2003-066 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: P20030066 Date Issued: Monday, September 13, 2004
This is to certify that work requested to be done as shown by Permit Number P20030066
has been completed.
Tax Map Number: 523400-308-018-0002-036-000-0000
Location: 14 KIMBERLY Ln
Owner: PATRICK& DANA POMERVILLE
Applicant: PATRICK& DANA POMERVILLE
This structure may be occupied as a:
By Order of Town Board
Inground Pool TOWN OF QUEENSBURY
Director of Building&Code EnYorcenienft
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030066 Application Number: A20030066
Tax Map No: 523400-308-018-0002-036-000-0000
Permission is hereby granted to: PATRICK & DANA POMF,RVIT.T,F,
For property located at: 14 KIMBERLY Ln
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. Tie of Construction Value
Owner Address: PATRICK& DANA POMERVILLE Inground14 KIMBERLY Ln Total Value
Pool
Total
QUEENSBURY,NY 12804-0000 -
Contractor or Builder's Name /Address Electrical Inspection Agency
SPRAGUE POOLS COMMONWF,ALTH F,LF,CTRICAL 1
294 BROADWAY RON MIJMBI,O
NY 12804-0000
FORT EDWARD_NY
Plans&Specifications
2003-066
INGROUND POOL AS PER PLOT PLAN SPECIFICATIONS
$35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 13,2004
(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 Town eensbu TP7rs ay, March 13,2003
SIGNED BY f• for the Town of Queensbury.
Director of Building&Wode En orcement
Building& Codes Office ,Swimming Pool
Town of Queensbury 6
742 Bay Road Permit Application �� '
Queensbury,NY 12804
(518) 761-8256 n
1. Applicant: � �► yWVlely� �C e�wner: r
OYU—
Address: ]q t� Address:
2So�}
Phone No. ' Phone No.
2. Person responsible for code requirements: -
3. Contractor/Installer fyanl 10 P"'Is
Address RECEIVED
Phone No.
l� �+ MAR 1 0 2003
4. Pool Location Address:
OF
5. Tax Map Number: 5 a 3�1 0 6 - 3 U S = U 1 SS -060 a- b 3 � `
c�zrr�BUINLDING AND CODE
Y
6. Type of Pool: above-ground pool / in-ground pool
7. Size of Pool: length 3g ft. diameter ft.
width �_ft. depth ft.
8. Approximate Water Capacity gallons
9. Materials used in construction(circle below)
Steel/vinyl Fiberglass Gunite Poured Concerte Other
10. Submit a diagram; drawn to show property lines, existing structures,proposed or existing septic
system, location of proposed swimming pool. ,Show all setback distances from property lines to
both the pool and the structures, as well as separations between them.
An electrical inspection is necessary before the Certificate of Compliance is issued.
See attached sheet for electrical inspectors.
The Building and Codes Office needs to be notified upon completion of construction; including
installation of fencing. A final inspection will be made before use of the pool is authorized.
Applicant Signature: r Date: 31�,, o3
Owner Signature: aS above Date:
(if different from applicant name)
Pool Inspection
Queensbury Building&Code Enforcement
Office No.(518)761-8256
742 Bay Road,Queensbury,NY/h� 12804
Date received:
i
NAME:
LOCATION: )
PERMIT#:
INSPECTED O 3 0 am/pm
Arrive: am/ part: ekham/ in
Inspector's Initial
Above Grou In-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 ''/z" spacing in
ate�enin s
Gate open outward, self
closing
Padlock provided on gates
and ladder
Indoor pool all doors self
closing or alarmed per
AG 105.2 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,INC.
Main Office 357 Elwyn Terrace — Manheim,PA 17545 -\�
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Panel Board No... ............. Cert. e 2 922 Cut-in Card No......AV�i�......
�
Owner.............. /..lZlc-l.4..... .....oY.�2r__lL.U/4..L..�...........................................
Occupant............................................................................................................................
Location...1..Y......14.1.M..b.cxz/.yl...4-ey...................Q.u.. �n S.,L, 14.1�/.....
Installation Consistingof..../22....../-.lz.a.can..io.........�'.LAd.�.m.s�-r../.n j. ...............
r
..........P0.0..4.........� ...'..............................................
............................................................................................................................................
InstalledBy...S'<�•yit�..................................................... Lic.#.....................................
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...... �.�.6.-4,�.......... INSPECTOR. 1 . ..............
Member N.F.P.A..I.A.E.[.
Pool Inspection 1
Queensbury Building&Code Enforcement r�r
Office No. (518)761-8256 G�1�
742 Bay Road, Queensbury,NY 12804
Date received:
INSPECTED ON: LA
m/pm
Arrive: am/pm Depart: a pm
Inspector's Initials:
NAME:
PERMIT#:
LOCATION: 0
Above Ground: In-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 ''/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 C7
AG 105.2 Item 9
Timer on pool pump (no (�
plug in timer allowed)
Final electrical
Vehicle access gate closed
& locked
Ok to issue C/C
W_Z), f eex
COMMENTS: t. �
o
^� LOT 27
':8J.5.5'OU
78,
i
V
,D. r:
O T 28
TOTAL
C.
'
-- - - -.Hpr;sr: - LOT 29
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