POOL-000577-2017 i
j TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
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CERTIFICATE OYCOMPLIANCE
Permit Number: POOL-000577-2017 Date Issued: Tuesday, June 26, 2018 -�
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This is to certify that work requested to be done as shown by Permit Number POOL-000577-2017
has been completed.
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Tax Map Number: 288.16-1-49 j
Location: 85 MCCORMACK DR
Owner: Lorraine Dougan,James Dougan
Applicant: James Dougan
This structure may be occupied as a: In ground pool 16 x 32
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By Order of Town Board
TOWN OF QUEENSBURY
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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.
AG h 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-0005 77-2017
Tax Map No: 288.16-1-49
Permission is hereby granted to: Northern Pool Scapes
For property located at: 85 MCCORMACK DR
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
Tvne of Construction
Owner Name: Lorraine Dougan Swimming Pool $0.00
Owner Address: 85 MCCORMACK DR Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Hectrical Inspection Agency
Northern Pool Scapes
PO Box 791
Glens Falls,NY 12801
Plans&Specifications
In ground pool 16 x 32
$75.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Monday,September 17,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbuujrfore the expi ion
4idaoter
date.
Dated at the Town of eensb 2017
SIGNED BY: r the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING POOL PERMIT APPLICATION office use only
....... ... ....
Permit#:
..... ..... .
Town of(Zccnsburp / V U
742 Bay Road,Queensbury,NY 12804
SEp 12
2017 Permit Fee:$ . , Invoice#:
P:518-761-8256 www.gueensbury.net Notes:
Project Location: 11 Me7L 1VW1J C D4. A
Tax Map ID 9 Subdivision Name:
CONTACT INFORMATION:
• Applicant:_
Name(s): S- f'�t . -j�- o/LtZ AE' �'►'l �VLt.G✓tti
Mailing Address, C/S/Z: FS A L&04- M4Oe 14,` �r�6-4:' Avg f1�Y'
Cell Phone: (Sig ) 3e'7 76S7 Land Line: (�� ) 792-02/10
Email: ��u ��/ 4' 1 . 10e Ce;1I
• Primary Owner(s):
Name(s): S,1,"67 /15 Xlde4r�
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Installer/Builder-
Business Name: ���Jlt-�-c.�4.� 1 Z&Afe-S-
Contact Name(s): �Se iLIV STw-j
Mailing Address, C/S/Z qtc 74/ Z' eo5 y'7//1 Viv/
Cell Phone: _( - �� ) � �7 � Land Line:
Email:
Contact Person for Building & Code Compliance: Z�044-S D0U(-'V(e\J
Cell Phone: ( ) Land Line: _( 54 ) 79Z--0o'/1b
Email: D vuz oC J i(/YG'�p • /Z&. �f/Yyi
Town of Queensbury Building&Code Enforcement Revised February 2017-
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND IN-GROUND
SIZE OF POOL: 32-
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK 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.
PRINT NAME:, J b/J6%zcY�9r�'
SIGNATURE- O4 DATE:
Town of Queensbury Building&Code Enforcement Revised February 2017
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UNO£,Q G/YO VNO fbaJE.e, A TEGEPNaNE � CABGE T✓, 1
288.16-1-49 POOL-000577-2AVention Home Owner
Dougan, James & Lorrain me assure you are familiar wit H the TOWN OF QUEENSBURY
85 McCormack Drive i Enclosure requirements specifiiQ to BUILDING DEPARTMENT
Your po6l. We will be happy to e�on our limited examination,compliance
In Ground Pool 16 x 32 ur comments shai; ;•jt be crmstrued as
whet Requirements you will have! ating the plans anu specifications are in
1 •:. er Appendix G Of the II compliance with the Building Codes of
New YcState Residential CodQw Y°rk state.
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I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPS Y LINES TO THE �
PR SED STR ] E(S) OR SIGN(S)
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