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POOL-0391-2020 f SWIMMING POOL PERMIT APPLICATION Office Use Only ,,,� . ) ' Permit#: ?Ob L,— O-cl 1 ' Z02.J Town of Quccnsbury Permit Fee:$ 122 ; Invoice#:Z-ntc2 b 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net Notes: Project Location: 26 WEST DRIVE QUEENSBURY,NY 12804 Tax Map ID # ,308.12-1-9 Subdivision Name: Click or tap here to enter text. CONTACT INFORMATION: • Applicant: CECILY BURLINGAME Name(s): Click or tap here to enter text. Mailing Address, C/S/Z: 26 WEST DRIVE QUEENSBURY,NY 12804 Cell Phone: (518) 683-5658 Land Line: ( ) Email: PAYTDOM123@YAHOO.COM ��.____ --�-- -- -' El V E n Ei' • Primary Owner(s): CECILY BURLINGAME Name(s): Click or tap here to enter text. LJUL Lg 1 5 2�2iB i U Mailing Address, C/S/Z: 26 WEST DRIVE QUEENSBURY,NY 12804 ° TOWN uFnfJcL!`iaifRY Cell Phone: (518) 683-5658 Land Line: ( ) BUiLDIN : CODES Email: PAYTDOM123@YAHOO.COM @ Check if all work will be performed by homeowner only • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Click or tap here to enter text. Contractor Trade: Click or tap here to enter text. Mailing Address, C/S/Z: Click or tap here to enter text. Cell Phone: ( ) Land Line: ( ) Email: Click or tap here to enter text. **List all additional contractors on the back of this form Contact Person for Building & Code Compliance: SCOTT ROWLAND Cell Phone: (518) 683-3410 Land Line: ( ) Email: O;63M Swimming Pool Packet Revised May 2020 , 1 SWIMMING:POOL INFORMATION: CHECK ONE: ®ABOVE-GROUND ❑IN-GROUND SIZE OF POOL: LxWxH: 24 x 15 x 48 MANUFACTURER: ki et kt. MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl'© Fiberglass ❑ Gunite ❑ Pod:red'Concrete ❑ Other ❑ (Explain: Declaration: 1I`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: CECILY BURLINGAME SIGNATURE: Click or tap here to enter text. DATE: 06/16/2020 Swimming Pool Packet Revised May 2020 oo o rs \e--% ‘' '.- 1";) N a. REVISED 11g 93 fi — TOWN OF QUEENSBURY BUILDING DEPARTMENT up pp I Based on our limited examination,compliance Ira i with our comments shall lot be construed as k indicating the plans and specifications are in co ���.OF QUEENSBURY full compliance with the Building Codes of L. i � '�'BUILDING &CO ES. PT. New York Btste, 1 I Reviewed,Sy ®ate: L , ___ . . 1 _1ST - e c< * c O . . Fo 0 , = 1.1 L kI. a p3 co .h f \ a n o. €€ o O v, i O 17 o — r o �yt O a I Gv two o � LJ ATTENTION HOME OWNER r ��a N ou are familiar with the P 1 N gp Please assure y i. p ar zr Enclosure requirements specific to your You are required to meet all applicable •,es \ :., in Is, spas & hctit tubs D at the time of inspection. Ltdu v m NI n m L..CO A� ecam :••m\a„- A., Zflt,3 �A"�� We 'k t �� o .„ - ,,, . tJ-r \z2( � - D E C E E OCT 13 2021 TOWN OF QUEENSBURY BUILDING&COD`S > t;f3NJiVION-WEA'l,:TH ELECTRICAL INSPECTION;`iERVICC INC. a yfah)(,Xrwc 176 Doe Run Road•Manheirn.PA 17545 KO>:aICAPAU CLIRTIFICATC, - ELEC'TRIC,,�L APPROVAL 0 5 0 Q 15 Cut-in Card No..................................... . v.• Pet'mil No.....,....•........................ Owner.................... .,.......................,,.,....,...,..................... ,.,.,..........., 'F�F 7fiF to:;��• Location........................ ,.,..P..p-......................................................................................,. r InstallationCoti:,ititir:i•:of....... ........................................................... ............................................ =(•,;:•. . ...........................................................,...............R.il,.,Y,..,�J!:C...,.`:,:':.;G�......4.{.:.Y,..f.trawm7�t-rt.,r,.......{n=a.(?..6•n I 'i�;` Yh,Y til..f?r(ti r'". .. 4Cl. l.►�.�''�............... : .:. Installed By.......ti7x.,....f� s?.w f, ?:0. ........................_Lic.No.......,.............:............................. ! ! rt -flic(:audition,,I'iAN)win�,;.ovemed the issuance of tltis c e:t7jfieate,and+uty+:crtifieaCC previously issuctl is ;Y+•;;,-; This certitic:k ;',rtv ccrvraF, tP,c ciccuicNl equipment and instajlnuun conditions :is +>1'dote. Upon the t'•. introduction of ar:Ijci.;ioj c+ui)Item or ulteralimis.a m)►icarion shalt be pro ifl madc for inspection. :•:� :*i•`,:`; Inspectors oi' OIL, t.bmpaav ahall have the priviloge of maki+ig inspections at +tny time. and if its +y rules are Violfuc;l. l'!te•(:amp-,'my.hell have the rigl+t•to r kc this certificate, . . Date.... .< .............. ..--.... . ....,,............... ..... ........... : Member NAPA.,I.A.r:.l. 90 39bd O-iSWfIW NOd V8ST8GL 96:LT IZOZ/61/ei