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POOL-0182-2022 SWIMMING POOL office Use only PERMIT APPLICATION Permit#: Pao - Q152_-7:U2Z TUwn of Qeensbury 742 Bay Road,Queensbury,•NY 12804 Permit Fee:$ ��0 ;Invoice#:. ��' P:518-761-8256 www.aueensbury.net Flood Zone? Y Reviewed By! Project Location: 5 -S �a >'\r e to a iu y Tax Map ID #: T-- 7— r 3 Subdivision Name• Proposed Install Date: s v~r� 0 l y1 Y r u 2 p,. 9 FPR 13 2022 TOWN O QOUEENEMIRY SWIMMING POOL INFORMATION: LUII_DING &CODES CHOOSE ONE: ABOVE-GROUND V IN-GROUND UNHEATED HEATED (pool cover heater, R-12 req'd) SIZE OF POOL: f f X 3 r MANUFACTURER: A' MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl V/' 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of amended plans,-additional reviews and re-approval 2: If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury.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:/ 2 PRINT NAME: w d �l �� IV e5 SIGNATURE: `^"�`' DATE: 13 _ 21 Swimming Pool Packet Revised November.2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): E N fJ c 5 Mailing Address, C/S/Z: 51S' Cell Phone: ( 3 r ) (2-Y /14 ' 3 Land Line: (5-1 F C 3 4 &'3 49 Email: 4-- A Y t 0 t CO Ao L, C e^ • Primary Owner(s): Name(s): Mailing Address, C/S/Z: 5"S`" Tv4Ne e"JoN ��, Ca��ce��S' 6av^�e, &,y /zfol/ Cell Phone: _(6 3 t ) 61`� 1113 Land Line: —( 6-1 r- �) S� 6� Email: �� t4 (o i ca-) A 0 4, 6a m ❑ Check if all work will be performed by property owner only • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): A M y Pi u 4 L oG (< <- A-o fJ.,v e, 1%,o 4 s,,ATeUc-- ContractorTrade: Srvir' Pvf ooZ, .,��s' /. 4j�,7Li o&.� _Mailing Add ress,_C/S/Z: 23 e r- J? W RaL. C,rq L /1 • 19-0741 Cell Phone:_( ) Land Line: _(S) Y2 6-110 Email: M `/ ?Y-o cif wet "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: w v- d ('4. 1 N es Cell Phone: 2 1 L 6, 3 Land Line: S-9 6e Email: Swimming Pool Packet Revised November 2021 TOWN OF QUEENSBURY i BUILDING DEPARTMENT Bas �l npur limited examination,compliance ,omments shall not be construed as J inc-,u .g the plans and specifications are in full compliance with the Building Codes of New York State. ATTE . TIO .HOME WIdER Please a you famllla with the Pool Enclos require ' ants specs to your pool. APR 13 �. Yo io, required meet all a licable codes ® ,� e rding s a l� pgols, s s & hot tubs `�? 1 a the b Ins �ectf�n. �a Bt1f,_ e.`E-1+,38 ly COPY TOWN OF QUEENSBURY PT sewed By. D PO ST c 4v (pb 0 �- 3 y' F 295.15-2-13 PO Hines, Edward OL_0182-2022 55 lohn Glendon Rd .In ground pool (heated) �• NAP REFERENCE: NOTES' °tl 1. 'LEUCI - JONN CLENOON ROAD SUBDIVISION' ,q,onwl fJ PARCEL IS SuBJECT OFRECORD fag-ASMENTANDruNTS.AND / C.,r_A I^• 6 j„ r BY: VAN DUSEN 8 STEVES LAND SURVEYORS AND AGREEBEN(SOFRECORD(¢p..EASENENTAN000NORDONS Vdi hY < NACE ENGINNERINGI P.C. nESOR/BEDweoox l67l oFDEEOs.arvacE T!} © �np6a .\ f y DATE: MARCH 15, 2016 2J 7NISAIAPIS LOPVRIGHTG•701B VANDUSENd SIEVES UND `� V` 1 N �'•• ' ��,1 LA57 REVI6ED: JUNE 12, 2017 SURVEYORS.UNAUDIORIZCOALTCRATIONORADDMONTODIIS FILEO: DULY 12, 2017 DOCULIEMISVIONT/ON OF SECTION TXtA SUBDIVISION 20F ,1�� 5�� +.' / 1 g t"'V y "� PLAT D-13 `� •s! NEWYORK STATEEDUCATIONLAW. V y� Y^+6•, �� ' ]•'' d INSTRUMENT NO. 2017.3000063 LOT 15 r • I S 06°30,20" W Yi I 1000 GAL. I —� SEPTIC TANK� `\ DISTRIBUTION O n o I - BOX I m ...Y../' m {v il. / s _• Lot 16Area ni u •nP;.AL � 37800.0'-Sq. Feet o T� 4 - 40 LF ABSORPTION O.B7_Acres TRENCHES ( c 360.00' N 06"30.20v E RECORD DRAWING NOTE: f 1 F SENTATIVE OF OUR OFFICE NS11E0RING CTHE S STM AND TISDVTHAT THE SYSIEII IS INSTALLED W CONFORMANCEWITHTHEAPPROVIDND THIS RECORD DRAPING. FC/ALJ FWISMWC AND TURF ESTABCISHAR:NTTO BE COMPLETED.CENTER,P.E.020 1 ' LOT 17 ` 1SEYTIC SYSTEM - AS I31.1ILTi' IY NACI ENGINEERING RECORD DRAWING ,,\ - - - - -- -- - - � _ 1NS(.ALLATION DATE:0412412020 1 INSTALLED BY-SUPERIOR EXTERIOR EXCAVATING —_ 1, D S Dote,H1 10,2019 a & T� Dlnp nE n tiur ccr m:Wr Tor Scale l'=30' Steve s �l _1 L a z1(1 S li r v e y o r s - Foothills Builders 3 06/15/20 SEPTIC RECORD!DRAMNG , M.+,wa>dr�.�••,�a.R " 2 04/10/20 FINAL UPD 91&T 10F1 In9 IIu;iLwd f:o ul 1lur,•n-Curl. >va 1or6 ,101 'I',nI•u nt(Inr:•u:bu:•}. PnrTru 1'nnu:r. �,• h+r 1. ..) 1121031191 FINAL ^•'t�Y (� (.11111 �:1'!-Illil \r•n l,if l: N... No. :Allan trX.i::�na Jn•:I^:.i. NO. DATE DESCRIPTION f Sep, 21, 202.26;51A MDIA No, 0176 P. 2/4 • MZDDLE DEPARTMENT' �N�PECTI®N A.�'ENC'�, INC. WexJ *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: Ed Hines Date: 09/09/2022 Occupant: Same Location55 John Clendon Rd. Occupancy Swimming Poo! Queensbury,Warren Co. NY Applicant [E � Q 1�0 E GBM Electrical ...... D Attn:Matthew Wing . :� 'SEP Z 1 2022 22 Fox Hollow Ln. • -' Queensbury NY 12804`. J TOWN OF QUEENSBURY '71-, • . BUILDING&CODES Joseph A.Holmes _ i ZoZ2- No. _147929172178FL y - Equipment: ..... 2-LV Fixtures; 1 -Pool Pump; 1 -Chlorinator; 1:_'50A'Heat Pump;V-100A Pool Control Panel This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate appries 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 change in the use,occupancy or ownership inspection, No warranty is expressed or implied as to the Mechanical safety,affi- of the property indicated above,this certificate shall be immediately null and void, eiency or fitness of the equlpment for any particular purpose. This certificate shall In the event that this certificate becomes Invalid based upon the above conditions, he valid for a perlod 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 attefed in any way,including but not limit Inspectlon Agency,Inc. An application for inspection must be.submitted to Middle ed to,the introduction of additional electrical equipment and/or 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 certificate shall be process. A tee will be charged for this service.