POOL-0331-2023 f SWIMMING POOL Office Use Only
PERMIT APPLICATION Permit#:_�(
Town of Queensbury Q zV
742 Bay Road,Queensbury,NY 12804r.Permit Fee:$ l U . Invoice#:
P:518-761-8256 www.gueensbury.net D I ne? �,�1 1 Reviewed B
JUN 1 s 2023
Project Location: SSQ
7 BUI DING $CODEgRY
Tax Map ID #: 7��� =C2 � u Ne e: -ftGYM �-
Proposed Install Date:
SWIMMING-POOL INFORMATION (please fill out completely):
TYPE: CHOOSE ONE:
ZABOVE-GROUND ✓ UNHEATED
IN-GROUND (inc. partially) _HEATED (pool cover heater, R-12 req'd.)
COST OF CONSTRUCTION:=JET-
SIZE OF POOL:
I
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl 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:
SIGNATURE: DATE: /3 )
Swimming Pool Packet Revised March 2023
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: -
Name(s):
Mailing Address, C/S/Z:- -DC�> „ y
,
Cell Phone: ( 51,4, ) —JLIy—SS9(!)CJ Land Line:.__)
Email:!
• Primary Owners :
Name(s):
Mailing Address, C/S/Z: :f2 S OJOCWJ2
Cell Phone: _( ) - Land Line:._(
Email:
ACheck if all workwill be performed by property owner only
• Installer/Contractor: (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"
Contact Person for Compliance in regards to this project:
Cell Phone: _�) Land Line: � )
Email: ----
Swimming Pool Packet Revised March 2023
0ZE
V)I N
m o=
�+ l
mro
�0
o;
rn
ESSEX COURT
OWN OF
L=s U G
R=4 .00
' e ed yo
ti
Da e:1
w c.0 `n
`Rd�®�o,� f p I u,L tL CD
Of
ui
--
I PORCH
u 0
LLa N
m M0N0
tli`1?'j�ti
/•-g&
41
TOWN OF QUEENSBURY
v i BUILDING DEPARTMENT
� Based on our limited examination,compiia ce
with our comments shall not be construe as
indicating the plans Epd specifications ar in
full compliance wig4he Building Codes of
,New York State.
co
tAO� DO NO I O V
n
c �^
z
1 �w
f oCO
�o uuu
I C Z `.
} Zo z' Cs�
0
! "M c.- a
I ;�•�m
J
a�i
} 00
} : C
ATTENTION HO OWNER
Please assure you are familiars g.76,
Enclosure requirements specific to yo6°
You are required to meet all applicable as 49•70'
regarding swimming pools, spas & hot s ses°25�12"W
at the time of inspection.
� 308.19-2-13
POOL-0331-2023
Jeffrey &Vanessa Ives
23 Essex Court
ol
� Above Ground Po
COMMONWEALTH ELECTRICAL INSPECTION
SERVICE,INC.DUPLICATE CERTIFICATE
For Municipal Confirmation Only
TYPE OF INSPECTION...................................................
Permit No. Cut-in d No.. N 11 061
.... .................................... �..........................
Owner............ ....!/Jr./U.Pr��..�..gt......... 11.e.�.... ..............................
. .. ...........
Location..1. .....�:..�.�'.;s..s�..1........... ..Rr..t........ �r�lC e�./s// ./Q ...................
InstallationConsisting of...................................................................................................................................
...............�� .. .......................................................................... ...�.,�.14....�..................
Installed B .........................Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipAaninstallationlation conditions as of date. Upon the
introduction of additional equipment or alterations, l be promptly made inspection.Inspectors of this Company shall have the priinspections at a ie andiits
rulesa olated, the Com any shall have the rightertificate:
Date... ..........:.z...A. ......... INSPECTOR....
... .. . . ... ...........
embe A., .A E.1.