POOL-000593-2017 4iia--
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-000593-2017
Tax Map No: 253.3-1-23
Permission is hereby granted to: Sprague's Mermaid Pools
For property located at: 5 KNOLLS RD NORTH
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: VICKIE WATERS Swimming Pool $0.00
Owner Address: 5 Knolls RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sprague's Mermaid Pools
300 Broadway
Fort Edward,NY 12828
Plans&Specifications
in ground pool 20 x 32
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,September 28,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensburyjxfgre the e;i�te-
Dated
)at the Town of eensb urs tember 28,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
C
SWIMMING POOL PERMIT APPLICATION office Use Only
Permit#: POOL 5e>• 2a 1':l-
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Permit Fee:05 ;Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbuy.net Notes:
Project Location: S'h" ���R(k 196CA41
Tax Map ID #: oc 5-3 . J ' I ' a3 Subdivision Name: j i' V ✓LO
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CONTACT INFORMATION:
• Applicant:
Name(s): ✓+C 4/ct LUS
Mailing Address, C/S/Z: S f1n S2 1 A)6C- /U
Cell Phone: SI ) 361 - 36 a ) Land Line:
Email: • r-)If y L
• Primary Owner(s):
Name(s): JAL
Mailing Address, C/S/Z: f h n,f) /I< <bL-14 tvY
Cell Phone: _(i!�119_) 361-360- 1 Land Line: _( )
Email: /j-df- $ 0 v a moo, c4 m
• Installer/Builder:
Business Name: S u.t OCT
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Building & Code Compliance: VIGh f-t- 6k)a
Cell Phone: _(St ) � Land Line: _( )
Email:
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TOWN OF QUEENSBURY
Town of Queensbury Building&Code Enforcement BUILDING&CODES Revised February 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND IN-GROUND
SIZE OF POOL: 0 X-5'�
MANUFACTURER: I� Manj
J
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:
SIGNATURE: / , ` /G'l/C DATE: ' �l
Town of Queensbury Building&Code Enforcement Revised February 2017
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