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POOL-0202-2021 SWIMMING POOL office Use only Permit#: �v�—J PERMIT APPLICATION 14ZNrjoa �i�(_P:518- Queembury,NY 12804 Permit Fee:$ �Invoice#: .N J. 761-8256 www,queen—net Flood Zone? Y N Reviewed By: Project Location: Tax Map ID#: Q g — ' — ` Subdivision Name: Proposed Install Date: 2021 SWIMMING POOL INFORMATION: APR FE , 21 CHOOSE ONE: ABOVE-GROUND X IN-GROUND � EEIVSf�URY SIZE OF POOL: 2 1 + NM 1`� ^CODE MANUFACTURER: T MATERIALS USED IN CONSTRUCTION (CHECK ALLTHAT APPLY): Steel/Vinyl X Fiberglass Gunite Poured Concrete Other ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans.prior to or during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100%of the fee is retained. 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- V y\- n r�l 1 SIGN DATE: 2- 2 Sv+imming et Revised December 2020 4i CO";- T INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • A licant: Name(s): Mailing Address, C/S/Z. )p� \� ov-, Cell Phone: ` a Z )23l'0 _ 5.55y Land Line: Email: 13 @ r�1Q i 1 m • Primary Owner(s)• Name(s): v Mailing Address, C/S/�Z- o N 12 b Cell Phone:_(3D2- 5%0 � Land Line: _ Email: �LO.1r1c�Y� r1 R L4 (0 Q`( ock�k.Csflf"" ❑ Check if all work will be performed.by property owner only • Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): \-Xfv`f1Cac Rk-s\ Contractor Trade: 0- Mailing Address, C/S/Z: Knor4 Cell Phone:_( Land Line: _(-Iff) Email: — e 0oo\S (E) Du+lip , (c)rn _ **Workers' Comp documentation must be submitted with this application** Contact Person for Compliance in regards to this project: C rQ j 06\ Cell Phone: l_) Land Line: k 5 Email: Swimming Pool Packet Revised December 2020 P,002 RX Date/Time 091'2912021 13;49 15182731202 No. 7967 P. 2/2 w^Sep, 29. 2021 1 :24P MDIAFiR MIDDLE DEPARTMENT INSPECTION AGENCX INC. 'E6Wilt,—,that the electrical wiring to the electrical equipment listed below,has been examined and is approved as being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date noted below and is issued subject to the following Conditions, Owner: Date; Kyle Hartman 09117/2021 Occupant:Pool Location Woodshire Court Occupancy' Queensbury,Warren Co. NY ' Swimming Pool Applicant GBM Electrical, Pop L.- O Z©Z- z02 Attn;Matthew Wing 22 Fox Hollow Ln. ;. .. . :.. ' LOueensbury NY 12864. ` Joseph A;Holmes No. � �. ... _ _ '•1'47929'154804EL''.••— — •• -- — r '_ _.:; — :— — — — •— - — — Equipment: 1 -60 Amp Control Panel; 1 ..Switch;.1''=Receptacle;33=E'ixtuftis; 1"='Po4-'P6mp - • `V•. Ttiis cerfificate applies to the electrical-wiring to the electrical equipment I•islaa immediately null arid void. This certificate apprias only tn'the use,occupancy and above and the installation•fnspected as of the above noted date based an a vlsual ownersitip.es.hidicated herein- Upon a change in Me use,occupancy or ownamhlp' inspection, No warranty is expressed ar implied as to the mechanical safety,W- of•the'pmpefty indicated above,this cartificate•shall be immediately null'and void. ciency or Mew of the equipment for any particular purpose. This certificele 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 dare. should the etectrltdr tnis certificate may be revalldalad upon reinspactidn by Middle Department system to which this certificate applies be altered to-any way,including but not limit. Inspection Agency,Inc_ An application for inspection must be submitted to Middle ed lo,the invoduction of additional electrical equipment and/or the replacement of Department Inspection Agency, Inc,to initiate the Inspection and revalidation any of the components inst8lted as of the above noted date,this cer6flcate shall be process. Afee vn11 be charged for this ssrYice. . _ � �Ao� EE E C E " APR 0 8 T Tow c OWN OF OU-cN")3u UIL IN _ac 0_ R BUILDIN6 g:C 1�BURY 0 O )\tAG Go 00 ID3 co CL 0 CD 001 .0 are famill ase assure You me to yo plel qu,rqmqn%spec es Yo are e e, pJjCgkbl'Ired to Meetallap eclij' - I spasm arding s i he tirrve of InS9 pools, tv