Loading...
POOL-0345-2022 WXSWIMMING POOL Office Use only "M mom PERMIT APPLICATION Permit#: Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ ; Invoice#: P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By: Project Location: tjzf ixv-l- o ,di'e Tax Map ID #: �,Qd,-%- 9 Subdivision Name.- , D E Proposed Install Date:. s�''J�� Z z' [TUN 0 2 2J21_ �! SWIMMING POOL INFORMATION: TOWN OF QUEENSBl1R BUILDING& COPI::" CHOOSE ONE: _ABOVE-GROUND `GROUND _UNHEATED IN , (pool cover.heater, R-12 req'd) SIZE OF POOL: {/© MANUFACTURER: MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT.APPLY): Steel%Viriyl �'`' .. Fiberglass - Gunite Poured Concrete Other ✓p 6 ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans prior to or during construction will require the submittal of amended plar�s,.additional reviews and re-approval. 2. If, for any reaso"6, the building permit application is withdrawn,=30% of the fee is retained by the Town of Queensbury.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: SIGNATURE:�it�O DATE: Swimming Pool Packet Revised March 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: , Name(s): ikgdl, s Mailing Address, C/S/Z: lylp 91.nfe Cell Phone A Land Line: ( ._.) ,I�/�. Email: ��.�, lS,� , s e�✓ �1,�OG . Cmn� • !Primary.Owner(s): Name(s): /�1 i� ' oiEC arP�r.,�.fC,o �� fA, Mailing Address,-C/S/Z:/" (!/, es��J-4- R 1 ie AA.t, fig.*& ems Cell Phone:_(,fj g } •D Land Line: _( ) Email: ftiet A zetTS ❑ Check if all work will be performed by property owner only V • Installer/Contractor: (Lilt all additional contractors on the back of this form) Contact Name(s): DR A G. Contractor Trade: " &&I r- 1��r.yIC.�Tie.✓ Mai.ling'Address, C/S/Z: �?ep &,CT�al.� -Aar L ,',J67a.� �2 120�B Cell Phone:_( ) Land Line) rl f 2 �!D Email:yt eAa&uA 40� ,s�-� "Workers' Comp documentation must be submitted with this application** Contact Person for Compliance in regards to this project: 117,t j g ee 9?4�&47-i Cell Phone: /S ).?,*q Land Line: (S8 ) — 27.0 Email: Swimming Pool Packet Revised March 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): onlith .S Mailing Address, C/S/Z: d- glid60 a Cell Phone: (45j 2 2 , D .2 y Land Line: Email: M1 410,e 141100 on ,$ a0/ 910416G . C-41M • Primary Owner(s): Name(s): ;e 1 Or-&, X1,g2a2i tA, Mailing Address, C/S/Z:/y/ eh,�es-f,,.J„� R:I 1,6 A0,94, ,�.�.✓ n1.y i2 Q a ai Cell Phone:_(fj g ) .p Land Line: Email: S E ® Check of all work will be performed by property owner only • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): SOR A G-�.Es d!W �/��d ,!odd Contractor Trade: 02141E1 -r 1rr.ot1�T,e.✓ Mailing Address, C/S/Z: _�300 &O,",oy FDie��d.�,�,g,,l A!A&&.k4e,75"Q x2 12,0A 10 Cell Phone:_( ) Land Line: -47 2 70 Email: s PRE IMPS—�b r•�-L.ea�c'. r�Ati "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: kdoee �pL,�'n Cell Phone: (dill );?,p7 -� 2Y� Land Line: �t,) 124-,!-9210 Email: Swimming Pool Packet Revised March 2022 TOWN OF QUEENSBURY bs - D ECE � � E BUILDING DEPARTMENT SUN U 2. 2022 Based on our limited examination,compliance with our comments shall not be construed as indicating the plans and specifications are in TOWN OF C�UEENBBUP.Y full compliance with the Building Codes of New York State. ' BUILDING&COIDEB ATE NTQ HOM9 OWNER Please assure you are familiar with the Pool TOWN OF Q U E E N S S U RY Enclosure requirements salt applicabcific le able your pool. BUILDING & CODES �To to meet all ap CodesYou are requiredis, spas & hot tubs Reviewed By: regarding swimming Poo Date: Z at the time of inspection. ."' F lad'-6L D H1 211'�__ IcA RP51LP3 i J J f \ 2.0 sf { 15' f; 1sAV!Unf B First Floor 2776 sf V f rt 29' PP7 sf 13' r� ,_n f 290.-1-94 POOL-0345=2022 Smith, Michael & Pamela T 146 Chestnut Ridge Rd In ground heated pool MAY p 01Z al,--.�.H.. �•�rPdr � � "BURY COMMONWL-ILTII ELECTRICAL•INSPECTION SERVICE,INC. y��!:•.' Mnin Oftiee 176 Doe Run Road-Manheim,ZA 1.754 i l MUNICIPAL CERTIFICATE —ELECTRICAL APPROVAE, '4 Permit No,....•.. ................Geri. N 0 5 0.14 4 Cut-in(„ttrd No..,.. ........................,..... Owner....... .............. .... ........... . i ;• Location...............1..`Y.Ca...... ....rQ%tQ ...........,....•.......•.•.. ............. ...... installation Con.4uetdng L...................... L.. C4.'.i!"..4.......................................................... v ' 'tom Installed By...../�:....�,jl�a�,x�.........•.. ..............•....................Lie.No................................................... y°'l.':r'• Tho cotdilkio,,followhlg governed the issuance of this certificate,and any cerrifcate previously issued is �^i7 'r cancelled: ' This corzinum only covers the electrical equipment and installation conditions as of date. Upon the .F:• 7 �• .' � introduction ol'nddilit>nal equipment or alterations,application shall be promptly made for inspection. {" ti Inspectors or this Contpony shall have the privilege of tiiaking inspections at any time, and if its ? 4��•}}}v rulos are violated the compatty shall have the right to revoke this certificate, y' Date. „ :711.Z.'5-.. . NS ECTO .......�..�'.. ....................... . ........................................... Meniber NXM.,1.AC.1. TO 39tid O awm NOd PBST86L ZE:ET EZBZ/Ze/99