POOL-000762-2017 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-000762-2017 Date Issued: Thursday, August 16, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-000762-2017
has been completed.
Tax Map Number: 301.19-1-28.4
Location: 29 EVANNA DR
Owner: Heather Walters
Applicant: Heather Walters
This structure may be occupied as a: In Ground Pool 18'x 44'
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, r-ima4/9 14\
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-000762-2017
Tax Map No: 301.19-1-28.4
Permission is hereby granted to: Clearwater Pools
For property located at: 29 EVANNA 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
TvW of Construction
Owner Name: Heather Walters Swimming Pool $0.00
Owner Address: 29 Evanna DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Clearwater Pools
1100 State Route 29
Greenwich,NY 12834
Plans&Specifications
In Ground Pool 18'x 44'
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 13,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenefore the ex ' tion ate.) -
Dated at the Town ofsbu ed 0 ecember 13,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SWIMMING P office use only
pc a Permit#:
Own of(Lucensbul-y QEC $ D 217 Permit Fee:J � D Invoice#: —1 t
742 Bay Road,Queensbury,NY 12804
Notes:
P:518-761-8256 www.gueensbury.net
TOWN OF QUEENSBURY
BUILDING&CODES
Project Location:
Tax Map ID #; "CA Subdivision Name:
CONTACT INFORMATION:
e A li�ant:
Name(s): it ! C. 1 l I ( %J (A�Ir r�
Mailing Address, C/S/Z:Y �.t����l ��(. - (--.-(4 L
Cell Phone: k - L -1 Land Line:
Email:-\1 k,' �9c- k� N
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Primary Owner(s):
Name(s): I
Mailing Address, C/S/Z: ci (-V'1.n-)L— �.
Cell Phone:_( �) A", Land Line: _( j i1 1 - k �(
Email:
e Installer/Builders
Business Name: C'\('-'(P]
!
Contact Name(s):
Mailing Address, C/S/Z: (. (11� ),L Cil
Cell Phone: _( ) Land Line: _( )
Email:
Contact Iverson for Building & Code Compliance: LL t44v,r
Cell Phone: _( _) �1�+ 1, f,��t-lnS Land Line: _( �t V) � — �
Email: \n'e \
Town of Queensbury Building&Code Enforcement Revised February 2017
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND IN-GROUND
SIZE OF POOL: 1 qy,,�\
MANUFACTURER: {i(�L :2bc�
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass Gunite Poured Concrete ,' Other
Declaration: I acknowledge no constriction 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: `�� �� -� i°�►4 k
SIGNATURE- ` DATE: V1 1
Town of Queensbury Building&Code Enforcement Revised February 2017
MAP REFERENf,"K,
MAP O A SUBDIVISION MADE FOR TOWN OF
QUEENSBURY
�n�cl�AliL DICKINSON TOWN
& CO -`
BATED: JANUARY 15, 2003 S
BY: DAM ,k BOLSTER Q4 EENSBURY FOREST PHASE 111 Reviewed B ;
Date:
LOT 15
LOT 14 :'
TOWN,OF Q D
UEENSBURY
BM
BUILDING DEPARTMENTLOT 13
ased on our limited examination,Compliance �C 2017
with our comments shall not be
indicating the lans ana s constred
full compliances
with the PBU�� mations are in TOWN OF QUEENSBURY
New York State, f� Codes of
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PERMIT__F' nPJnth 301.19-1-28.4 POOL-000762-2017
I HAVE PERSONALLY MEASURED ME DISTANCE Walters, Heather
FR M THE PRC7RTY LIME TO THE 29 Evanna Drive
P OSED , 46& 'RE(S)OR (S)
in ground pool
SIG'Z'AT D I
OF NE
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Late
te= AUGUST 15, 2005
all Dus c4
p�� - j "U AUTHORIZED AL7ERAP.CN OR AUDITION TO A SURVEY `f aTl f a Ju�e�y mace f .. 3r-30'
/�/d"/�f� MAP
BEAR NO A.LICENSED LAND SURVEYORS SEAL IS A �, c
VIOLATION OF SECTION 7209,.SUB-01 V"ON 2,OF THE -
NEW YORK STATE.EDUCAMON LAW.'
;f'�Qsves
'ONLY COPIES ORI THE OF THE AN THIS SURVEY _. -
[�Rs�'°��l" MARifeU H4M AN ORIGINAL OF THE lM+p SURVEYORS
SEAL SHALL.BE CONSIDERED TO BE InLID TRUE COPIES.' NATHAN
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'CERTIFICATIONS INDICATED HERE[.n„GNIFY THAT �� �� 1 � �\� .ia• +�`1� HER E . ! .;� -
THIS SURVEY WAS PREPARED IN ACIuD SU CE ORS THE .Il 1 \� ,
-yam arid �� EXISTING LADE OF PTATT A FOR Li[D SURVEYORS ADOPTED
JlRiie.mrl, BY THE NEW YORK STATE ASSOgAIi1,N OF PROFESSIONAL I
rve ors LAND SURVEYORS.SAID CERTIFICATIi;IJS SHALL RUN ONLY i TO THE PERSON FOR.414i0M.THE SUneEY IS PREPARED AND - - SHEET I OF I
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;{a��}!� ON HIS BEHALF TO THE:TITLE COMP"y,GOVERNMENTAL I rev -
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