POOL-0449-2022 SWIMMING POOL Office Use Only I
PERMIT APPLICATION Permit#: � � ^D TO—
Town of Queensbury �7'0 p <`,�Q
742 Bay Road,Queensbury,NY 12804 Permit Fee:$ G ; Invoice#:
P:518-761-8256 www.gueensbury.net Flood Zone? Y N eviewed By:4A& )
Project Location: 3l \ C R W E
I
Tax Map ID#: bdivision Name: JUL 18 2022
JOW. I, (-
2
Proposed Install Date: TOWN OF OUEENSBURY
BUILDINr �CODES
SWIMMING POOL INFORMATION:
CHOOSE ONE: ABOVE- GROUND IN-GROUND
0 �
SIZE OF POOL:
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass Gunite Poured Concreted 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 If,for any reason,the building permit application is withdrawn, 30% of the fee is retained by the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:
DATE: 7' 1 1
SIGNATURE: 7 n d—
Swimming Pool Packet Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z: SNIA l j GSA-
Cell Phone: Land Line:
Email: 5\2-160-9 4 6�
�yc)r.\0i0' C.v(�
• Primary Owner(s):
Name(s): E,,,, (-\ (f`�
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email: Sig-�6vPgy �7
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): Cone�ca ?co\5 S�0.s
Contractor Trade:
Mailing Address, C/S/Z: 156 S Vc\� ` �,�, �'2�11
Cell Phone: Land Line:
Email: ..,[
:ck,az\tag: o ���[��ts,.��oo�S. COO-
"Workers?
eomp documentation must be submitted with this application**
ct�t�cr,�a, �«�\� s�.:a �,,,�.;� ;��t c`�a.4;�� •,� on �:\.e_ .�,1� ��
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email: S18-Zg3-$ct71
Swimming Pool Packet Revised December 2020
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Erin Ely
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314 West Mountain Road
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, OOF_ In-Ground
0 u n d Sw
imming
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Sep, 21, 2022 6:52A MDIA No, 0116 P, 4/4
M�DDL,� DEP.ARTMJEN�' INSP�CI���I� �C��IVCY, ��TC.
1& i 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: Ely Date:
09/09/2022
Occupant: Same Locatio
n314 West Mountain Rd.
Occupancy mming Pool Queensbury,Warren Co. NY
Applicant-
Erin Ely
311 West Mountain Rd.
Queensbury, NY 12804..•
Joseph A.Holmes,. SEP 2 2022 _
No. 3180141721,- -,EL' '__ . .._ _
Equipment: TOWN OF QUEENSBURY
BUILDING&CODES
1 -Receptacle;3-LV Fixtures; 1 -50A°Heat-Pump;-1 -SaltGenerator,-1 -Poo
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. i his certificate eppries only to the use,occupancy and
above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a eMnge in the use,occupancy or ownership
inspection. No warranty Is expressed or implied as to the mechanical safety,etfi• of the property indicated above,this certificate shall be immediately null and void.
ciency or fitness of the equipment for any particular purpose. This certific*te shall In the event that this certificate becomes invalid based upon trke above conditions,
be valid for a period of one year from the above noted date, Should the electrical this certificate may be revalidated upon reinspection by Middle Department
system to which this certificate applies be altered in any way,including but not limit. inspection Agency,Inc, An application for inspection must be submitted to Middle
ed to,the introduction of additional electrical equipment andfor the replacement of Department Inspection Agency, Inc.to initiate the inspection and revalidation
any of the components installed as of the above noted date,this cartifloate shall be process. A fee wilt be charged for this service.