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TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130263 Application Number: A20130263
Tax Map No: 523400-315-010-0001-011-000-0000
Permission is hereby granted to: DANIEL R GIBBS
For property located at: 28 QUINCY Ln
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Twe of Construction Value
Owner Address: DANIEL R GIBBS Inground Pool
THERESA D GIBBS Total Value
28 QUINCY Ln
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
BOB BAKER
SOUTH GLENS FALLS.NY 12803-0000
Plans&Specifications
2013-263
POOL In-ground 22'x 34'
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 19,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town f Quee bury �e s y June 19,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Office use OnlyA
Town of Queensbury Building & Codes ;; y
Rec ehW:
SWIMMING POOL PERMIT APPLICATION Tax Map ID: 3 ' 3
A permit must be obtained before beginning construction Permit No.: 4 3 / caro Z)-l-I 1
Permit Fee: $ v
ff Site PlanNarian a No.:
1. Date: (0
2. Tax Map ID:
3. Pool Location Address: C) V i V1 C. cA
4. Zoning Classification:
5. Site Plan Review,Variance or Subdivision Approvals(list)
6. Property owner t�A n�'-ft)e C S CA 6( 6b_S Phone: 90 -02-N
Mailing Address: 25 Go 6rM L ri .
City: GQUnSbun/ , NS (165
7. Contractor's Name: 0,-Ker tS Phone:
Mailing Address:
City:
;� / f �
8. Contact Person for Building&Code Compliance: �,/��r1 1 e- � L.7 � -� 71(3 Phone Y
ABOVE-GROUND OR INGROUND? InQnouncl
SIZE OF POOL: 11), X 3 LI
MANUFACTURER: zm !_ -d POO 15
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 NY State Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. I
acknowledge that I have read the application&plot plan requirements and I or my agents will obtain a certificate of occupancy before use
of the pool.
Signature: n Date
Na e/ i e
Town of Queensbury Building&Codes Swimming Pool Permit 518-761-8256
Pool Inspection
Queensbury Building &Code Enforcement
Office No. (518) 761-8256
742 Bay Road, Queensbury, NY 12804
Date received:
NAME: LTJ .�
LOCATION:
PERMIT#: 1 �3-
INSPECTED ON: am/pm
Arrive: a /pm Depart:
am/pm
pector's Initials:
Above Ground: In-Ground:
Y o, N NA
Pool enclosure around
pool or yard
4 feet above grade
2 inch maximum
clearance to grade from
underside of fence
4 inch maximum
clearance in fence
pickets 01
Wall or Doors have self
closing device or alarms
30 second Alarm time) 1001
Pool Surface Motion
Alarm
Ladder secured in place
and latched
Deck gate <56" to latch
no more than '/z" spacing
in gate openings
Gate opens outward, self
closing
Padlock provided on
gates or ladder
Indoor pool all doors self
closing or alarmed per
AG 105.2 Item 9
Timer on pool pump (no
plug in timer allowed
Final electrical
Vehicle access gate
closed &locked
Ok to issue C/C
COMMENTS:
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I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPERTY EINES TO THE
P 0 0 TR, TURES)OR SIGN(S)
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