POOL-0387-2020 SWIMMING POOL PERMIT APPLICATION Office Use Only
Permit#: QOQ,I_ — O6 -L0 2,J
Town of Queensbury Z-t��11 11��
Permit Fee:$ \25 ; Invoice#: 5U
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Notes:
Project Location: A(.p Co y F4-1 11 2 ci-
Tax Map ID #: i . i 2 - 2, - Subdivision Name: Wcc,r-o 3
CONTACT INFORMATION:
• Applicant:
Name(s): I r i Sha c sao
Mailing Address, C/S/Z: 3L Co1-k�L*-i \l 2.:1
Cell Phone: (5lg )ci 2)C-1-y1-<0 Land Line: I )
Email: fi je+;acIkSoe) @c6rnc,.411 • Corn
• Primary Owner(s):
Name(s): r 11 c,c,K.SUY)
Mailing Address, C/S/Z: 3Lit Call-r.,cc l ll 12
Cell Phone: ( E L ) Qc-I14"9--ce Land Line: ( )
Email: T se-1-�c cik- P tp c.A.S • rm
Check if all work will be performed by homeowner only
• Installer/Builder: Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
**List all additional contractors on the back of this form
Contact Person for Building & Code Compliance: kW tao„y , -----
Cell Phone: ( ) Land Line: ( j � .y 1 ,_-
Email: 0 E k ti i P_a
JUL 13 2023 1 J
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TOWN OF CUEENSBURY
BUILDING&CODES l
Swimming Pool Packet Revised May 2020 '
SWIMMING POOL INFORMATION:
CIRCLE ONE: CA-BOVE- GROUND IN-GROUND
SIZE OF POOL: Z� F
MANUFACTURER: id ; b4 r / M ni GA AA 906L pctko-kpc.sEb ` 2v1 Nam.0 O
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: / ' S` L .J0.GK S O " )
SIGNATURE: DATE: ER" - 01 -ZO
•
Swimming Pool Packet Revised May 2020
i 1 I 1
301.12-3-3 POOL-0387-2020
Jackson, Trish
•
36 Cottage Hill Rd
u) Id o Above ground pool T
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INSPECTION WORKSHEET (POOL-007772-2021)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:POOL-0387-2020 Case Module:Permit
Inspection Date:Fri Apr 30, 2021 Inspection Status:Failed
Inspector:Dyer, Charles Inspection Type:Pool
Job Address:Parcel Number:36 COTTAGE HILL RD
Queensbury, NY, 12804
301.12-3-3
Contact Type Company Name Name
Granted Permission JACKSON, TRISH
Applicant JACKSON, TRISH
Primary Owner JACKSON, TRISH
Checklist Item Status
Building Inspector Notes Failed
Pool must be inspected by TOQ code enforcement
Please call 518-761-8207 to confirm
ÿþ Failed
Pool enclosure around pool or yard Failed
4 feet above grade Failed
2 inch max to grade from underside of fence Failed
4 inch maximum clearance in fence pickets Failed
Apr 30, 2021 Page (1)
INSPECTION WORKSHEET (POOL-007772-2021)
Checklist Item Status
Maximum spacing of wire fence 1 3/4"Failed
Self closing device or alarms (30 sec Alarm time)Failed
Pool Surface Motion Alarm Failed
Must provide
Ladder secured in place and latched Failed
Gate less than 56 to latch ½ max spac in openings Failed
Gate opens outward, self closing Failed
Padlock provided on gates or ladder Failed
Must provide
Indoor pools all doors self closing or alarmed Failed
Timer on pool pump (no plug in timer allowed)Failed
Must provide
Suction outlt must be protected agst user entrpmnt - (eff 5/12/2020)Failed
Bottom pool drain vacuum relief system-REQUIRED Failed
Apr 30, 2021 Page (2)
INSPECTION WORKSHEET (POOL-007772-2021)
Checklist Item Status
Final Electrical Failed
Must provide
Vehicle access gate closed & locked Failed
Ok to issue CC Failed
Apr 30, 2021 Page (3)
Dyer, Charles