POOL-0407-2018 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: POOL-0407-2018 Date Issued: Tuesday, July 17, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-0407-2018
has been completed.
Tax Map Number: 297.9-1-1
Location: 286 MEADOWBROOK RD
Owner: AMY NELSON
Applicant: Robert Nelson
This structure may be occupied as a: Above ground pool 24 round
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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property owner of the responsibility for compliance with Site Plan, Nis
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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1 z i f 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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. Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: POOL-0407-2018
Tax Map No: 297.9-1-1
Permission is hereby granted to: AMY NELSON
For property located at: 286 MEADOWBROOK 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: AMY NELSON Swimming Pool $0.00
Owner Address: 286 Meadowbrook RD Total Value $0.00
Queensbury,NY.12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Empire Pools
127 Forts Ferry RD
Latham,NY 12110
Plans&Specifications
Above ground pool 24'round
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,June 28,2019
(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 of Queensbury; Thursd y,June 28,2018
SIGNED BY: ( for the Town of Queensbury.
Director Building&Code force t
l - .SWIMMING POOL PERMIT APPLICATION Office Use Only
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Permit#: O�9� 1-QIA
Town of Qecnsbury Permit Fee:$ 125 ;Invoice#: Q �
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Notes:
Project Location: 94.6 . .4,.4. c A-
Tax Map ID#: 2 9 —1 . 9 •— i — I Subdivision Name:
CONTACT INFORMATION:
• Applicant:
Mailing Address, C/S/Z: (,9 ve,Ae et'e j (
Cell Phone: ( c-t ) i�3'L= �t�i Land Line: (
Email:
• Primary Owner(s):
Name(s): v. Nab.
Mailing Address, C/S/Z: 1Si ,i k 3
�I Cell Phone:_( . Y ) 1 cx ? Land Line: _( )
Email:
• Installer/Builder:
Business Name: L{ ; fc4Is 4 a (
.v- 3'
Contact Name(s): 5 Is, /'1 0S'cit40
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: QV+ 'litrl'_ re n re n nn
Cell Phone: ( ) Land Line: _( �� U u W U II lI
Email: _ I I Ir�� I I III I
u JUIN L b 2018 J
TOWN OF QUFBNSBURY
BUILDING&CODES ;
Town of Queensbury Building&Code Enforcement Revised March 2018
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SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: •
MANUFACTURER:
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
have read and agree to the above: . • _ -
PRINT NAME: J"�j NIA lsc '
SIGNATURE: DATE: ' '2-Cc, r •
Town of Queensbury Building&Code Enforcement Revised March 2018
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Attention? Ho e Owned th -----
Please assure you are ; _
Pool Enclosure require- ents specific to
Your pool. Vy.e*ill be apPy to expla "' T
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meet per Appendi, G the 1 NAME p B!Y r41E UREt7 f L:�i'.l�t
New York State7entiaI Code. FROM THERSNA PROPEKTYS t OR�}i 5�
PROPOSED STRUCTURES)7 i -. A — .._2k !
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TOWN OF QUEENSBURY -
BUILDING & COD i .*T.
a Reviewed By:
R : . . r p 5.
__ Date.
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TOWN OF QUEENSBURY L- C_ 1
BUILDING DEPARTMENT �_____�.
Based on our limited examination,compliance �
with our comments shah not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State. ,
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