POOL-000342-2017 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-000342-2017 Date Issued: Tuesday, May 8, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000342-2017
has been completed.
Tax Map Number: 295.17-1-1
Location: 21 VERANDA LN
Owner: LYNN MILONE
Applicant: LYNN MILONE
This structure may be occupied as a: In Ground 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, 4
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-000342-2017
Tax Map No: 295.17-1-1
Permission is hereby granted to: Adirondack Pools
For property located at: 21 VERANDA LN
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: LYNN MILONE Swimming Pool $0.00
Owner Address: 21 Veranda LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Adirondack Pools
5 BOULEVARD
Queensbury,NY 12804
Plans&Specifications
In Ground Pool
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 23,2018
(If a longer period is required,an application for am extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of eensbun p}iday to ,20
SIGNED BY: tiil Vjk('/ /vf for the Town of Queensbury.
Director of Building&Code Enforcement
OL SWIMMING POOL PERMIT APPLICATION Office Use Only �r� n
Permit#:%OL" 'L' 'ZQP -
Town of Queensbury
Permit Fee:$ :Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbrury.net Notes:
Project Location: a) L,) /
Tax Map ID#: Subdivision Name:.—(-,Re!
CONTACT INFORMATION:
L JUN 1 S 2-iii
• Applicant: ! !,
Name(s): L-/nn Yri \0�2� 1 TO` ;;i;! O t?'. _ -`!Si?l; Y
Mailing Address, C/S/Z: \ Vev- -y-i .o—
Cell Phon\e: (Siff ) 14 23 - I S-4 ( Land Line: �)
Emdll: pO.c�L.\n k'; b• ,,j 6� ya-1.-,aU LmYyN
• Primary Owner(s):
Name(s):Irv, -
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Installer/Builder:
Business Name: - AL4,, Jatjk PadT d5
Contact Name(s): Uklis o '
Mailing Address, C/S/Z: L) ,
Cell Phone: SI ) 5 Land Line:
Email: , kbc (�k)& , C-anl
Contact Person fo Building & Code Compliance: l �lf i�S `lod�0
Cell Phone: ( Id 4 SWo I Land Llne 30k-�-,5 6Q X3
Town of Queensbury Building&Code Enforcement Revised May 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: / ABOVE-GROUND IN-GROUND
SIZE OF POOL: 11AA1/
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECIJAUL THAT APPLY):
Steel/Vinyl y 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.
I have read and agree to the above:
PRINT NAME:
SIGNATURE: Q DATE:
Town of QueensburyBuilding&Code Enforcement Revised May 2017
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Attenti n Home Own UILDIPJG & CO S T.
R P e ass ou are familiar with the
c P I Enclo re requirements specific to Rcvi e B
L6 o > 0 �% appy x
N N 5 what Requirements you will have to
meet per Appendix G Of the
New York State Residential Code. PERMIT PLOT PLAN
I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPERTY LINES TO THE
P OP SED STRUCTURE(S) OR SIGN(S)
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SI A RE ATE
DESCRIPTION: