POOL-0294-2018TOWN 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-0294-2018 Date Issued: Monday, May 13, 2019
This is to certify that work requested to be done as shown by Permit Number
has been completed.
POOL-0294-2018
Tax Map Number:
Location:
Owner:
289.9-1-33
301 GLEN LAKE RD
Jill Pederson
Applicant:Erin Rosecrans
This structure may be occupied as a: In ground pool
Cross Ref. Area Variance Z-AV-31-2018
Approved: May 23, 2018
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
Planning Board or Zoning Board of Appeals.
Director of Building & Code Enforcement
-¢ TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: POOL-0294-2018
Tax Map No: 289.9-1-33
Permission is hereby granted to: Erin Rosecrans
For property located at: 301 GLEN LAKE 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
Type of Construction
Owner Name: Jill Pederson Swimming Pool $0.00
Owner Address: 261 GLEN LAKE RD Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Concord Pools Ltd.
60 BIG BOOM RD
Queensbury,NY 12804
Plans&Specifications
In ground pool
Cross Ref. Area Variance Z-AV-31-2018
Approved: May 23,2018
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,June 5, 2019
(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 th xpiirration e.
Dated at the TownrQUee �Tu une 5,2018
SIGNED BY: V for the Town of Queensbury.
Director of Building&Code Enforcement
47 Ilt
SWIMMING POOL PERMIT APPLICATION Office Use OnIV
-. -P-46,
Permit#:
Town of Queeiisbury
Permit Fee:$ Invoice#:�
742 Bay Road,Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net Notes:
Project Location: ii') kA ke
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Tax Map ID 3 - Subdivision Name: Fi 0,il 1
H MAY 24 2018 UU
CONTACT INFORMATION: TOWN OF QUE N CRY
COM
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• Applicant:
Name(s): EV-iAJ KQ5F_U2AAJS
Mailing Address, C/S/Z: _q01 C71r-Ai I_AkF konb , L.QL6 deuarE ', AIV Id-Eq-'S
Cell Phone: (5'/? Land Line: /V0A/F
Email: hk'SJ . 0('q
0 Primary OwneE(sh
Name(s): cjl'/ PF1_)E2_%tJ
Mailing Address, C/S/Z: . 262/ ('WFA) LAk_r-_ P-OAL) LAlk-r- (7 rnoK6 F , t,,IV I 219'q�
Cell Phone: _(_27( ) Land Line: 72 2-'Io
Email: P2der5or) LOQQC�? , 00_drunr)(9_r- . Cotr%
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• Installer/Builder:
Business Name: nQKJrzP__b Jpno/s As
Contact Name(s): Tono VC2_t"4F_
Mailing Address, C/S/Z: //)0 20,0M P-061) , Q/FEALS80kV d, -Q
Cell Phone: _(_) Land Line:
Email: -"g rn 10 y Cne-S LO) (6'Ai C-6,-dQ 0 0 Is. corm
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Contact Person for Building & Code Compliance: / / A_)
Cell Phone: -(_F j�) Land Line:
Email:
Town of Queensbury Building&Code Enforcement Revised March 2018
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND IN-GROUND
SIZE OF POOL: j Z.' k 2,1' 2--7(0 -
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass_ Z' 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.
have read and agree to the above:
PRINT NAME: �!z//j /27 (=CR-AAL
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Revised March 2018
(T] TOWN OF QUEENSBURY ECEOV
(TI 0 BUILDING DEPARTMENT E
0 Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in MAY 2 4
L
full compliance with the Building Codes of
New York State, To
�rl OF QUEENSSU�y
VRJ;NITY DE-:VELOPMENT
P >
TOWN OF QUEENSBURY
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BUILDING & C D
EPT.
Reviewed B Srn
Date: 4,
Attention Hon,
Please a e own
P001 Enci assure yoU re familiar owner
Os�ure
Q� Your Po6l. We rements s
what Requireme It be happ Pec'flc to
nts you W y tO exPlain
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Your
Mee'Per APPendix ill have to
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289.94PFR SIT t� T
-33 POOL-0294-20`18
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Pederson, Jill I HAVE PERSONALLYMEASUR�0 THE DISTANCE
7t) 7- Lake Road
o C 301 Glen MUM THE PROPERTY-L-NE&TO THE—'
in ground Pool PRUHOggffSfk6 ° URE(S)OR SIGN(S
legLiq
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aws3 0. 2 U 1 al 1 1/IA , MD I A:- .'_, ,,:,.r'.;,.,.:,:,,�; No. 4356 P. 3/6
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.�.. MIDDLE'DEPARTMENT INSPECTION AGENCY, INC. c>>
�� .that the electrical wiring to the electrical equipment listed below has been examined and is approved as i
tl being in accord with the National Electrical Code,.applicable governmental, utility and Agency rules in effect on the date
to noted below and is issued subject to the following conditions. ��%�
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�'� Owner: ��-
Rozencrans • Date: 07/24/2018 CP )
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. Occupant: •
Pool Location:. �';)
• 01 Glen Lake Road •a
�(4 •Occupancy. •j •
?� •p ySwimming pool Queensbury,Warren Co. NY ��•
�'� Applicant:int r 001
C� 1709 Dorsett Street '- ' _ 5r
0 Schenectady, NY 123 , �••_ • ,
•
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C�` J '/ fCJ.,
g( Joseph
„ No. ., . "032688104049EL it •��. - . . . . _
- - - - - - - -
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C Equipment: • ;I' ' ' _... �cti�
•
1 -Chlorinator; 1 -50 Amp. Sub Pani I •1 --Switcli;I1'=• -'GPI--Receptacle;1'=-Low Voltage'Fixture;:1 -Pool Pump; 1 - t
.Q Time Clock ;.. , • �;��
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l�`.. This certificate applies to the electrical wiring to the electrical equipment listed. Immediately null and void. This certificate applies only to the,use,occupancy and 7.a:
(t`1 above and the installation inspected as of the above noted date based on a visual ownership as Indicated herein. Upon a change in the use,occupancy or ownership i
4inspection. No warranty is expressed or Implied as to the mechanical safety,efti- of The property indicated above,this certificate shell be immediately null and void. j:
e��; ciency or fitness of the equipment for any particular purpose. This certificate shall in the event that this certificate becomes Invalid based upon the above conditions, ,N be valid for a period of one year from the above noted date. Should the electrical this certificate may,be revalidated upon reinspection by Middle Department )��
h7) system to which this certificate applies be altered In any way,including but not limit- Inspection Agency,Inc. An application for inspection must be submitted to Middle '�
k-i ad to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to initiate the inspection and revalidation r(.aj
%%` anyof the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service. e'
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1 AUG 01 2018
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TOWN OF rU ENSPURY
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BUILDING&CODES