POOL-0414-2018TOWN 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-0414-2018Date Issued: Tuesday, July 16, 2019
POOL-0414-2018
This is to certify that work requested to be done as shown by Permit Number
has been completed.
301.12-1-50
Tax Map Number:
15 HELEN DR
Location:
Robert Nelson
Owner:
Robert Nelson
Applicant:
This structure may be occupied as a: Above ground pool 18'
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
ti
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Peituit Number: POOL-0414-2018
Tax Map No: 301.12-1-50
Permission is hereby granted to: Robert Nelson
For property located at: 15 HELEN 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
Type of Construction
Owner Name: Robert Nelson Swimming Pool $0.00
Owner Address: 15 Helen DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Robert Nelson
15 Helen DR
Queensbury,NY 12804
Plans&Specifications
Above ground pool 18'
$ 125.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,July 3,2019
(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 , e e�x+pirati•n •a .)
Dated at the To of Que sb f �/ T ;. July 3,2018
1,44
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
r SWIMMING P c O.L-PERMITAP-P-L-ICA.TIQ► Office Use Only
!j) _
�� � `� E � VER Permit#:
41,
Town of`Queensbury ?_ o
742 Bay Road,Queensbury,NY 12804 -
ll I JUN 2 8 2015itjj
Permit Fee:$ gnvoice#: ir) d e -
P:518-761-8256 www.queensburv.net Notes:
TOWN OF QUEENSBURY
BUILDING&CODES
Project Location: J 5 I U(tr\ C\f.
Tax Map ID #: 301 , 12- 1 -SO Subdivision Name: Ever. ,ceer
CONTACT INFORMATION:
• Applicant:Name(s): C7..)beA4- NI a5Dr
Mailing Address, C/S/Z: 15 Ao,;4. , Cioecv,512wr1, NV I Z.soai
Cell Phone: ( Sl 8 ) 3 fQ 1- 1 S6S Land Line: ( S;3 ) 7/13- a 2,3z./
Email: MT^312. rb ,rovivar,Coon
• Primary Owner(s):
Name(s): ix
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _(
Email:
• . Installer/Builder:
Business Name: e
Contact Name(s): ( b(xi+ (so'\
Mailing Address, C/S/Z: CCkr- Cl rise eipe.e"dr,ury 1o`k I2150'--�
Cell Phone: _( Si 8 ) 3(o 1- 156 5 Land Line: _( 51 J ) 74/3- ez34
Email: rr) 312CA-) tuck romax , rarer
Contact Person for Building & Code Compliance: 23 f4 0,450 r\
Cell Phone: ( Sig ) 301 - c Land Line: ( 5'1g' ) 7c'3 - 02341
Email: 09ekh 312-- , Corr',
Town of Queensbury Building&Code Enforcement Revised November 2017
4
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: f S
MANUFACTURER: J ht (766 ( Eat/}old/
MATERIALS USED INCONSTRUCTION (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:
PRINT NAME: (.\150,e(i.
\AP_�36 r
SIGNATURE,�� C DATE: (p —25 -10
Town of Queensbury Building&Code Enforcement Revised November 2017
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I HAVE PERSONALLY MEASIIN€@ THE DISTANCE
FROM THE PROPERTY LINES TO THE
PROPOSED STRUCTURE(S)OR SIGN(S)
29-it
`SIGNATURE DATE
ECEOWER .
MAY 2 4 2019 gi •
TOWN OF QUEENSBURY
BUILDING&CODES
3-11)0 k--- — 060.6t -2-0 to
Aii.:.:;•. . :
. • . ...:..;,1
COMMONWEAI:fH ',I.,ECTRICAL INSPECTION SERVICE,INC.
• •
Main Office 176 Doe Run Rusid-Manhaint,PA.17545
','i..,•!' ' • ••!';',i4,
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL "':'•'?. •••;:',,i
Permit Notk...QcliN- 2.C4-j•49.-Ccrt N2 42440 cut-in Card No • •;4?
r•ii'•T•.
;i:••..:. •:•••:.',
:Ili.;!... • Owner 23P Ati166,1- Ai c,-4,45,Ai . •'.•,,!:'i
•fg'•:;'• .
.:iti•:.:‘Y . Location i,c ,,A/r-r..e-ex 0 i'7,, ca.s.t c..Q0:4.kt.sieri ' -•::,;1
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,:.‘..,
ir..,• . Installation Consisting of ....,,,..,
. .
.Y:Y.'7: • •'-iCi:
A imdz..*-... ...C.70 147 ii0.4 ,ShIV.i.tfri et.3.1.4 " Pat'4^ •
Vi'.•;• •• •
(-A-)t Ai/1 Cr 4 445 CZ,d 109 G.-
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Installed By ?...4 ..acs;,A.F..0- Lic.No. ..,..,.,
14:':',::;'' : •:i;"
t,;.1.:-.-.• The conditions following governed the issuance of this certificate and any certificate previously issued is • ..:ii•
''''ii:'''•:.;• ' cancelled:- . ....:...,
This ccnificate only covers the electrical equipment and installation conditions as of date. Upon the :••,:,!‘•i
:', .....::., introduction of additional equipment or alterations,application shall be promptly made for inspection.
. ..,.
',..;?..'.• • Inspectors tit'this Company shall have the privilege of making inspections at any time and if its '
:Z!;•'••••!.. rules are violated,the Company shall have the right-to revoke this certificate,
•....••
•',:'••,....;.•
,..- • .; Date 5-2 Li-11 INSPECTOR.-0
,•;,..:'•••: ,
Member N.F.P:A.,LA_E.I. . ,•..'
10 39Vd oiswnw NMI P8ST8EL. •
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