POOL-0165-2018
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-0165-2018Date Issued: Tuesday, January 8, 2019
This is to certify that work requested to be done as shown by Permit Number
POOL-0165-2018
has been completed.
252.-1-36.6
Tax Map Number:
268 LOCKHART MOUNTAIN RD
Location:
Celena Johnson, JAMIE JOHNSON
Owner:
JAMIE JOHNSON
Applicant:
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,
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
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.» 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: POOL-0165-2018
Tax Map No: 252.-1-36.6
Permission is hereby granted to: Concord Pools Ltd.
For property located at: 268 LOCKHART MOUNTAIN 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: Celena Johnson Swimming Pool $0.00
Owner Address: 268 LOCKHART MOUNTAIN 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
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 25, 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 the expiration date.)
Dated at the Town ensbury W e pri125,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING_P�OL PERMIT APPLICATION office use only
ow E I g V - Permit#: poti --61&
Town of Queensbury Permit Fee:
$ - �nvoice#:OR- 7 l
742 Bay Road,Queensbury,NY 12804 fq�� 6 201
P:518-761-8256 www.aueensburv.n t Notes:
I BUILDING-
Project Location: LA1`e-e- D
Tax Map ID#: �5 � �� �� Subdivision Name:
CONTACT INFORMATION:
• Applicant:Name(s): JDAon oA
Mailing Address, C/S/Z: 2-&S WCk-(gak+ It 0"-{Z( th (24 Ah/ /2-WIS-
Cell Phone: ( 7-01 ) Z::3Z -14 72- Land Line: ( )
Email: cele., ao G�WtGGf , �.owl
• Primary Owner(s):
Name(s): �,P('�i1/ltj 1/J( G'IO►I P, ���ir f/tC/�1/1
Mailing Address, C/S/Z:
Cell Phone: ( ) v Land Line: ( )
Email:
• Installer/Builder:
Business Name: ("0M"PW
Contact Name(s): -T-ovm qyr-fte-S
Mailing Address, C/S/Z: l0 0 8 off ;w-v 01" �Zv�
Cell Phone: ( ) Land Line: ( S/F ) -7 Ltl
Email: im le-kialp/t/\
Contact Person for Building & Code Compliance: 0,eIP1,7,t )t7�//fS01'!
Cell Phone: ( 7,0 f ) 232- Land Line: ( )
Email: Ai/Y!Gl,l • Gd
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Town of Queensbury Building&Code Enforcement Revised March 2018
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND IN-GROUND-'
SIZE OF POOL: ----_
MANUFACTURER: \IiC�.IL-11
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl 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: 0�evA k VL S 0 h
SIGNATURE: DATE: 41 ! 1 Sr
Town of Queensbury Building&Code Enforcement Revised March 2018
mention Home Owner
;sSure you are familiar with the
Ho 16Sure requirements specific
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o1. We will he hap- ►-Py to expiain
at Requirements you will have to
meet per Appendix G Of the
ew York State Residential Code.
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