2004-455 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040455 Application Number: A20040455
Tax Map No: 523400-290-000-0001-067-000-0000
Permission is hereby granted to: ROBERT &TIORT RODRTOTTF,7,
For property located at: 19 BROOKFIELD Rills
{
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. Type of Construction Value
Owner Address: ROBERT &LORI RODRIQUEZ
19 BROOKFIELD Run I Tootaltal Val
Pool
Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-455
INGROUND POOL
J
$35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, June 28, 2005
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenshury before the expiration date.)
Dated at the To n of s ; , une 28, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Swimming Pool Permit Permit No. ion g-q 5
Building&Codes Office—Town of Queensbury 742 Bay Road Queensbury,NY 12804 ��
(518)761-8256 Fee Paid ti
Instructions and requirements are attached. Notes:
1. Applicant/Owner /Contractor or Installer Information:
b rn )r
2. Person Responsible for Code Requirements: b�� �od✓��cj die
3. Pool Location Address: �� !-_�Fo c�V 2�C�. �c W Tax Map No.
4. Swimming Pool Information: (check whichever applies and fill in the blanks)
A. []Above ground pool LOInground Pool
B. Length o ft. / width ft. / diameter ft. / depth ft.
C. e. s u""s r ca s n : 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 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- de 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: (�Ll� Date: V - 1 7- O 7
Signature of Owner: Date:
_
- - - -- _ - POO
- -
-Yo- e
Pr
N
--_ _ — -
�. s
- -- _ _ 4 �" '� � '
,_ `
- - -
_ 5 _ -.. - - -- -
f-
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. P20040455 Date Issued: . ,Friday, November 17, 2006
This is to certify that work requested to be done as shown by Permit Number P20040455
has been completed.
Tax Map Number. 523400-290-000-0001-067-000-0000
Location: 19 BROOKFIELD Run
Owner. ROBERT & LORI RODRIQUEZ
Applicant: ROBERT & LORI RODRIQUEZ
This structure may be occupied as a:
Inground 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, let
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No........................................Cert. NO 75891 Cut-in Card No.............................
o�dzl
Owner..................................................��r.LL f.....Z. .......... l...... .......
.,..../...................................
Location........................� � �i� C..��'�
G
........... ..................................................................................... ..... ..
. DcB�. 1! .fl G d—�o AlD/.tJ G U�
InstallationConsisting of. ................ .i�...�.........................................................................................
....................................................................................................................................................................................
............................. ................................................................................... ................................................................
InstalledBy.... .1'5.g........c .......................................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 pwrAptly made for inspection.
Inspectors of this Company shall have the privilege of making i pec ons at any time, and if its
rules are violated,the Company shall have the right to "vo this cc ific}� e.
Date.. .-Z --�!•••............ INSPECTOR............ ............... ..........................................................................
Member N.F.P.A.,I.A.E.I.
Pool Inspection
Queensbury Building &Code Enforcement
Office No. (518)761-8256
742 Bay Road, Queensbury,NY 12804
Date received: L ^
NAME:
LOCATION:
PERMIT#: -- i`
INSPECTED ON: _� f `\ am/ m
p
Arrive: am/pm Depart:._ ain/pm
Inspector's Initials: — v
Above Ground: In-Grounds
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 ''/2" 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 r' t
Vehicle access gat clo ed
&locked
Ok to issue C/C
COMMENTS:
L ���� �
i :ram
s
Pool Inspection
Queensbury Building&Code Enforcement
Office No. (518)761-8256
742 Bay Road, Queensbury,NY 12804
Date received:
NAME:
LOCATION: V`���N
PERMIT#:
INSPECTED ON: am/pm
Arrive: am/pm Depart: am/pm
Inspector's Initials: �✓��
Above Ground: In-Ground:V
Y N/A
Pool enclosure around pool
or yard
4 feet_abo_ve grade----_
-inch maximum clearance
( to grade from underside of
ce
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 %z" spacing in
ate openings
Gate—open outward,Qelf
closin
Pad ol�c c provided on gates
and ladder
Indoor pool all doors self
closing or alarmed per
AG105 2 Ite.-
imer on pool pump (no
N_Lig in timer allowed)
Final electrical 2—
Vehicle access gate tcldsW
&locked 7
Ok to issue C/C
COMMENTS:
��1� �
Rough Plumbing / Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 1//
Queensbury Building&Code Enforcement Arrive: am/ Depart: am/pm
742 Bay Road, Queensbury,NY 12804 Inspector's Initials.
NAME: PAA PERMIT #: 0
LOCATION: INSPECT ON: �5
TYPE OF STRUCTURE:
Y N N/A
PVC: R-1,R-2,R-3,R4 Drain/Vents
Cast Iron, Copper Drain/Vent/ Comm.
Plumbin Vent/Vents in Place
' Rough Plumbing/Nail Plates
1 % inch min.Drain Size
Washi 'Machine Drain 2 inch min.
He dor Air Supply Test
rain and Vents
5 PSI or 10 feet above highest
connection for 15 minutes
Cleanout every 100 feet/change of direction
Water Supply Piping
Cooper Commercial
Cooper, CPVC,Pex One and Two-Family
Insulation/Residential Check/Commercial Check
Proper Vent,Attic Vent
Duct/Hot Water Piping Insulation
If required unheated spaces
Combustion Air S!!pply for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
LASueHemingway\Building.Codes.Inspection.FORMS\Rough Plumbing Insulation Report.doc November 17,2003
Rough Plumbing / Insulation Inspection Report
Office No. (518) 761-8256 Date Inspection request received: y �
Queensbury Building& Code Enforcement Arrive: am/p'pi rt. m/pm
742 Bay Road, Queensbury,NY 12804 Inspector's Initials: ��99
NAME: 4n,,Z&J, 119 PERMIT #: � ���
LOCATION: 1 L��(c lc� INSPECT ON:
TYPE OF STRUCTURE: ly 7 dzv
Y N N/A
PVC: R-1, R-2,R-3,R4 Drain/Vents
Cast Iron, Copper Drain/Vent/Comm.
Plumbing Vent/Vents in Place
Rough Plumbing/Nail Plates
1 % inch min. Drain Size
Washing Machine Drain 2 inch min.
ead or Air Supply Test
Drain and Vents
5 PSI or 10 feet above highest A ,�.�
connection for 15 minutes f
Cleanout every 100 feet/change of direction
Water Supply Piping
Cooper Commercial
Cooper, CPVC,Pex One and Two-Family
Insulation/Residential Check/Commercial Check
Proper Vent,Attic Vent
Duct/Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supp!y for Furnace
Duct work sealed properly/No duct tape
COMMENTS:
L:\SueHemingway\Building.Codes.Inspection.FORMS\Rough Plumbing Insulation Report.doc November 17,2003