BOTH-000039-2016 TOWN OF QUEENSBURY
4742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
-- Community Development-Building&Codes (5 18)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000039-2016 Date Issued: Monday, April 25, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000039-2016
has been completed.
Tax Map Number: 290.14-1-9
Location: 2 CLEARVIEW LN
Owner: Kristin Bergin
Applicant: Kristin Bergin
This structure may be occupied as a: Above-Ground Swimming Pool
18 ft.by 40 ft. By Order of Town Board
TOWN OF QUEEENNSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the / �/'
property owner of the responsibility for compliance with Site Plan, ���IYY�
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
742 Bay load,Queensbury,NY 12804-5904 (518)761-8201
�Y
Community Development-Building& Codes (618)761-8256
... �
BUILDING PERMIT
Permit Number: BOTH-000039-2016
Tax.Map No: 290.14-1-9
Permission is hereby granted to: Kristin Berlin
For property located at: 2 CLEAR VIE` LN
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
"1"yne of Construction
Owner Name: Kristin Bergin Swimming fool $().00
Owner Address: 2 Clearwiew LN 7"otal"Value $f).0I)
Queensbury,NY 12804
Contractor or Builder's Name f Address Electrical Inspection Agency
Islander pools
1967 Central AVE
Albany,NY 12205
Plans fir.Specifications
Above-Ground Swimming fool
18 f1.by 40 ft.
$40.00 PERMIT FEE PAID 4 TI IIS pl Itly Ff EXPIRES:IRE : Monday,January 30,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
orthe'rowwn of Queensbury before the expiration date.)
Bated at the']'own o1" ury; I'rid , `c 4ary,5,2016
SIGNED BY: k� for theTown of Queensbury.
Director of Building&:Code Enforcement
Kristin Bergin BOTH-000039-2016
Town of Queensbury Building & Codes 2 Clearview Lane
SWIMMING POOL PERMIT APPLICATION Above-groun:d swimming pool
A permit must be obtained before beginning construction Permit No.: IbTlA
Permit Fee: $'1_1��16_11� Ak
Site Plan/Variance No.: 1A_4T11
1. Date:
2. Tax Map ID:
FEB 0
1 2016
3. Pool Location Address:
4. Zoning Classification: i_-6(YN I I� �A B U
S. Site Plan Review,,Variance or Subdivision Approvals(list)
6. Property Owner: S +1 N., Phone: S -21 �-3
Mailing Address: 0 v cc,.) ec,'k-k—
City- rzn�Jjv � '4' L)"t
7. Contractor's NaeNannie: hagid:W Phone:
Mailing Address:
City:
8. Contact Person for Building&Code Compliance: Phone
ABOVE-GROUND OR INGROUND?
SIZE OF POOL: cl 0
MANUFACTURER: l"v
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyls/ Fiberglass ".1/ 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, andl 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: 'Cz6 I'
Signature: —-------- Date k LA)t
Name/Title -
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
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Ap r. 27. 2016 1 :46P MOIA No. 1703 P. 3/4
MIDDLE DEPARTMENT INSPECTION A.GENCX, INC.
�aWy&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: Kristen Bergun Date: 04/18/2016
Occupant: Pool Location Clearview Lane
Occupanc%wimming Pool Queensbury,Warren Co. NY
Applicant:
Dan's Electrical Service
Daniel Grogan
3 Freight House Rd_
Corinth; NY 12622 ( OTV ,.'w 0 7,�•?-a 4 b
Joseph A.Holmes
No. 032627200394EL
Equipment:
1 -Time Clock;2-Receptacles; 1 -GFCI Receptacle; / -Water Heater, 1 -Pump(Pool); 1 -1 1/2 HP Motor
This certificate applies to the electrical wiring to the electrical equipment listed Immediately rwIl and void. This certificate applies only to the use,eccupancy 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,effi- of the property Indicated above,this certificate shall be Immediately null and void.
Clancy or fitness of the equipment for any particular ptorpose. This certificate shad In the event that this certificate becomes Invatto based upon the above conditions.
be valid for it period of one year from the above noted date. Should the electrical this Certificate may be revalidated Upon feinspeetion by Middle Department
system to which this cenificate applies be altered in any way.Including but not limit- Inspection Agency,hm. An application for inspection must be submitted to Middle
ed to,the Introduction of additional electrical equipment and/or the replacement of Department Inspection Agency. Inc.to Initiate the;nepeCtion and revalidation
arty of the components Installed as of the above noted date,this cerdncate shall be process. A fee will be charged for this service.
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