POOL-0214-2023 SWIMMING POOL office Use only
PERMIT APPLICATION Permit#: t"' ti2k4- 2026
Town of Qeensbury
742 Bay Road,Queensbury,NY 12804 Permit Fee:$ ;Invoice#: 0�5
P:518-761-8256 www.gueensbury.net Flood Zone? • Reviewed By
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Project Location: 126 Burnt Hills Drive
Tax Map ID #: 308.12-1 -38 Subdivision Name: Burnt Ridge
Proposed Install Date: 5/22/2023
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SWIMMING POOL INFORMATION (please fill out completely): P��Y 0 TYPE: CHOOSE ONE: v�74 0 �J
URY
ABOVE-GROUND UNHEATED — BUILDING = CODES
X IN-GROUND (inc. partially) x HEATED (pool cover heater, R-12 req'd.)
COST OF CONSTRUCTION: $50,000
SIZE OF POOL: 16' X J' `p
MANUFACTURER: Imperial
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl X 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: Christopher Wheeler
SIGNATURE: DATE: 5/4/2023
Swimming Pool Packet Revised March 2023
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Christopher Wheeler_
Mailing Address, C/S/Z: 126 Burnt Hills Drive, Queensbury, NY 12804
Cell Phone: _)681-2677 Land Line:
Email:wheelercj74@yahoo.com
• Primary Owner(s):
Name(s): Christopher Wheeler
Mailing Address, C/S/Z: 126 Burnt Hills Drive, Queensbury, NY 12804
Cell Phone:_(518 " )681-2677 Land Line: _( )
Email:wheelercj74@yahoo.com
❑ 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): Spragues Mermaid Pools and Spas, Mike Brancati
Contractor Trade: Pool Sales and Installation
Mailing Address, C/S/Z: 300 Broadway, Fort Edward, NY 12828
Cell Phone:_(518 207-6258 Land Line: _(518 )747-9270
Email:spraguepools@outlook.com
**Workers' Comp documentation must be submitted with this application**
Contact Person for Compliance in regards to this project: Mike Brancati
Cell Phone: ( )518-307-6258 Land Line: _�)518-747-9270
Email:spraguepools@outlook.com
Swimming Pool Packet Revised March 2023
06/22/2023 11 : 03 From : 15182209014 MDIA Elec . Certs . - Latha Page : 2/2
f •that the electrical wiring to the electrical equipment listed below has been examined and is approved E5 .
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the dal:
noted below and is issued subject to the following conditions.
Owner: Chris Wheeler Date: 06/20/2023 ;
Occupant: Inground Pool Locatio%6 Burnt Hills Dr.
Queensbury,Warren Co. NY
OccupancySwimming Pool
Applicant- D a 3
GBM Electrical '
Attn:Matthew Wing l_
22 Fox Hollow Ln. J�N 2 Z j
Queensbury NY 12.804
L- TOWN OF�QUEENSBURY
BUILDING&.CODES
Ray Novak Jr.
No. 147929180b8.5EL... __. ��L. 6Z l -ZO
Equipment:
1 -Intermatic Panel; 1 -Timer, 1 - GFCI Outlet; 1 --Salt Chlorine Gen.erator;1 -20A'2'Pole GFCI Breaker; 1 I6A
GFCI Breaker foMeater; 1 -6.QA Double Pole Breaker; 1 -Pool Pump ,
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void, This certificate applies only to the use,occupancy ar,s ,
above and the installation inspected as-of the above noted date based dn.a.visdai ownership as indicated herein. Upon a change in the use,occupancy or ownershm
Inspection. No wartanty is expressed or�impliddas to the mechanical:satety,eifi- of the property Indicated.a¢ove,this certificate smi be immediately null and vole
ciency or fi•,ness of the equipment-for any parti s de
cular purpose..This'certificate.shall 1n the event that.thirtifidate,becomes invalld based upon the above condition!,
be valid for a period of one year from the'atiove.goted date. Should:the`eiectrical this certificate inay'be'revalidated'upon'reinspection by Middle Department
system to which this certificate applies be altered in ariy way,Including but riot*limh- Inspection Agency,.lno. An applidation for inspection must be submitted to Middy;
ed to,the Introduciion'of additibriaf electrical;e0ipirfdnt:and/or.the'replaceinem of Department Inspection Agency, tnc.to initiate the inspection and revalidatio^
any of the components-instalted as of the above:riotei?..date;this certificate shall be process. A fee will be chafged for this service.
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Open Space: 39