Number: 308.14-1-27
Location: 5 AMETHYST DR
Owner: John Ingalls
Applicant: John Ingalls
This structure may be occupied as a: Inground Swimming Pool
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,
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
OL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000182-2017
Tax Map No: 308.14-1-27
Permission is hereby granted to: John Ingalls
For property located at: 5 AMETHYST 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 tiled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: John Ingalls Swimming Pool $0.00
Owner Address: 5 Amethyst DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Sprague's Mermaid Pools
300 Broadway
Fort Edward,NY 12828
Plans&Specifications
Inground Swimming Pool
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 4,2018
(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 �ensbu [ J �iursd y 17
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes ori Use only
Received:
SWIMMING POOL PERMIT APPLICATION Tax Map ID: 309144-1-�7
A permit must be obtained before beginning construction Permit No.: poo L- /S'.l --10 ( 7
Permit Fee: $ 77 eoa�' inrac c
Site PlardVariance No.: I&I C
1. Date:
d C
2. Tax Map ID: [ECE0 D
3. Pool Location Address: APR Z 5 it
4. Zoning Classification: TOWN OF QUEENSBURY
COMMUNITY DEVELOPMENT
5. Site Plan Review,Variance or Subdivision Approvals(list) 2
6. PropertyOvmer: KIM 4-' Joh►1 a-n � �� Phone: 683 - `�/� 7Q
a�
Mailing Address: M J)t'
City: &PAnsbgr(, WY
,/n
7. Contractor s Name: f Q I� I'W m�� ?M� Phone: )8 g`1 - ?Z 9P
Mailing Address: 60W J t` 2
City: +-
fn-
City: I ) 828
8. Contact Person for Building&Code Compliance: �� ) i Phone 2W
ABOVE-GROUND OR INGROUND? __Lo S >rboy)
SIZE OF POOL: 18 X r
J b
MANUFACTURER: J tY)d2Qfl(}I ODI.
MATERIALS USED JN CONSTRUCTION(CHECK ALL THAT APPLY):
Steel/Vnyl ✓/ Fiberglass_ Gunke 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: ��V—tvYibtx-(�j ZnAci(1S
Signature: ( 3c_. _ Date
Name/TRI
Town of Queensbury Building&Codes Swimming Pool Permit 518-761.8256
308.14-1-27 POOL 182-2017
Kim & John Ingalls —
5 Amethyst Drive
Inground Swimming Pool D
TOWN OF CIUEENSBURY
DEVELOPMENT
FNewYork
WN OF QUEENSBURY
ILDING DEPARTMENT I
r limited examination,compliance
ments shall not be construed as
plans and spc�f�ations are in
ce with the uB ilding Codes of
te. t TOWN OE UEENSBURY
`30 'BUILDING & COD S T.
Reviewed B
Date:
3�
cE D,S-A?i
1�4l�
141 `AI- )