2015-095 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
CL Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150095 Date Issued: Wednesday, November 02, 2016
This is to certify that work requested to be done as shown by Permit Number P20150095
has been completed.
Tax Map Number: 523400-279-015-0001-018-000-0000
Location: 122 MUD POND Rd
Owner: ALLEN & ANGEL VAN GUILDER
Applicant: ALLEN & ANGEL VAN GUILDER
This structure may be occupied as a:
Above Ground Pool
By Order of Town Board
TOWN OF QUEENSB�JURY
Issuance of this Certificate of Compliance DOES NOT relieve the /JJ
property owner of the responsibility for compliance with Site Plan, VVV
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
V$11 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150095 Application Number: A20150095
Tax Map No: 523400-279-015-0001-018-000-0000
Permission is hereby granted to: ALLEN&ANGEL VAN GUILDER
For property located at: 122 MUD POND 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 Value
Owner Address: ALLEN & ANGEL VAN GUILDER Above Ground Pool
122 MUD POND Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-095
above-ground pool 15x3
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 22,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration dat .)
Dated at the To n of ens ry�J i' - ,esday, April 22,2015
Q
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Cod Office Use Only
C E 1 REIC4v
SWIMMING POOL PERMIT APP I TaxNa l : 21-ci .1",-1- 16
A permit must be obtained before beginning tctio$pp 17 20lhermi 2015— cic\,5
—Pauli Fee: $ \0 v -'.J6
TOWN OF QUEENSBURY
/�
BUILDING&CQMeIanNar nce No.:
1. Date: O prl I 17, 2-o 1�
2. Tax Map ID: + P0V\cl 3. Pool Location Address: 122 '►nnI Rd - Rd .
►
4. Zoning Classification:
5. Site Plan Review,Variance or Subdivision Pod R(list) �1
6. Property Owner: 122. d ('7ond • Phone: -7 q
S-3 S 6
Mailing Address: q A'e_-e_h S buy-9 IJ> I'56 O Li
I
City:
7. Contractor's Name: Phone:
Mailing Address:
City: nN(i , , 1� n�/ Q
8. Contact Person for Building&Code Compliance: An I\ �3 i \lptu ld Phone 1"{ 0' D'S9
ABOVE-GROUND OR INGROUND? Above -6 uaa Pool
SIZE OF POOL: I 5'x 3
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 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: n4 e 1 V Qx�1U ' E{'
Signature: 4 '• f ' 16 10 Date I- 111\ZO\J
Name I •i-
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
Pool Inspection
Queensbury Building & Code Enforcement
Office No. (518)761-8256
742 Bay Road, Queensbury, NY 12804
Date received: ly
NAME: Chu/ I
LOCATION: I MAJ rd,.cl ( G
PERMIT#: R,00 I,
INSPECTED ON: 60 -2615 am
Arrive: a /pm Depart:
a
m
/p
m
n (�
Inspector's Initials:
Above Ground: � In-Ground:
Y N NA
Pool enclosure around
pool or yard
4 feet above grade
2 inch maximum
clearance to grade from V/
underside of fence
41nch maximum
clearance in fence
pickets
Wall or Doors have self
closing device or alarms
30 second Alarm time
Pool Surface Motion
Alarm
Ladder secured in place
and latched
'Deck gate <56"to latch
no more than '/2" spacing
in gate openings
Gate open outward, self
closing
Padlock provided on
pates and ladder
Indoor pool all doors self
closing or alarmed per
AG 105.2 Item 9
Timer on pool pump (no
plug in timer allowed
Final electrical
Vehicle access gate
closed & locked
Ok to Issue C/C
COMMENTS: Z
IF VC QAf
4 2J`
Pool Inspection
Queensbury Building & Code Enforcement
Office No. (518) 761-8256
742 Bay Road, Queensbury, NY 12804
Date received: ^t z_A?,olb y r
NAME: 1fCAfgNIAaAe'y `TfilUivilo.
LOCATION: rZZ MuA 964,A Ari
PERMIT#: 1015- iKS
INSPECTED ON: 114 am/pm
rive: am pm Depart:
am/pm
Inspector's Initials:
Above Ground: In-Ground:
Y N . NA
Pool enclosure around
pool or yard
4 feet above grade
2 inch maximum
clearance to grade from
underside of fence
4 inch maximum
clearance in fence
pickets
Wall or Doors have self
closing device or alarms
30 second Alarm time
Pool Surface Motion
Alarm
Ladder secured in place
and latched
Deck gate <56" to latch
no more than 1/2" spacing
In gate openings
Gate opens outward, self
closing
Padlock provided on
gates or ladder
Indoor pool all doors self
closing or alarmed per
AG 105.2 Item 9 10,
Timer on pool pump (no
plug in timer allowed
Final electrical
Vehicle access gate
closed &locked
Ok to Issue C/C
COMMENTS:
Ok
TOWWOE _ QUEEN SBURY—,,,
BUILT' NG & CODESQEPT.
Reviewed By: _
Date:
Attention Flame Ownei°
Please assure you are familiar with the
Pool Enclosure requirements specific to
Your pool. We will be happy to explain
what Requirements you will have to
meet -er .Appendix G Of the
New York ;Mate Residerlial Cade,
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TOWWOE _ QUEEN SBURY—,,,
BUILT' NG & CODESQEPT.
Reviewed By: _
Date:
Attention Flame Ownei°
Please assure you are familiar with the
Pool Enclosure requirements specific to
Your pool. We will be happy to explain
what Requirements you will have to
meet -er .Appendix G Of the
New York ;Mate Residerlial Cade,
�j
a
.9
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.s
r�
ro
-
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n
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