2004-307 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040307 Date Issued: Tuesday, June 21; 2005
This is to certify that work requested to be done as shown by Permit Number P20040307
has been completed.
Tax Map Number: 523400-308-008-0001-053-000-0000
Location: 11 BURNT HILLS Dr
Owner: RUSSELL & DARLENE PALMER
Applicant: RUSSELL & DARLENE PALMER
This structure may be occupied as a:
Above Ground Pool
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Bu mg&Code Enfor ment
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040307 Application Number: A20040307
Tax Map No: 523400-308-008-0001-053-000-0000
Permission is hereby granted to: RUSSELL AND DARLE N PALMER
For property located at: 11 BURNT HILLS Dr
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. T3Te of Construction Value
Owner Address: BURNT HILLS LLC
15 F BIRDIE Dr Above Ground Pool
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2004-307 RUSSELL AND DARLENE PALMER
ABOVE GROUND POOL
F i
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 19, 2005
(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 Toyayof Quee ury; YInesday,May 19, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
JApplication for Swimming Pool Permit Permit No. � -307
Building&Codes Office—Town of Queensbury 742 Bay Road Queensbury,NY 12804
(518)761-8256 Fee Paid c S' pb
Instructions and requirements are attached. Notes:
1. Applicant/Owner /Contractor or Installer Information:
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2. Person Responsible for Code Requirements: ��,S�c(,�. � ��,-e—(✓yi d 2004
3.. Pool Location Address: � ^f S ��'� Tax Map No OV ^ 1 r,WY
4. Swimming Pool Information: (check whichever applies and fill in the blanks)
A. Above ground pool ❑Inground Pool
B. fi o Length ft. / width ft. / diameter d? ft. / depth r8
C �u ers s uset�rn r Z sr steel/vinyl; ❑fiberglass; ❑gunite; ❑poured concrete;❑other
5. Fencing Requirements for above-ground & inground swimming pools:
A. If an above-ground,indicate height from ground-grade to top of pool height _5;�2 inches
Note: If your above-ground pool is less than 48 inches above-grade,a fence must be installed within
the area of the pool.
If your above-ground pool is exactly 48 inches above-grade or more,a lift-up ladder with lock
must be installed.
B. If an inground pool,a fence must be installed meeting NYS Regulations,Appendix G.
6. Pool Pump Requirements—Time Clocks:
Pool pumps must be equipped with time clocks so the pumps can be set to shut off during periods of peak utility electrical
demand and set to control the length of time during which the filter runs.
7. Final Inspection Information:
You are responsible for scheduling the following: A) Electrical Inspection; B) Final Certificate of Compliance Inspection
An electrical inspection is required before the Certificate of Compliance is issued. See attached sheet listing electrical inspectors.
The inspectors are contracted through the Town of Queensbury and you are responsible for payment to them directly. Their fee is
not part of this application.
A final inspection by the Queensbury Building&Codes Office is required before use of the pool is authorized. The Code Officers
will look for an approved electrical inspection(sticker on the panel box)and proper fencing around the pool or lift-up ladder.
Signature of Applicant: LaeAZAQ5.�9�--- Date: 55 0
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Sienature of Owner: % ��( _._ Date: J�/,� C�7
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Attention Home Owner
' Ple&se assure you are famili with the
Pool Enclosure requirements. pecifc to
s ►a, �, .. Nt�W� py- o explain
.40.43' - f w, at Requirements you will ave to
meet p 'Appendix G the
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Pool Inspection
Queensbury Building&Code Enforcement
Office No. (518)761-8256
742 Bay Road, Queensbury,NY 12804
/
, /
Date received U� 7�1?��'f S 1 I
NAME: r e- a
LOCATION: (� Jiu r� 1 l ��,,i✓
PERMIT#: pv% - O
INSPECTED OI�7: [)S amhpm
Arrive: �d am/pn epart:Wn_ain/pm
Inspector's Initials: `
Above Ground: hi-Ground:
Y N N/A
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
Wall or Doors have self
closing device or alarms (30
second Alarm time)
Ladder secured in place and
latched
Deck gate < 56" to latch no
more than Yz" spacing in
ate openings
Gate open outward, self
closing
Padlock provided on gates
and ladder
Indoor pool all doors self
closing or alarmed per
AG105.2 Item 9
Timer on pool pump (no
lug in timer allowed)
Final electrical
Vehicle access gate closed
&locked
Ok to issue C/C
COMMENTS:
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INCIO
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE
7 ELCTRuCt-ALCard
PNROVAL
Permit No........................................Cet. NE ....
Owner.................Y ........ .................................................................................
Location...........IJ............ ........................................................................
In.stallation onsisting of.......Ahav..........C-A..9.�./7.o.....vlk��l..... /9!RP.�m .
fy I V -S. .... ... .............
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.................:.................................................................................................................................................................
InstalledBy........seqzn ...............................................................Lic.No..................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making inspections at any time, and if its
rules are violated,the Company shall have the right to revoke this certificate.
Date...... ................. INSPECTOR.—.�62,pl...l.'.r2 ............................
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