BOTH-000540-2016 TOWN OF QUEENSBURY
4ft 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000540-2016 Date Issued: Friday, June 30, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000540-2016
has been completed.
Tax Map Number: 295.16-1-3
Location: 109 FARR LN
Owner: Jason Miller
Applicant: Jason Miller
This structure may be occupied as a: Inground Pool
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (�� r/ 4
property owner of the responsibility for compliance with Site Plan, Ljy1Y
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 Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000540-2016
Tax Map No: 295.16-1-3
Permission is hereby granted to: Jason Miller
For property located at: 109 FARR 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
Tvce of Construction
Owner Name: Jason Miller Swimming Pool $0.00
Owner Address: 109 Farr LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Cypress Pools,Ltd.
115 Wade RD
Latham,NY 12110
Plans&Specifications
Inground Pool
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,August 14,2017
(If a longer period is required,an applic tion for an extepil most be made to the code Enforcement Officer
of the Town of Que ury fore th a ins, n da
Dated at the Town f Q ee sb �V F ust 19,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Building & Codes Office Use Only
Received:
SWIMMING POOL PERMIT APPLICATION Tax Map ID:
A permit must be obtained before beginning construction Permit No.: r
Permit Fee: $ 7 S • L'/�
Site Plan/Variance No.:
1. Date: 1 I d s tl(,
2. Tax Map ID: �P 95, &,- 1 - 3
3. Pool Location Address: 9 torr a Q p vaoy
4. Zoning Classification:
5. Site Plan Review,Variance or Subdivision Approvals(list)
6. Property Owner. Phone: 6 - - s.) Slw5
Mailing Address: I0c� i�r r
City: Ci �' 'r pi5� •ti
7. Contractor's Name: �T�re s S PaA Phone: 5c2c3 o
Mailing Address: /)5 (LAZ a I
City: L Lha Yv
8. Contact Person for Building&Code Compliance: ��� ly�wn Phone 7 Sf 3- So1�a
ABOVE-GROUND OR INGROUND? n ren
SIZE OF POOL: I//� x 3(Fn
MANUFACTURER: lQr8S5 PoO�
MATERIALS USED IN CONSTRUCTION(CHECK ALL THAT APPLY):
Steel/Vinyl w"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:
Signature: Date I
jam 1 Title
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
Attention Home Owner
MAP REFERENCE: ' Please assure you are familiar with the
INDIAN RIDGE PUD Pool Enclosure requirements specific to
PRASE THREE Your pool. We will be happy to explain
DATED NOVEMBER 15, 2002 PER?V11T what Requirements you will have to
REVISED JANUARY 24. 2003 I NAVE P pL�T _ meet per Appendix G Of the
ERSONAL�YA4EASup P� �'� New York State Residential Code.
BY VAN DUSEN -f- STEVES FRO T EG T,yr,.
LAND SURVEYORS. LLG HE PROP -J STA;,cE
PROPOSED ERT1 LI.4IE•S TO THS
STRUCTURE ) 0 -
NATURE
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DA7E TOWN OF QUEENSBURY
49 E BUILDING & C
N29 T.
Reviewe B• :
Date:
I
N22° 5A' I I OWN�OF QUEENSBURY
0UK.D,N`.D B"ART,IV,C:
6ased on our limitsd a;t; i�aior,,com;.;,iiance
aklfy our comments =ot be cont ued as
/ inaicatir�7 the ?a cifications are in �y4
I full compliance
an
3' 0,01 Codes of
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