POOL-0244-2022 SWIMMING POOL office Use only
PERMIT APPLICATION Permit#: 202'L.
Town of Queensburyj
742 Bay Road,Queensbury,NY-12804 - . , Permit Fee:$. �' vo' a#: , ,
P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:
Project Location: « b i f_A�CA-(/ LL-c—
Tax Map ID#: Subdivision Name: __
Proposed Install Date:
MM
SWIMMING POOL INFORMATION: :_. TOv` 'or- � ®IDES Y
CHOOSE ONE: _ABOVE-GROUND /",-GROUND
UNHEATED ✓ HEATED (pool.cover heater, R-12 req'd)
SIZE OF POOL: .Xo
MANUFACTURER;
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl V 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 If, for anV"reason, the building permit application is withdrawn, 30%of the fee is retained by the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: 1
PRINT NAME: 14,01'vi tyA6%
SIGNATURE: ILLDATE:
-
Swimming Pool Packet Revised March 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z: iv -
Cell Phone: Sl4S ) 2yz- 3f 3°) Land Line:
Email: kev1,a Z1 PaCOL°I Ec�,M
• Primary Owneds):
Name(s): &cAVI Lo
Mailing Address, C/S/Z: QLx'-0e-gaV..LCV 28C
Cell Phone:_(51:tj ) 222- 3�3 Land Line: _( 1
Email i,,\ 2l eccil c�,M
❑ Check if all work will be performed by property owner only
• Installer Contractor: (List all additional contractors on the back of this form)
Contact Name(s): A�MM,'J Pole'(S. LL(,
Contractor Trade:
Mailing Address, C/S/Z: 3oc) I cx �-y ��e �- Fc."C /V Y l2�sZ
Cell Phone:—(____,_) Land Line:
Email: S
**Workers' Comp documentation must be submitted with this application**
Contact Person for Compliance in regards to this project: ev,n Lvrig .
Cell Phone: sv�; ) 2zz Land Line:
Email:
Swimming Pool Packet Revised March 2022
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296.5-1-15 POOL-0244-2022
Long, Kevin
15 Birdsall Rd
In ground heated pool 16' x 36
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1 I. 1 1 1 1 1 1 1 1 1 I. 1 It 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 , 1�11 I I I--
LO i\ � C
FROM A TO: FROM B TO: FROM Ci TO: FROM 0 TO:
D 39'-4 3/4" C 39-4 3/4" 8 39'-4 3/4" AE28'-73/4"
H 10'-9 1/4" H 26-3 3W4 H 15'-7 1/2" HJ 23' J 13' J28'-01/ JK 15'-7 1/2" K 28'-7 3/4" K 10'-914" KL 28'-01/4" L 20'-71/2" L 23' L
36'
A CF 8 8 8 8 4 B
CF
4'
8 H 8
40"
71 DEEP
16' DEEP 8' 39'-43"
4' 6' 13' 13' cusfowb'�
e K 8
CF L
C
S 5"S `
SKIMMER 8 8 4
CF-90°.CORNER FILLER(05216) `Z7/
5'SS-5"SIDE STAIR PANEL(04120) 8°R TOP 8'STEEL STAIR
SF—RECTANGLE STAIR FILLER(04206H/04207H) STEP s°R TOP
FILLER STEP
FILLER
3'4" 3'-4"
7'
L ............
4' 6' I 13' 13'
36'
O CONCRETE DECK COPING THIS POOL CONFORMS TO CURRENT CUSTOMER SIGNATURE REQUIRED GATE
EWT'TH
FILE NUMBER: 220329601 NON DIVING APSP/ANSI11CC-S2011 &ISPSC2021H 31S"O BOLTS RNUTSEA, E II STANDARDS FORRES16ENTIAL
PANEL END P@rlm@t@r: 104-0 PeH,Ir.crilW.cva.r..,+ann INOROUNDSWIMMIN('iPOOLS
&IXI'3[•0ANnAItUS
A-FRMIEBRACE PUILRI�IUI?N1'IAL ■ DEALER Surface Area : 576.00 SQ FT INGINUND • ImperialVINYLUNER PUOLS,THEINSTAI.L[R 15NAMESTEEL
RESPON$IBI.EFORBRACE HORIZONTAL Volume : 17,945„a�. PLACING POOLS+ CUSTOMER ---
A7 I M51mF:11 FOR EVERY NAME:
2'POOL BOO".R&I REI•URN 33 Wade Rd.Lalham,NY 12110 WARNN0:SWIM40NO POOLS CAN DC DANGEROUS WHCN USED IMPROPCRLY CONSULT YOUR DCALERFOR wr.TY
BOTTOM DRAwNIav: h sham FOR EVERY Al10 AR.a. + INFORMATION ON SAFE USE.RISTHE RESPONSIBILITY OF TOWN OFFlCIAlS.BUILOERHMND'RIE HOMEOWNERS TO FOLLOW
9 hn:518-786-1200 /fax:318-786.0954 ALL SAFETY RECOMMENDATIONS OF ANSIIAPSP,LOCAL ORDINANCES AND EQUIPMENT MANUFACTURERS.
OEX MO SMOG OF POOL MEET MINIMM ETANOARDS OF THE INTERNATIONAL MWMINO POOLMb SPA CODE 0001 FOR INAROUND BVAMMNG TOM,A MEANS ENTENS IT FOR EOM THE DEEP FND AND THE SHALLOWENO OF THE POOL MUST M PROVIDED IN ACCORDANCE WIN THE 0021 INTERNATIONA.EWiML0N0 POOL ANO SPA
comucTION800.EGUIRGTENTIAL DONDINOMUSTOE PROVIDEDINACCOROANCE WRH THE NATIONAL ELECTRICAL COOS NFPA 70.ALLA FRAME SPACES ARE TO BE MOUNDEDVAM MINIMUM S INCH DEEPPOURED EAW P.S.I,COMMETECOLLM MOUND SNIPE PCRNETEROFPOM NOOMING LADELS APE 100E INSTALLFOARMNO
—z-e-OVERDIGJ T,MPERINETER OF POOL AS REOUIRM.SU*7100 EIRMPMENTAVOIDANCE ID TO OB NSTALED NACCOROANCE WITHANSVAPOPAMT,ALL W MUM SPECIFICALLY S110'MI 13 TOOE DONE W ACCORDACC WITH INC REOUIREMENTD OFTHE 2021 INTERWTIONN0MA9ANO FOOLMOU ACOOCAVtl ALI.ONICRN 4CAOLC C000O.
FROM A TO: FROM B TO: FROM Ci TO: FROM D TO: BILL OF MATERIALS
D 39-4 3/4" C 39'-4 3/4" B 39`4 3/4" A 39 4 3/4" QUANTITY NAME UNIVERSAL LEGACY ONLY
H 10'-9 1/4" H 26-3 3/4" H 15'-7 112" H 28-7 3/4" 2 4'PLAIN PANEL 04110 04110
J 23' J 13' J 28'-01/4" J 20'-71/2" 1 6"SIDE STAIR PANEL 04120 04120
n 2 S"RADIUS TOP STEP CORNER 04888 04888
K 1T-71/2" K 28-73/4" K 10-91/4" K 26'-33/4 FILLER
L 28'-0 1/4" L 20'-7 1/2" L 23' L 13 11 8'PLAIN PANEL 05102 04101
36' 1 B'STEEL STAIR COMPLETE W/BEAD 04186B 04188E
8 HARDWARE
1 90'RECT.STAIR FILLER LIR-Wl 0420SH/04207H 04206H/04207H
FLATHEAD HARDWARE
A CF 8 8 8 8 4 B 3 90'SPECIAL ANGLE RECT.FILLER 05216 05216
J CF 9 A•FRAME VARIES VARIES
5'-8" 4'
8 H 8
4011
71 DEEP
16' DEEP 81 39,-44„
4' 6' 13' 13'
8 K 8
4'
CF L
C SF 5"SS
8'-1085 8 8 4
SKIMMER
CF--90"CORNER FILLER(06216) 57
5"SS-5"SIDE STAIR PANEL(04120) WR TOP 8'STEEL STAIR
SF-RECTANGLE STAIR FILLER(04206H J 04207H) STEP WR TOP
FILLER STEP
FILLER
0 75 PACK HEX BOLT AND WASHER PAK75 PAK75
Ittttttltttttltttitt OR a 111I1111;4IMM
3,�n 3'4- 0 100 PACK HEX BOLT AND WASHER PAK100 PAKI00
1)ITEMS MARKED WITH AN ASTERIX I-)ARE NOT NORMALLY STOCKED IN
BRANCHES-PLEASE CHECK STOCK BEFORE ORDERING,2)CODE NUMBERS
7' 0410058,0410025,04100F,0410OR AND SPCL DENOTE A SPECIAL ITEM-PLEASE
3'-8" CHECK WITH YOUR LOCAL BRANCH FOR LEAD TIME,AVAILABILITY AND PRICING.3)
ALL SARATOGA STEP CODES ARE THE BASIC,WHITE VERSIONS-PLEASE CHECK
WITH YOUR BRANCH FOR OTHER VERSIONS.4)HARDWARE ESTIMATE DOES NOT
INCLUDE HARDWARE TO CONSTRUCT SPECIALS-PLEASE CONTACT CORPORATE
SERVICES FOR REQUIRED ADDITIONAL HARDWARE INFORMATION.
4'—1 6' -1 13' 13'
36'
4'CONCRETE DECK COPING T141S POOL CONFORMS TO CURRENT CUSTOMER SIGNATURE REQUIRED DATE
YT. FILE NUMBER: 220329601 NON DIVING APSPIANSIIICC--52011 &ISPSC2021 I
BACKFIUWITH 318*0 BOLTS --- �- STANDARDS FOR RESIDENTIAL
CLEAN EARTH a NUTS EA. I
PANELEND. Perimeter: 104-0 FBR 'sn sn�ar .r,nl/ INGROUND SWIMMINO POOLS
B"MINIMUM & 8/t' 1�: S'1"ANUAItoS
CONCRETE A.FRAMEBRACE I'OR tISIDI!NT•IAL ■ DEALER __
COLLAR Surface Area : 576.00 SQ FT INUROUNnSWIMMING • Imperial
-
(2500psi) VINYL LINER FOOTS.THR INSTAIJXR IS NAME: STEEL
• HORIZONTAL RESPONSIBLE FOR CUSTOMER
srAKE BRACE Volume : 17,945 al. PLACING POOLS NAME: ""'
9 J�IMNINR FOR EVERY.
2"POOL BUR' 6,1_e_F,TuaN 33 Wada Rd.Latham.NY 12110 WARNING:OW1MAtlNO POOLS CANOEDANGEROUSWHENUSEOIMPROPERLYCONBULT YOUR DEALER FOR SAFETY
BOTTOM DRAWN BY: h raham FOR EVERY JY D e4.nA INFORMATION ONSAFEUSE.RIS THE RESPONSIBERY OF TOWN OFFICALS.BUILDERS AND THE HOMEOWNERS TO FOLLOW
g hn:519-786.1200 /fax:518-786-0954 ALLSAFITY RECOMMENDATIONS OF ANSYAPSP.LOCAL ORDINANCES AND EOUIPMENT MANUFACTURERS.
CRPfMANRBMAPp OCPOOI.MFPTMWILWM9TANOAMBOF TNN PlTRRNATNNNN 6WIMMING P0.01 ANRSPACOCK 2021 FOR INARWNDSEAMNCPOOLS AMEWS F.HTRY/FRITFOR--F4EFP INC AND THE SNA:1OWFND OFTHF vDOI.IAU6T flRVROVICFI1 I...CO...WI..R001INIFRNATIONM,SWTMIANG PCO'Mr SPA
COOS SECTION 000.EOUIPOTENIIALSONDING MUSTOEPROVIDSO N ACCORDANCHWITII THE NATIONAL ELECTRICAL CODE NIPA 70.ALLA•FRAMS DRACESARE TO SSMOUNDED WITH MINIMUM O INCH OREPPOURED 2W RDA.CONCRETE COLLAAAROUNO RNNRR PERIMETER OF POOL NO DIVING LABELS ARE TO DE INSTALLED AROUND
LAY-B'OVERDIGJ THE PENMETTAOf POOL ASRCOVAM,OUORONC"I"APMCNl AvommCC ISTO CCWMXLC004 A000RON4C WrrH ANOUMOPACGT.ALLWOM NOT OPCCO'ICALW SHOWN 10 TO BC OONCIN ACCOAOANCC WRN IRCRCOUIRCMCNIO OR THC 2021 MTCRNATONALLOWIMMINO POOLAND SPA CODCANOALL OTHCRAPPLICAOLC COCCO.
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No.ULV-..�...... .....Cert.N Q 50066 Cut-in Card No...................................
Owner...................... }Y!-.......4:d.-.�...................................................................................................
Location...................i�.........I'�.r{.��S.FFl.�...Z2:f............................��.C�:'1�..�.4.!�:/.................
Installation Consisting of./.-.1...G cure, ...... .................................
W1,z i✓7 c- c .bG.!7....5 !n:..�.....................................................................
... .. .................
..................................................................................................................................................................................
InstalledBy...............S.f5� .ve......................................................Lic.No.................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued i
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon thi
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making inspections at any time, and if it
rules are violated,the Company shall have the right to revoke this certificate.
Date.............,.-2..(Q.:..2.. .... INSPECTOR......... .................
M—h-N_RP.A._LA_F._I_