POOL-000145-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building & Codes (518) 761loi_R— , --L
-8256
CERTIFICATE OF COMPLIANCE
Permit Number: POOL-000145-2017 Date Issued: Friday, April 6, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000145-2017
has been completed.
Tax Map Number: 301.9-1-31
Location: 644 WEST MOUNTAIN RD
Owner: Jim Fitzgerald
Applicant: Jim Fitzgerald
This structure may be occupied as a: In Ground Swimming 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, �d
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
OL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000145-2017
Tax Map No: 301.9-1-31
Permission is hereby granted to: Jim Fitzgerald
For property located at: 644 WEST 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: Jim Fitzgerald Swimming Pool $0.00
Owner Address: 644 WEST MOUNTAIN RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Bob Baker Pools
75 Sisson RD
South Glens Falls,NY 12803
Plans&Specifications
In Ground Swimming Pool
$75.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Saturday,April 14,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Toef Que // Fr' 2017
SIGNED BY: /d for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING POOL PERMIT APPLICATION Office UseOnni
Permit#:POO l.- — 1!315 - 7-C
Permit Fee:$ '45 Invoice#: I
10
742 Bay Road,Queensbury,NY 12804 Notes:
P: 519-761-8256 www.aueensbuv.net
Priiject Location: wpSk MsA ntlt to Qa
Tax Map ID#: 25D 1 ' I — I — ?) Subdivision Name:
CONTACT INFORMATION:
•
Applicant'
icaant
Name(s):
Mailing Address, C/S/Z: Z
Cell Phone: (;-/2) Land Line: jj(
Email:
• Primary Owner(s):
Name(s): Sr e s 4 L ✓-e
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Installer Builder:
Business Name: 47 o l
Contact Name(s): f
Mailing Address, C/S/Z:
Cell Phone: _(S'/ � ) 9� — �/ Land Line: _( )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: _( ) Land Line: _( )
Email:
Town of Queensbury guiiding&Code Enforcement Revised February 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: A9
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass Gunite Poured Concrete Z 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.
L
PRINT NAME: t/iW-1 r�-('T ZG; e oa L
SIGNATURE: DATE: 7
Town of QueensburyBuilding&Code Enforcement Revised February 2017
301.9-1-31 POOL-000145-2017 _ D
Fitzgerald, Jim 2d` ���, PIVM �Irti (r�� .
644 W. Mountain Rd. 0 Se
In Ground Swimming Pool ` 3
W
_ _ I
FILE COPY'; Attention Homeowner
"`
Please assure you are familiar with the
Pool Enclosure requirements specific to
Your pool, We will be happy to explain
I. what Requirements you will have to
meet per Appendix G Of the L —
�- re"Ca-Neh, State Residential Code,
Po p l
TOWN OF QUEENSBUR I
16 � 1RUILDING & COD S T. E r E10 d E
6 / IC-2 jeviewe By:
Date: L `\ APR 0 b 2017
TOWN OF QUEENSBURY
BUILDING&CODES
TOWN OF QUEENSBURY I
BUILDING DEPARTMENT
Based on our limiCeexamination,
with our comments shall not be construed as
indicating the plans and kalions are in
G, full compliance with.the ullding Codes of
New York Slate, T V-1
6 qq Ve . *-
Fe N c e74o Kse--
only has been
visually inspected and certified as of
this date pursuant to applicable
codes C Q
APR 0 6 2018
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P(JOL-
BUILDING&CODES
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Inspector t 'I Allf ,
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