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POOL-0770-2021 / SWIMMING POOL office Use only Permit#: p GAL— -7 70 PERMIT APPLICATION y Toxin of Queensbury 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ .U�Invoice#: �f 31 Z- P:518-761-8256 www.gueensbury.net Flood Zone? Y ONReviewed Bye l Project Location: jdAl'/C.W':;0� Tax Map ID#: -Q-cr(p Subdivision Name: Proposed Install Date: / �— 2-0Z- EOF E SWIMMING POOL INFORMATION: CHOOSE ONE: _ABOVE-GROUND _&N-GROUNDOCT BURySIZE OF POOL: I X as- `S MANUFACTURER: �mNel* S MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl Fiberglass Gunite Poured Concrete Other ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans prior to or during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained. 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: SIGNATURE: DATE: f�' I V Swimming Pool Packet Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN. EMAIL • Applicant: �I Name(s): Mailing Address, C/S/Z: -wr e-woo D 6200�21 6,JM N 4 12koy Cell Phone: (.S)Fl ) 7yN - 1q.3r Land Line: 1 ) Email: A WOop.con • Primary Owner(s): Name(s): 'rttar !�'� C`o�uE3s LWv rs'�f s Mailing Address, C/S/Z: 3T /Uoc! Cell Phone:_( Sr) 7YY -./q39'- Land Line: _( ) Email: ` mcc t6s 99 ❑ Check if all work will be performed by property owner only • Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): IGNat-L �R�a�Rri S�pRACiiU5"S Contractor Trade: 'Pop T.s-r&L -4 Mailing Address, C/S/Z: ?Qa &!A? ► n�. �a� c,I �21� Za PrCA N`4 Cell Phone:_( S)Sr ) .�o� - IL la7 Land Line: _( .S"1 727 - 4 11° Email: 15p f -p r i�L� 0 we Lodz. Oom "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: . Cell Phone: ( '57j" 90'7 &Z S 8 Land Line: �)9- ) `/V9 Email: Swimming Pool Packet Revised December 2020 • Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): M*TTt+EW Waiei12ic- Contractor Trade: Rlgc-mi c.t Ln Mailing Address, C/S/Z: Cell Phone: _( SW ) &/S'— 1143/ Land Line: _( ) Email: **Workers' Comp documentation must be submitted with this application** • Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): . Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: **Workers' Comp documentation.must be submitted with this application**- • Installer/Builder: (List all additional contractors-on the back of this form) Contact Name(s): Contractor Trade: . Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: Email: **Workers' Comp documentation must be submitted with this application** Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: **Workers' Comp documentation must be submitted with this application** Swimming Pool Packet Revised December 2020 RX Date/Time 06/07a2022 10:44 15182731202 P,004 -'v 'Jun. 1. 2022 10: 16A MIA— No, 9451 P. 4/4 MIDDLE DEPARTNI.ENT INSPECTION AGENCY, INC. V_t14 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 effect on the date noted below and is issued subject to the following conditions. Owner: Terry Bowman Date: 06/01/2022 Occupant; Pool Location- 38 Twicwood Ln. Occupan%wlmming Pool Queensbury,Warren Co. NY Applicant r GBM Electrical Attn:Matthew Wing Fob 01f}Q .Zp21 22 Fox Hollow Ln. L Queensbury NY 12804 J Joseph A.Holmes No. ," 147929159369EL•_ _ _ Equipment: 1 -30 Amp Pool Panel W/Timer, 1 -GFCI Receptacle;2'-Fixtures;2'-Barrier,Wld g"&Controls; 1 -Pump ;E R !�! JUN .0 8' 2022 TOWN OF QUEENSBURY BUILDING&CODES This certificate applies io the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and above and the installation Inspected as of the above noted data based an a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership inspection, No warranty is expressed or Implied as to the mechanical safety,effi- of the property indicated above,this Certificate shall be immediately null and void, clency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certltcate becomes invalid based upon the above conditions. be valid for a period of one year from the above noted date. Should ire electrical this certificate may be revalidated upon reinspeetion by Middle Department system to which this certificate applies be altered In any way,including but not limit- Inspection Agency,Inc, An application far inspection must be submitted to Middle ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc.to initiate the inspection and revalidation any of the components installed as of the above noted date,this certificate shall be process_ A fee will be charged for this service. _! �I I I — _ 296.9-1-35 POOL-0770-2021 Terry Combs 38 Twicwood LaneM� LA _ Lie, L In-Ground Swimming Pool _ .L .o —I_ I I I06 AA l—l—I 1—i———L—► _ af o I— - III I I i I Cal _ TI OW — -'— !— !—� — i— 1 Ala r e I sure �►ot�_ar ! e-tamllia -with-t!heiP I I i ! I _ —= u� , 4 I t I--, I � Y •i. .LL — Y°U, anal—required tai meet)all I I I ( 1 _ BUILDING & C D S Q�S ' _ I I regards swi ' ig1.PF bled codes- ems, .! mmi I _ W _1`V y-— I "g ' hot tubs- - �at the tl of Inspects l -� -- -� � I -I- I � iii ► � ! I . I _ II I ! • I I � I , ! ! r.; :_I !---I-I - I - II � 1L.I-j- -.i. -- -.!����.�:�.-` - ► _ '-i�� -' - _!_l-1-� lam- -�- ---1 - - INNLQ A�_`' �1_'! LL LIL 1 1 J.