BOTH-000164-2016 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: BOTH-000164-2016 Date Issued: Tuesday, June 28, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000164-2016
has been completed.
Tax Map Number: 295.11-1-20
Location: 63 SARA JEN DR
Owner: Jennifer Nadler, Howard Nadler
Applicant: Howard Nadler
This structure may be occupied as a: Inground pool
By Order of Town Board
TOWN OFFQQUEENSBBURY�J
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.
Jul. 8. 2016 2:38P MDIA No. 2931 P. 7/1
MIDDLE DEPARTMENT INSPECTION AGENCY, INC.
(e>4� that the electrical wiring to the electrical equipment listed below has been examined and is approved as
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the following conditions.
Owner: Nadler Date: 06/15/2016
Occupant: pool
P Locatior$3 Sara Jen Drive
Occu anc Queensbury, Warren Co. NY
P ySwimming Pool
Applicant r S&J Electric
68 Burden Lake Rd
East Greenbush, NY 12061
L J
Joseph A.Holmes
No. 141022200697EL
Equipment:
1 - GFCI Receptacle; 1 - Fixture; 1 - Bumer, Wiring &Control(Gas); 1 - Pump; 1 - 1 HP Motor; 1 -Easy Touch Sub
Panel; 1 -Chlorinator
Trial certificate applies to the electrical wiring to the electrical equipment listed immadiatay null and void. This certificate applies only to the use,occupancy and
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
Inspection. No warranty Is expressed or implied as to the mechanical safety,effl- of the property indicated above,this certificate Mall be immediately null and void.
cien y or fitness of the equipment for any particular purpose. Tnls cervicate Mall In the event that this cMlficate becomes invalid based upon pie above Conditions,
be valid for a period of one year from the above noted date. Should the etectricel this certificate may be revalidated upon reinspection by Middle Department
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
ed to,Ne introduction of eddltionel electrical equipment and/or the replabement of Department Inspection Aganty, Inc.to initiate the inspecdpn and revalidation
dry of the componentY InSWlletl as of the eoove notetl tlate,Nia certificate shell he process. A Ie9 will be charged for this service.
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RECEIVED
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TOWN OF QUEE SBURY
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: BOTH-000 164-2016
Tax Map No: 295.11-1-20
Permission is hereby granted to: Howard Nadler,Jennifer Nadler
For property located at: 63 SARA JEN DR
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plat plans and other information hereto filed and approved and in compliance with tiro NYS tfnifonn
Building Codes and the Qrieensbury Zoning Ordinance
Type of Construction
Owner Name: Jennifer Nadler Swimming Pool $0.00
Owner Address: 63 SARA JEN DR "total Value $'0.00
Queensbury,NY 12804
Contractor or Builder's Name 0 Address Electrical Inspection Agency
Concord Pools
156 Sparrowbush RD
Latham,NY 112110
Plans&Specifications
Inground pool
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 25,2017
(If a longer period is required,an application for an extension must be made to the code Entbrcement Officer
of the Town of Queensb before the iration dk, ,
Dated at the Town Queens a 54arch 30,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Tern of Queensbury �u �,..,fl
kVJE Received:
SWIMMING POOL PE ��N'��"l ax Map ID:
A permit must be obtained bef r inn!q ns y tio2 n( ermit No.: 00-i. 14 _ 1 Z v t
ermit Fee: $ 5
OUI OiN M f Site Plan[Vadance No.:
COOT
1. Date:
2. Tax Map ID: A1° ✓'
4A n/r,
3. Pool Location Address: 07
4. Zoning Classification: '
5. Site Plan Review,Variance or Subdivision Approvals(list)
6. Property Owner: war,NL-s( Phone: ,
Mailing Address: ,,. �n Qk o
City:
j "
7. Contractor's lame: Phone: "�.�"z"� ""'" ' '�' ��`
Mailing Address:
City: milo
8. Contact Person for Building&Code Compliance: Phone
ABOVE-GROUND O INOROUND.
a
SIZE OF POOL: n
MANUFACTURER: `
MATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY):
Steel l inyl Fiberglass Ounite Poured Cancrete_Z0ther_,� ,,,J.,-A.
,► sW
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; r
Signature: Date
Name l Tithe
Town of Queensbury Building&Codes Swimming Peal Permit 518-761-8256
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