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CERTIFICATE OF `COMPLIA.NCE
TOWN OF +QUEENSSURY
WARREN COUNTY, NEW YORK
Date ] obr�r 7 f} 39 _$9
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This is to certify that work requested to be done as shown by Pcrmit No.
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has been completed.
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` This structure may be occupied as a Above-Gr2Mndt Pool
}orsv 45� Wpgzt Hnunfa n iRn td --- -
Locaeion .._. - --
Owner Joseph Santa Lucia
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1 By Order Town Board
TOWN OF QUEENSBURY
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f Director of Bldg. & Code Enforcement
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BUILDING PERMIT x
TOWN OF QUEENSBURY
No. 89-384
WARREN COUNTY, NEW YORK co
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PERMISSION is hereby granted to Jocsanh Santa 1 sicia
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OWNER of property located at BOX 17P egt Mountain RYNKM Road Street. Road or Ave.
in the Town of Queensbury, To Construct or place a Aboyt%�Crotind Pool
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is r
Same �
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2. CONTRACTOR or BUl LDE R S Name
SX Aqua Falls
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3. CONTRACTOR or BUILDER 'S Address
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R*1 *K R STAXI Route 9
ZAMMKX Snuth Glens Falls . J . 12M3
4. ARCHITECT'S Name
5. ARCHITECT'S Address
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6_ TYPE of Construction — IPlesse indicate by xl
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i ) wood Frame 1 1 Masonry I 1 Steel ( ) �-
7. PLANS and Specifications
No_ 27 ' x 4 ' above ground pool as per plot plan and aipplication .
B. Proposed Use
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Above-Ground Pool
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$ 2500 PERMIT FEE PAID — THIS PERMIT EXPIRES January 1 i9 90
Rif a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
CK
not
Dated at the Town of Queensbur D y of June 1989 rr
SIGNED BY for the Town of Queensbury r� C
Building and Zon1ng Inspector C
olwre o uet�i� sfiu ,r-ear 11+
BUNGING ana ZONING DEPARTMENT
Bay and IHavilanQ Road. R, 0, 1 Box 98 / --,—
Queensbury, New York 12801 �` � 1 / — �, 3 6'�Q 09.j46
�
SWIMMING POOL PERMIT APPLICATION 00
'0:is` 65, �
F E E Fri JAL D7
Owner ' s Name��rp/j � J.�] .✓/�'fq�yC-/ �4 Te � . �� t5"2 � �
Location �/f- S��rX s 2 2v5�v. f w- ,�✓ ' / 2 ��i! � /`YsT r-rI'G3
Typo of Pool - - in -ground k`o� above - ,around
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Si Me : Lenrath Z. ft . - idth _,ft . - Diameter.. ft . - Depth _ft . $ ra / y
Approximate crater capacity d4d> 0 , 00�4alZons .
Materials used in construction : ( circle one )
Steel /vinyl - - FibregZass - - Gunite - - Poured Concrete - - Other
�?v9 ✓� t3i4. P.+�'S
Contractor/InstolZer �� t.�t, r�i4LCs C+4 _Tel 79 ce- Z. 7
Address - /'CJ R
IMPORTANT INSTRUCTIONS :
On a separate piece of paper , submit a diagram ; drawn to show ;
PROPERTY LINES - EXISTING STRUCTURES - LOCATION OF PROPOSED
SWIMMING POOL - Show all distances from lot lines to both the
pool and the structures , as well as separations between .
Application for Electrical Inspection is necessary . A copy of the
application is to be filed with this office .
This office is to be notified upon completion of construction ;
including installation of fencing . A FINAL INSPECTION WILL BE
MADE BEFORE USE OF THE 'POOL IS AUTHORIZED "
Signature of Applicant Date
02/ 86 and - vl
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Section 7 . 074 Accesoogftr Structured and Ueea
4 . Private Swimming Poole . Private swimming poolsp permanent and
portablev which shall be accessory to u principal , non-commercial
dwelling use shall be regulated as follows ; except that these
regulations shall not apply to portable swimming pools which shall be
not more than three ( 3 ) feet in height nor more than fifteen ( .1 � )
feet in length .
a ) May be erected only on the aamc lot as she principal structure .
b ) May be erected only in the rear yard of such structure and shall
be of a distance not less than twenty ( 20 ) feet from the rear lot
lines or buffer zone where appropriate nor less than ten ( 10 )
feet from the side lot line , or buffer zone where appropriate
principal structure or attached or detached accessory structure .
c ) Such use shall not adversely affect the character of the
neighborhood .
d ) All private swimming pools shall be enclosed by a permanent fence
of durable material at least for ( 4 ) feet in height .
e ) In the case where a lot fronts on two ( 2 ) or more public rights-
or-way , a private swimming pool shall be erected only on that
portion of the said lot that is directly adjacent to that side of
the • principal building which is directly opposite the archi -
tectural main entrance of said building and the neighboring side
lot line . In no case shall the pool be any nearer to the lot
lines abutting any public right-of-way than the required front
setback for the principal building of the zoning district in
which it is located .
Furthermore , the pool shall be screened from the view or the
public right-of-way and the neighboring property by means of
landscaping . ( See "Landscaping" )
$ 25 . 00 Fee for Above Ground Swirnming Pool
$ 35 .00 Fee for In-Ground Swimming Pool
NOTE: ALL POOL PERMIT APPLICATIONS MUST STATE MATERIAL TO BE
USED.
WORKERS COMPENSATION AND CNA Insurance C
EMPLOYERS LIABILITY INSURANCE POLICY I CNA PI[aza
INFORMATION PAGE f[ f'Ior .ill the {"eprn IIH reu•,sts kiw %14tkt- Chkca9c, n4lnors 60685
"JS✓_VRANCE IS PROVIDED BY THE COMPANY DESIGNATED BELOW
Item •tack Rlsurance company. hefean callod the company)
f . Producer No. Branch Prefix Policy Number ❑ Continental Casualty Company
075151 1 WC 50 357 50 52 ❑ National Fire insurance Company of Hartford
THE INSURED B MAILING ADDRESS: !Number 4 Street, Town, County, B State, Zip Code ^�
David Barnes 'DBA Aqua Falls Pools & Spas ,f American Casualty Company of Reading, Pa.
Box 4 . Sara r oga Rd . Transportation Insurance Company
Gansevoorr , N . Ya 12833 Transcontinental Insurance Company
OTHER WORKPLACES NOT SHOWN ABOVE 0 Valley Forge Insurance Company
as ❑ Individual ❑ Partnership L7 Corporation IOTHERI NCCI CODE NO . 12408
2. Policy Period: 12 01 A M. STANDARD TIME
AT THE INSURED TO: 2 . 1 -20 MAILING ADORE
INTERSTATE (DENT. NO 010
3. A, W[Irkers Compensation Insurance: Part One of the policy applies to the workers Compensation Law of the states listed here-
New York
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our 5-ability under Part Two are:
Bodily Injury by Accident S 100 ► 000 - Each Accident
Bodily Injury by Disease S 500 t o0o • Policy Limit
B� lily Injury by Disease $- 100 . 000 - Each Employee
C. Other States Jnsur Part Three of the policy applies to the states, if any, Ilsted here'
8. This Policy Includes these endorsements antl schedules:
1. The Premium for this poJicy will be determined by our Manuals of Rules, Classification, Rates and Rating Plans. All information required below is subject
to verification and change by audit.
Esllinatedl RATE PREMIUM BASIS .._4
Annual Per $100 of Total Estimated `H'r CLASSIFICATIONS
Premiums RamYn/ration Annual Reawneratloe
P/ R 1 . 085
S / R i . 076
37 8810 Clerical Office Employees N . 0. C. (if not specifically
$142 Salespersons, Collectors or Messengers — Outside included above.) —
7380 Drivers, Chauffeurs and their Helpers N. 0- C. — Commercial _
Total Premium subject to the experience modification
Premium adjusted by application of experience modification
SI Premium Discount Credit — Endorsement Attached
12 $ NA Loss Constant S 129 - S/ R Expense Constant
S Less and Expense Constant
S 166 . Total Estimated Annual Premium S 143 S / R Minimum Premium
Deposit Premium. If indicated, interim adjustments of premium shall be made: ❑ Semi-Annually; ❑ Quarterly: ❑ Monthly.
IN WITNESS WHEREOF, The Company designated on this declarations page has executed and attested these presents; but this policy shall nn2 be valid unless countersigned
by ilia duly authorized agent of this Company at the agency herelnbefore mentioned.
14, �j
Caryw,u� span a+ ar ea.ra ,rf./jy/¢,�����
Countersignature Date !Y 7 Countersigned by
Authorized Agent
aa-o -
uasl
Mern6er IV,F.RA. A I.A.F.I. .i....— ` fec trtcaf Certificate
e
NY ATLANTIC = INLAND, INC.
Electrical and Fre Inspection-Enforcing A Consultin Service -•_ �, -•--•
997 McLean Road, Cortland, NY 13045 DATE: CERTIFICATE NO.:
07 Lope -;antc"1 Lur' -I , AS APPROVED FOR:
OWNER:
ADDRESS: �,__,-,- :�s_ � = =�r•_
ELECTRICIAN:
z .1- Pri l i N y 1 rr�s lct
ADDRESS:
The Conditions following governed the issuance of this ceddgcate, and any Cantlicate previously issu+
is cancelled:
This 4anilicate only 44yvere rho elOctriGal equipment listed and installation conditions as of date_ Up
the introduction of addibanal equipment or alterations, application shall be promptly made 14r mspectior
COPY I kBlajs , t o7 this Company shall have the P'riFeV(* of malting inspections at ant time. and it its rut
are instated, the Company Shell have the right to ri" this iung i ate-
AI - 27
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
HAY & HAVILAND ROADS
326(35E
QUEENSBURY, NEW 79 128
TELEPHONE ( 528 )
832
BUILDING INSPECTOR' S REPORT
REQUEST FO INSPECTION RECEIVED
NAME
LOCATIO r�
D PERMIT
ATE
APPROVED
YES NO
FO03ING/PIERS
MONOLITHIC POUR FORMS
FOUNDATIONIDAMP-PROOFING
,BACK-ILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION:
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION :
CHIMNEY HEIGHT
ROOFING
SILTING
EXTERNAL PORCHES/STEP
STAIRs-CLEARANCE & RAMS
PLUMBING FIXTURES/RELIEF. VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS.
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
:....
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
J
A SIGNE CERTIFICATE OF OCCUPANCY MUST BE
D
OBTAINED FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIEDI
REMARKS :
IASPECTOZR
MAIN OFFICE ATLANTIC-INLAND, INC.
997 McLean Rd. NEW YORK
Cortland, New York 13045 MEMBER OF N F.P A AND I A E I
Phone- (607) 753-7118 FIRE UNDERWRITERS
(607) 753-7809
(607) 753-1396 (Electrical and Fire Inspection-Enforcing and Consulting Service) 56713
396 (Incorporated in the State of New YOrk)
Desiring Certificate at Approval. application is made tot inspection of electrical installation in the premises described below. On demand applicant agrees to pay for
inspection service in accord with schedule of Charges.
APPLICATION FOR ELECTRFCAL INSPECTION — PLEASE PRINT OR TYPEc�e
THIS SECTION TO BE COMPLETED BY APPLICANT DATE OF APPLICATION
CITY, TOWN. VILLAGE -" 'COUNTY STATE
STREET
ADDRESS .S G' ? �--- - $UILDG. NO
RURAL
DIRECTIONS POLE NO.
OWNER'S -tr ,,.•
NAME "�;y' ✓ r/f+'� L/4' ,011i OCCUPIED AS r-., te
OCCUPANT BUILDING — Maw ❑ Old ❑ WORK — Hew ❑ Additional 0 ---
OWNER'S P.O.
ADDRESS
APP. FOR — ROUGH WIRING ❑ FIXTURES ❑ OR READY FOR INSPECTION 1g
FEE REMITTED — $ BY CHECK ❑ CASH ❑ MONEY ORDER ❑ MAKE PAYABLE TO ATLANTIC-INLAND, INC — NEW YCRK
Number of Rough YWnng Outlets Fixtures Add Installation
Swtch Lung Racep. KW Mao, Mogul Fluor. 500 1 750 1000 1250 laott 1750 2000 2250 2500 2750 30M
Heat Base Bssa
Elect. Heat
Amp, Service Water "Ir. Burner Air Corid,
Surface Unit Oven Range Gr Disp. Oish W.
Dryer M.P. Pump EA. Fan Hood
OTHER EQUIPMENT (SPeaify Type a Capacities)
TYPE OF SIZE OF sue- BRANCHES NO, OF
WIRING PG,5rO N LED ❑ OTHER MAIN MAIN CIRCUITS
APPLICANT'S
SIGNATURE LICENSE a PERMIT N
APPLICANT'S NAME OF
ADDRESS UTILITY
OFFICE TO
CITY STATE ZIP CODE BE NOTIFIED
SPACEi FOR USE OF • •
ROUGH WIRING AMP SERVICE K.W. SURFACE
OUTLETS EQUIPMENT UNIT
SWITCHES AMP SERVICE K.W- OVEN
CONDUCTORS
H.P.GARSAGE
RECEPTACLES H.P_ PUMP DISPOSAL UNIT
MEDIUM BASE K.W.
FIXTURES K.W. DRYER DISHWASHeR
MOGUL BASE K.W. WATER
FIXTURES HEATER KW, RANGE
FLUORESCENT H.P. AIR AMP, RECEPTACLES
FIXTURES CONDITIONER
MERCURY VAPOR OR WIRING A CONTROLS FOR BURNER SMOKE FRAC. H.P
QUARTZ FIXTURES DETECTORS VENT FAN$
MOTORS, H.P. 1120 1Y12 1rlO 1fB iY6 tI4 t13 1/2 3/4 1 s+ 2 3 5 f'h 70 i5 20 25 30 40 50 75 100
MARK NUMBER
OF EACH 'SIZE
50U 756 x000 1250 Ism 1750 2000 j 2250 2500 2750 3000
APPARATUS EIacS. Heat
M+SC- INFO. Received InaPacted FEE PAID
❑ PROGRESS TOTALS
4.za �,p /C/PLEL`if,f Il DEFECTIVE
'!! �y A' ❑ Rough Wiring Gemficate Check No-
a. 1>. rF 2, 131T5L 60
/?
� ❑ Temporary Service Manny Order
og24?g'A1tUlt'.hY', / r. L�. .{.�. ..5•i� El FINAL CERTIFICATE
Cash
Mon.- Fri. 6-7 : 30A. M: ❑ Cup. Cart, Rea.
518-692-9295 ❑ MUNICIPAL charge
518-638-6339
MUN. ADDRESS
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