POOL-0154-2018 �^ TOWN OF QUEENSBURY
� 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
--__ Community Development - Building & Codes (518) 761-8256
CERTIFICATE OFCOMP 1ANCE
Permit Number: POOL-0154-2018 Date Issued: Monday, June 3, 2019
This is to certify that work requested to be done as shown by Permit Number POOL-0154-2018
has been completed.
Tax Map Number: 290.-1-92
Location: 794 RIDGE RD
Owner: Sarah Hagelin
Applicant: John Kern
This structure may be occupied as a: Inground Swimming Pool
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
4 3
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: POOL-0154-2018
Tax Map No: 290.-1-92
Permission is hereby granted to: Sarah Hagelin
For property located at: 794 RIDGE 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
Type of Construction
Owner Name: Sarah Hagelin Swimming Pool $0.00
Owner Address: 794 RIDGE RD 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 Swimming Pool
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,April 11,2019
(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 Town sbury W d e pril 11,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
315 706-9149
• -- ---- SWIMMING POOL PERMIT APPLICATION Office Use only
sarah@kern-home.com Permit#.?0.6 L- -)o
TO Of 0,yeensbury
- Permit Fee:$/d.) Invoice#:O--;l
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensburv.net Notes:
Project Location: ncord POC-Ngf'
APR 20'0
Tax Map ID#: Tom minion i.J RY
C0%,qV1UiX-.1-Vy 1,)EVELOPIVIENT q,
9Z gig E!QQM-Rd,-Queetq9bdFy N Y ;2804
CONTACT INFORMATION:
o Applicant:
Name(s): -teH9byFFies,,",.------
Mailing Address, C/S/Z: -2q r to4)4 Tk 1- Co--V 4.J
X
Cell Phone: A6 a,, --7�0 6 Land Line:
Email: Q Ve,r` A-) U'Ln (VIP— ,,
0 Primary Owner(s):
Name(s): a C el.-
Mailing Address, C/S/Z: -2044 k-tl�5 no(:-,(,- X,)3 a tj y 4-9d 51,
Cell Phone:_( )� 51 14 9 Land Line:
Email.-�6-, A� — �V 0 IL--z
• Installer/Builder:
Business Name: (",n Av'(% r-
3 Contact Name(s): "-\TC L
Mailing Address, C/S/Z:
Cell Phone: f i Land Line:Lin�_(
Email: r ri eA-!&�.00o t-DbS W-t
Contact Person for Building & Code Compliance:
Cell Phone: )�(p 6 Land Line:
Email: C 0 rvt
Town of Queensbury Building&Code Enforcement Revised March 2018
SWIMMING POOL INFORMATI9(N:n H Kern
CIRCLE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: 16 u q a '
MANUFACTURER: U1. t` l .) li� (�./�d A_ z c�
MATERIALS USED IN CONSTRUCTION (CHE 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:
PRINT NAME:
SIGNATUR DATE: �1 !
Town of Queensbury Building&Code Enforcement Revised March 2018
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(0) MIDDLE DEPARTMENT INSPECTION AGENCY, INC. ��'
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�� v t :that the electrical wiring-to the electrical equipment listed below has been examined and is approved as -•
being in accord with'the National Electrical Code, applicable governmental, utility and Agency rules in effecton the date i
(#;,j noted below and is issued subject to the following conditions. C�a?
It Owner: Date: 07/05/2018 C�
�;� Kern 0
A Occupant:
�' Location- �;�
ic?) Pool 794 Ridge Road fir;)
l�j Queensbu Warren Co. NY t y�
le,, Occupancy:Swimming Pool ry, .rr.
<<) Applicant: S&J Electric • •__ . . - f.*
0 68 Burden Lake Rd 1)
(;?) East Greenbush, NY::1;2061 l .;�,;•::-•:-,. - •?-� 0
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Joseph A.Holmes;t - CCU
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1 1410221:03559E1�• _ _ _ _ _ .. ... _ _ ,_ _ _ �c{,)
(, Equipment: \'
k 4-Low Voltage Fixtures; 1 °;Burner,Wiring'&Control'For'Gas; 1 -Pool Pump; 1 -.Easy Touch::Panel; 1 -Chlorinator
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This certificate applies to the electrical wiring to the electrical equipment listed ienrnedlatety null and void. This pertiticate applies only to the use,occupancy anD fr
() above and the installation inspected as of the above noted Gate based on a visual ownership as indicatett herein. Upon a change In the use,occupancy ar ownershi ?
(��� inspection. No warranty is expressed ar Implied as to the mechanical safety,et6 of the Property indicated above,this certificate shall be immediately null and void. �s)
.♦��j ciency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above conditions, r)�
›ket De valid for a period of ane year front the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Middle Department g:
1 ) system to which this certificate applies be altered in any way,including but not limit- Inspection Agency,Inc. An application for ins
peelion must toe submmetS to MidOie (-;t�
tC) ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to Initiate the Inspection and revalidation ((:j)
(� any of the components Installed as of the above noted date,this certificate shall be process. A fee will be charged for this service. Y�
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