POOL-000288-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000288-2017
Tax Map No: 302.17-2-3
Permission is hereby granted to: Mark Rock
For property located at: 54 FORGE 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: Mark Rock Swimming Pool $0.00
Owner Address: 54 Old Forge RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Above-ground Pool
PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 7,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of eensbu /�4f'/! `jedne d 17
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING POOL PERMIT APPLICATION OfficeUseonlv ��l�- j►
Permit p:
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Permit Fee:$`t ✓ ; Invoiceq: 18�P3
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensburv.net
Notes:
Project Location: S4
Tax Map ID #: Subdivision Name:
CONTACT INFORMATION: f'•. ( ? 2Ci':7 D
• Applicant: TOWN OF QUEENSBURY
Name(s): COMMUNITY DEVELOPMENT
Mailing Address, C/S/Z: . Cd 0
Cell Phone: 1,t4A ) '7?I - 3(09a Land Line: )
Email: Or y,
• Primary Owner(s):
Name(s): C's, �T P
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Installer/Builder:
Business Name:
Contact Name(s):
Mailing Address, C/S/Z•
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance:
Cell Phone: (5,g ) ala- -Vo S7? Land Line:
Email:S\ CW-)
Town of Queensbury Building&Code Enforcement Revised February 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: OVE- GROUNoDcr�a� !_p
IN-GROUND
SIZE OF POOL: cC (0 k'ckirl-APc^ '5t n lw
MANUFACTURER: Qx"U'f �
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl_'X' 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.
PRINT NAME:
SIGNATURE: C DATE: 1
Town of Queensbury Building&Code Enforcement Revised February 2017
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TOWN OF OUEENSBURY p
BUILDING DEPARTMENT CV
Based on our limited examination,compliance 00
with our comments shall not be construed as
(� indicating the plans and specifications are in N
eu full compliance with the Building Codes of
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