POOL-0120-2018 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-0120-2018 Date Issued: Wednesday, July 25, 2018
This is to certify that work requested to be done as shown by Permit Number POOL-0120-2018
has been completed.
Tax Map Number: 308.13-1-4.21
Location: 45 Pitcher RD
Owner: Tonya Dufour
Applicant: Ronald Dufour
This structure may be occupied as a: Inground Swimming Pool 22 x 36
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.
•
r _ 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-0120-2018
Tax Map No: 308.13-1-4.21
Permission is hereby granted to: Sandra Barlow
For property located at: 45 Pitcher RD
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: Tonya Dufour Swimming Pool $0.00
Owner Address: 45 Pitcher RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Pools Plus
45 MAIN ST
Queensbury,NY 12804
Plans&Specifications
Inground Swimming Pool 22 x 36
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 4,2019
(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 To of Que bury W d e ril 4,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
41
SWIMMING POOL PERMIT APPLICATION Office Use only
Permit#: ?4,OL-
Town of Queensbury Permit Fee:$ Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensburv.net Notes:
Project Location: AJdev klj�
Tax Map ID #: J Subdivision Name:
D E C 1E 2 U' EE
CONTACT INFORMATION: M 11 20'rl) J
e Applicant:A TOWN OF QUEE14SBURY
P 1,0, MMUNITY DE-WEELOPMENT
Name(s): (s,;1 d/i re vb, If r 16 CO
Mailing Address, C/S/Z: V — -A/,
Cell Phone: Land Line:
Email: A 14
• Primary Owner(s):
Name(s): S4 I—i
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
* Installer/Builder:
Business Name: 1->em / -,q P Afs
Contact Name(s): l')04V OP- ,R- A' A
Mailing Address, C/S/Z: SA- 0
Cell Phone: Land Line: ( S"19
Email:
Contact Person for Building & Code Compliance: e4r., AX%w /AGal 1N
Cell Phone: Land Line:
Email:
Town of Queensbury Building&Code Enforcement Revised May 2017
0
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND �IN-GROUN�
SIZE OF POOL: mil' �4
MANUFACTURER: n 4 r
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.
I have read and agree to the above: l
PRINT NAME: �cv. /.'/s�o ;� .I lA,,�l`r��r �
SIGNATURE: ,_/� DATE:
Town of Queensbury Building&Code Enforcement Revised May 2017