POOL-000652-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
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Permit Number: POOL-000652-2017 Date Issued: Thursday, June 21, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000652-2017
has been completed. .
Tax Map Number: 295.16-1-14
Location: 108 FARR LN
Owner: Brewerton Clarke,Linda Clarke
Applicant: Brewerton Clarke
This structure may be occupied as a: Inground Pool 14 x 30
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-000652-2017
Tax Map No: 295.16-1-14
Permission is hereby granted to: Brewerton Clarke,Linda Clarke
For property located at: 108 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
Tyne of Construction
Owner Name: Brewerton Clarke Swimming Pool $0.00
Owner Address: 108 Farr LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Concord Pools Ltd.
60 BIG BOOM RD
Queensbury,NY 12804
Plans&Specifications
Inground Pool 14 x 30
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 26,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of eensb )j �urs r 6,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING �—� office Use Only
DL� j L� Permit#:
Tenon of ueensb ��
OCT 17 2017 Permit Fee:$ ;Invoice#: Z 337
742 Bay Road,Queensbury,NY 12804 Notes:
P:518-761-8256 www.gueensbury.net TOWN OF QUEENSBURY
BUILDING&CODES
Project Location: l 0,P, E- -i. L e
_ 14
Tax Map ID#: 62.3 4 �L3 ���, / 6/•-iSubdivision Name:
CONTACT INFORMATION:
Applicant:
Name(s): egad 11"t, a
Mailing Address, C/S/Z: /i9g 6kjnt— Lowe, �S �� /V ! Z E6,74
Cell Phone: ( J R6 )2 4 9 - 04g l Land Line:
Email: L -wda c/ok-ke -G 04i0 ao/. Colo
* Primary Owner (s):
Name(s): - f� Civ kao ,g"d L in
Mailing Address, C/S/Z: 16,S 4&,ie ;
Cell Phone: _( I ) 24'*-- U43 i Land Line: _( )
Email: L1"aJa4'Jo,--4re .?v 0 C6t,-'J
• Installer/Builder: ii��
Business Name: JfGv1Cti•-'J /-ad/5 9? as
Contact Name(s): G s�✓vrC
Mailing Address, C/S/Z: GCS ,G'. J G v e N /-?
Cell Phone: _( ) Land Line: _( JET ) 7y�%- C�E'60 26<1
Email: o ,�v.�v�c>s C6�iCoYr��000Js� �Ol�
Contact Person for Building & Code Compliance: .y f2 i57 � L�
R�D Al�/ AI'2(%,�''(_,
Cell Phone: _( 396') 2-4q —04.7 f Land Line: _( )
Email: Lye-i-'ivki C <—'Op"
Town of Queensbury Building&Code Enforcement Revised May 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND QN-GROUN
SIZE OF POOL: /Q 1,V 2 d "
MANUFACTURER: L/��iv �j CGvYf h G s/��" ` do/S
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass X Gunite Poured Concrete Other
Declaration: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit.
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: �CyeL-11"0 l� ���V 4-c J�-
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Revised May 2017
29516-1-14 POOL-000652-2017
Clarke, Brewerton & Linda
108 Farr Lane
Inground Pool
00
TOWN OF OUEENS13URY
TA BUILDING8 CODES DEPT.
Reviewer By:
...... Date-
TOWN OF QUEEN
D E PA R S BEUNy
TM RT
2;"Y 6 BUILDING
Based on our limited examination compliance
Y41th our comments shall not be examination,
as
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