application SWIMMING POOL.PERMIT.APPLICATION Office Use Only
f. : Permit#: O1,24-ZQ2)
Town of Queensbury
Permit Fee:$ J 125 • Invoice#: 305
742 Bay Road,Queensbury;NY 12804
P:518-761-8256 www.queensburv.net Notes:
Project Location: 152 Farr Lane,Queensbury
Tax Map ID#: 295.20-1-62: Subdivision Name:Indian Ridge
ECEOVE [n)
CONTACT INFORMATION: • m OCT 0 8 2020tij
TOWN OFQUECNSBURY
• Applicants
: BUILDING&CODES
Name(s): Michael Murray
Mailing Address, C/S/Z: 152 Farr Ln, Queensbury NY 12804
Cell Phone: (518=796-7438 ) Land Line: .( )
Email: mdmurray09@gmail.com
• Primary.Owner(s):
Name(s): Michael Murray
Mailing Address,C/S/Z:.152 Farr Ln, Queensbury NY 12804
Cell Phone: (518-796-7438 Land line: ( )
Email: mdmurray09@gmail.com
El Check if all work will be performed by homeowner only
• Installer/Builder: Workers' Comp documentation must be submitted with this application
Contact Name(s):Northern Poolscapes Inc.=Jeff Rolleston
Contractor Trade:Pool Installer
Mailing Address,C/S/Z: 16 Willow St, South Glens Falls NY 12803
Cell Phone: (518-222-7128 ) Land Line: (518-793-9063)
Email: n/A
**List all additional contractors on the back of this form
Contact Person for Building & Code Compliance: ) c �
Cell Phone: ( ) Land Line:( )
Email: Click or tap here to enter text.
Swimming Pool Packet Revised May 2020
SWIMMING POOL INFORMATION:
CHECK ONE: ❑ABOVE-GROUND ►Z1 IN-GROUND
SIZE OF POOL: 16*36
MANUFACTURER: Latham Pools
MATERIALS USED IN CONSTRUCTION-(CHECK ALL THAT APPLY):
. Steel/Vinyl ►Z Fiberglass 0 Gunite
Poured Concrete ❑ Other ❑ (Explain: )
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: Michael Murray . .
SIGNATURE: Clic n xt. DATE: 10/08/2020
Swimming Pool Packet Revised May 2020
i -2447 ( 295:20-1-62 P00L-0624-2020
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ATTENTION HOME OWNER , -. • . .:''' :
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Please assure,you are familiar with the Pool
• - •:, . _, _. Enclosure requirements specific to your pool.
- ---- You are required to meet all applicable codes
regarding swimming pools, spas•& hot tubs
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SC at the time of inspection.
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Based on our limited examination,compliance with our comments shak lot be co.nstrued as
._--- ndlcating the plans end specifications are in
• full compliance with the Building Codes of• i
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MAP REFERENCE:
NDIAN RIDGE PUD • �i
PHASE THREE. _
DATED NOVEMBER 15.2002 ` "
BY VAN DUSEN 4 STEVES /0111
LAND SURVEYORS.LLD
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KEVIN W. & HOLLY M. KING S-1
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109 Haviland Road . Queenabury, New York 12804 o=r.o b. Town of eueenebury, Warren County, New York
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(518) 792-8474 New York Lio, No. 50135 NO. DATE` DESCRIPTION DING.No.ERGO
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New York 12804 . " 70554"" Town of Queensbury, Warren County, New York
'ic. No. 50135
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NO.
RX Date/Time 0412912021 09;42 15182731202 13.002
Apr. 29. 202.1-9:20A MDIA No, 6507 P. 2/3
MIDDLE DEPARTTM NT INSPECTION AGENCY, INC.
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(e—.�that the electrical wiring to the ctrical equipment listed below has been examined and is approved as
being in accord with the National Electrical,Cod applicable governmental, utility and Agency rules in effect on the date
noted below and is issued subject to the foliowinconditions.
Owner: i Date:Mike Murray 04/23l2021
Occupant: Location:
Pool 152 Farr Ln.
Occupancy: Queensbury, Warren Co. NY
wimming Pool
Applicant:l
GBM Electrical _
Attn:Matthew Wing
69 Peggy Ann Road
L Oueensbury NY 12804 I J
Joseph A.Nolmes
No. 147929159 393EL _ � —�p 2 •2-1ZI�.
Equipment:
1 -Switch; 2-Receptacles; 1 -GFCf Rdcep able; Fiktbres;•1 -1301 r Wlrin & Controls; 1 -Twist Lock
Receptacle; 1 -Control Panel;.1 -Chlorinator;
ED WE ,
.APR'._2 9'2021
TOWN OF QUEENSBURY
BU,IDfNG&CODES
This certificate applies to the electrical wiring to the electrical equ merri listed immediately null and void. This certificate applies only to the use,occupancy and
above and the Installation inspected as of the above noted date base o i a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
inspection. No warranty is expressed or implied as to the mechani I s rety,eM- of the property indicated above,this certificate shall be immediately null and void.
ciency or fitness of the equipment for any particular purpose. This ce i to shall In the event that this certificate becomes invalid based upon the above conditions,
be valid for a period of one year from the above noted date. 'Should ia electrical this certificate may be reveHoated upon relnspection by Middle Department
system to which this certificate applies be altered in any way,including not limit- Inspection Agency,Inc. An application for inspection must be submitted to Middle
ed to,the Introduction of aconionai electrical equipment antllor the M a ement of Department Inspection Agency, Inc,to Initiate the inspection and revalidation
any of the components installed as of the above noted date,this cerfifl at D shall be proem. A fee will be charged for this service.
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