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POOL-0481-2022 � - — SWIMMING POOL l3frice Use OnIV PERMIT P:518-761-82S6 www.gueensbury.net AUG 0 1 2822- F_I o Zone? Y 6//Reviewed By: TOWN OF OUEENSDURY Project Location: CA21 Proposed Install Date: /2 -Z_ SWIMMING POOL WFORMATION(pfease fift out TYPE: CHOOSE ONE: ABOVE GROUND UNHEATED ^� U��Jy0QNno. partially), �� HEATED heater, ��22 ^� ' - ''' �� `-- —` -` COST OF CONSTRUCTION SI-ZEOF POOL: / MANUFACTURER: Cln cia,,il Tz2k-sll MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APP[Y): Steel/Vinyl' Fiberglass GUnife Poured Concrete Othar______ | acknowledge no construction activities shall be commenced prior to issuance of valid permit. I certify that the application, plans and supporting materials are a true and complete statement/description of the work proposed,[ that a|[xvork xxUl'be performed-in accordance with the�NYS Budding Codes, [oca[buDding laws and ordinances and in conformance with local zoning regulations. | acknowledge that | have read the application and plot plan requirements and |, or my agents, will obtain a certificate of compliance before use of the pool. l have read and agree to the above: PRINT NAME: 6|GNATURE: DATE: i CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: ILc Name(s): Mailing Address, C/ /Z: ino ©t eL 2s2✓ s Cell Phone: ( � i2 ) 3`�7�— ,�. �� Land Line: �_) Email: �n A i I L -� G Vy'yl • Primary Owner(s): Names?: -,-J0 .2lx_ 2 ' Mailing Address, C/S/Z: n f17-1 CeII Phone:_(=bL Land Line: _( } Email: m k A ❑ Check if all work will be performed by property owner only Installer/Contractor: (List all adc4tional contractors on the back of this form) Contact Name(s): V cu�. _ Contractor Trade: J ,1 4J Mailing -�Address, C/S/Z: . C -G- Cell Phone:_(J I } `I °`j r l�Q O Land ne: _( ) Email: 5 61 n« "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: Cell Phone: •7 4C7 _ 17 27 z:;� Land Line: Email: Swimming Pool Packet Revised July 2022 ---------- rbvvN!0F blUE� ---BUlLDNG-DEPA our limited examination,n io co lianc B�sedbn comments shall-not-be ons jed;V: -----with our com, n MG "lans and ecifications� e t. indicating th p lance. full c6i� -Wflth,-the Building-Code -p New Yor TC)L :. R I? U Cl'p • D i�11,G Cow E SBU S p &C E ReViekNI(, V el .6 1.0 _A)" - - - = = - !E ---- ---- ------ ---- -- L J-- V, ei ;7. A II — _j ir 1W W 0 to U) -4 G) CD 0 0 0 0 Q_ _4. 3 CD M U) ATTENXI E OWN E m 0 F" `._. . =3 O.U-:ar P assure._. e1;aMlllar_WlthAh .,--'P' 3. CD Enclosure re uireryients spilcific t6yo q You are required to meet all apollcabl codes 4- o rding-sWm6n� PO It I ibb',' Me 01"W, t 0 0 pect on. r 6 00 II i R lia _t led e in �sd s _,q- - ---------- F S go I I "Sep, 7. 2022112: 574=01A No. 0086 P. 4/6 MIDDLE DEPARTMENT INSPECTION .AGENCY, INC. r• ce-kt 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 Jody Brann Date: 08/29/2022 Occupant: Pool Location• 63 Wincoma Lane OccupancySwimming Pool Queensbury,Warren Co_ NY Applicant� � • GBM Electrical Attn:Matthew Wing 22 Fox Hollow Ln, :`. .:.. Queensbury NY 12864 ; ZZ Joseph A.Holmes No. 147929171951.EL . Equipment. e 1 -Switch, I -GFCI Receptacle,2-Fb ttres;1 ='Pump- 1•"='50 Amp Heat-Pump; 1 -100 Amp Pool Control Panel 1 1 'V E <� SEP 0 8 2022 .. j TOWN OF QUEENSBURY BUILDING& CODES i his certificate applies to the electrical wiling to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and U above and the installation inspected as of the above noted date based on 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,eftl- of the property indicated above)this corttficate shall be immediately null and void. 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, <� be valid for a period of one year from the above noted date. Should the electrical this certificate may be revalidated upon reinspection by Wriddle Department system to which this certificate applies be altered in any way,including but not limit- Inspection Agency.Inc. An application for inspection must be submitted to Middle ed to,the introduction of additional electricei equipment and/or the replacement of Department Inspection Agency. Inc.to Initiate the inspection and revalidation any of the components installed as of tthe above noted date,this cartifrcate shall be process. A fee will be charged for this service. � I