POOL-000427-2017 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: POOL-000427-2017 Date Issued: Tuesday, June 12, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000427-2017
has been completed.
Tax Map Number: 308.12-1-27
Location: 15 WOODEN LN
Owner: Jackie Rosati, Richard Rosati
Applicant: Richard Rosati
This structure may be occupied as a: Inground 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,
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
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: POOL-000427-2017
Tax Map No: 308.12-1-27
Permission is hereby granted to: Concord Pools&Spas
For property located at: 15 WOODEN 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
Tvoe of Construction
Owner Name: Jackie Rosati Swimming Pool $0.00
Owner Address: 15 WOODEN LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Concord Pools&Spas
156 Sparrowbush RD
Latham,NY 12110
Plans&Specifications
Inground swimming pool
$75.00 PERMIT FEE PAID-TFBS PERMIT EXPIRES: Saturday,July 28,2018
(If a longer period is required,an application for an extension most be made to the code Enforcement Officer
of the Town of ueensb beforimthee irW
date.Dated at the Town QeensFri 28,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING POOL PERMIT APPLICATION office Use only
ft Permit#: (COOL- �7-
Towm of Queensbury �O 9
Permit Fee:$ ; Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensburv.net Notes:
Project Location: /S /Jiv o. loW L,q,uE
Tax Map ID #: 0 - (� /'� Subdivision Name: ,� J
CONTACT INFORMATION:
I
• Apghtant:
Name(s): ha,-,L a"( J..e-k tC TOVVN OFQJEE
Mailing Address, C/S/Z: .hlY /0B0f U1.�.oPMENL
Cell Phone: (5/sr Land Line: ( 1
Email: t',y'6 sw-ti ( @S en4i1.. C'6 VV\
Primary Owner(s): _
Name(s): -Q i cl. r>l
Mailing Address, C/S/Z: f�uear l�v� �� 12 p6 q
Cell Phone: . Ail A- a'7( ( Land Line: ( )
Email: ICSVosa ti iC�SwtaI .(26vA
• Installer/Builder: rr��
Business Name: �Nc_ava PaDL(S
Contact Name(s): Icrr. (3: .V-w)e c
Mailing Address, C/S/Z: L �c4.a M rv� C2 1 t
Cell Phone: If ) Land Line: ( -5 S ) 76S 'zs`' -7
Email: L!&r*cerd P6-LS . e.r*n-
Contact Person for Building & Code Compliance: 6 �.J nre q
Cell Phone: ( )v I -Ogro,p Land Line: ( t5ig ) 7t�3-gs92�
Email:
Town of Queensbury Building&Code Enforcement Revised May 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND �N-GROUND
SIZE OF POOL: 1 2,,,�, 2-'i D
MANUFACTURER: � 1 00 -5
MATERIALS USED IN CONSTRUCTION (CH ECK ALL THAT APPLY):
Steel/Vinyl ✓ 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.
I have read and agree to the above:
PRINT NAME: ay`1
SIGNATURE: C DATE:
Town of Queensbury Building&Code Enforcement Revised May 2017
&m.D,oh r..t-�' I �-k �2 6 � U l jj� `f ! �� i a lir-c0' E� P-i�.5I __TOWN OFQUEENSBURY Oki Tfvt OVdto! OF ��I?E BUILDING DEPARTMENT f'E.V
Based on our limited examination,compliance fi
With our comments shall not be construed as
indicating the plans and specifications are in �f
full compliance with the Building Codes of F� 308.12-1-27 POOL-000427-2017
New York Slate.
G Rosati, Jackie & Richard
i 15 Wooden Lane
Inground Pool
r
I
0C' f -�
6 � .��rCE Lr r2e
6t.1 —�
Attention Hone Owner
Please assure you are f miliar with the
Pool Enclosure requirements to ext
Your pool. We will be happy
in
what Requirements you will have to PERMIT PLOT PLAN
meet per Appendix G Of the
New York State Re al�Qd I HAVE PERSONALLY MEASURED THE DISTANCE
4RD
PROPERT LINES TO THE
�fnt STRU (S)OR SIGN7(S)
DATE
Oct, 16. 2011112: 22P MDIA - - No. 0455 P, 6/6
DIDDLE DEPARTMENT INSPECTION AGENCY, INC.
� t 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: Rosati Date,
10/06/2017
Occupant- pool Location,
10 Wooden Lane
Occupancy Swimming Pool Queensbury, Warren Co. NY
Applicant:
S & J Electric ..__• �••- --••--
68 Burden Lake Rd
J
East Greenbush, NY 12061•,
Y
Joseph A.Holmes
No.
- - - -- - - - - - - 14102213f0 794.- 7!..
Equipment-
50
quipment50 Amp. Sub Panel; 1 -GFCI Receptac:W;l -P00r ump;'r-Tim—i-Cl-b-ci
This certificate applies to the electrical wiring to the electrical equipment listed Immediately nuIJ and void, Thls 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,effi- of the property indicated above,this certificate shall be immediately null and void.
clency or fitness of the equipment for any pamcular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above conditions,
be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspectlon by Middle Department
system to which this certificate applies be altered in anyway,Including but not limit- Inspection Agency,Inc. 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 inspection and revalidation
any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this seMce.
Wo® L_
D 6 2017
OCT 1
TowO� CUEENSBURY
13UILDD&CODAS