POOL-0288-2023 SWIMMING POOL office Use only
PERMIT APPLICATION
Permit#:
Town of Queensbury f
Permit Fee:$ Invoice#: (CA
Bay Road,Queensbury,NY 12804 ; b
P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:
Project Location: 10 Zchimcnd h l L\ . QUtj2 1WUJ6T
Tax Map ID #: 303'7�7 J Subdivision Name:
Proposed Install Date: J U ne 2 2U2�
SWIMMING POOL INFORMATION (please fill out completely):
TYPE CHOOSE ONE:
VABOVE-GROUND UNHEATED
IN-GROUND (inc. partially) _HEATED-(pool cover heater, R-12 req'd.)
COST OF CONSTRUCTION: 5.00 ��q�' � 1
Q f 2023
SIZE OF POOL: 29 1- 08
MANUFACTURER: S 'i rV_110 ! ^ fP CODE-:,
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): /
Steel/Vinyl Fiberglass Gunite Poured-Concrete Other v
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: �Wsaan—Hx
SIGNATURE: DATE: d 9
Swimming Pool Packet Revised July 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z: i Jq m cnd, 1 I. ER r Z��
Cell Phone: )SI S --�I Land Line:
Email: ,SC1VVI'I"i L(/1 �gn-) 1Cq 6-)9cl 00-n
• Primary Owners :
Name(s):
Mailing Address, C/S/Z: & 7 �G l & r, 28 a�L
Cell Phone:_( Ip/b ) �]��I / / l:,-/ Land Line: _( )
Email:- (,lJh )+e 1 d - ) e cL1 e cw"
❑ 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): 11 oter ) S j S '
Contractor Trade: / Gf f.C4 1
Mailing Address, C/S/Z: 3 jNVJIL4pL eda- � - Ve ,I)G1 /��'� ,�'01L 12�20
Cell Phone:_( ) Land Line: "3
Email:
"Workers' Comp documentation must be submitted with this application"
Contact Person for Compliance in regards to this project: I en , 1&e oz—
Cell Phone: ) )5a 5 50 Land Line: (Q 2
Email: 1 GI, x. Cow
Swimming Pool Packet Revised July 2022
E ' 308.7-1-52 POOL
_ __y
201 Whitey Samantha &7ash��LEE
%r 67 Richmond Hill Dr
U
OF nU R�r
Above ground pool '
�3UILDINGOWN
QUEENSBU
BUILDI DEPARTME ����"'"
B d on our If d examination, m lianc �4 �✓ .
ith our corn s shall not be c f � �indicath the struued as . '7
F
9 ns and sppecificat s are in �kvi� -
full compli with the B
uilding des of t 1�
ate.
V ND
HILL DRI17
teie reo o CAW
105.0 N0a a43 8 0011E .:
ATT NT20 HOME OWNER *
o CAN
Please sur you are familiar with the Pool F,
Enclosu re fire ents specific to our , ;- ' IT PLO
Pe. Y pool. i;��,:.- , E. ' ALLY
You are uired t meet all applicable codes I:I ..1- 1. DISTA
a g swimm g pools,.spas & hot tubs t_ w P Y
''�;u.�% � Cr S 7
at th ction. U
roRcti
pq3 j 9
1
30.0
3 2 STORY WOOD
C _ FRAME HOUSE
O 00 •
LANDS N/F OR
TRA-TOV DEVELOPMENT.
OT 5 3
' AREA
20,4 . .DO sq., ft.
�'Q 0.47 acre4's
SOWN OF QUEENSBURY
BUILDING A COD[;,$ DEPT.
Reviewed By:
' Date:
.. NO CUT
ZONE
— ros.00,
I
J }: ,
D` ES E. ML1 �
POOL PRODUCTS
INSTRUCTION MANUAL
MODE D'EM-PLOI
MANUAL DE INSTRUCCIONES
POOL WATCH SWIMMING POOL ALARM
MODEL NUMBER
AC 50032
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Thank you for choosing Blue Torrent!
PLEASE READ BEFORE RETURNING THIS
PRODUCT FOR ANY REASON.
SAVE THIS MANUAL FOR FUTURE
. RFR�R�'NC'F
r
i
ORRENT
BLUE
POOL PRODUCTS o
BLACK DIAMONDTm FILTER SYSTEM
BLACK DIAMOND TM
Cartridge Filter Systems
High Flow Central Core
leant ban4g supponmM"azs
1M t Y
Available in 6 Sizes
Black Diamond""Cartridge Filters are designed and engineered N,nwp•a Ath"""p"" "°""•
from the inside out.Power,Precision and Performance to give
you clean water for your pool.
• 1 Piece ABS Spin-off Lid and Locking Ring' . .
• Finest Quality Cartridge Material 3
• Extra Capacity Cartridge with Fiber-Mesh Reinforced End Caps
• . Holds More Dirt,Creating Longer Filter Cycles and.Less
Servicing
• 2 Isolation Gate Valves Exterior Pleat Support Banding
• Built-in Auto-Actuated Check Valve • The Highest Flow Rates
• Top Mounted Easy to Read Pressure Gauge • Maximum Distribution of Dirt&Debris
• Longer Filter Cydes
• Easy Cleaning
a • Longer 6rtddge Life
CARTRIDGE FILTER
MODEL A B C D E GALLONS Patents Pending
�——
PER MIN Filter box-box 1 of 2
BS PRC30DB 18.1" 4.7 2.75" 10.5" 10.9" 25 GPM
I
BS PRC60DB 22,4" 4.7" 2.75" 10.5" 10.9" 35 GPM
BS PRC901313 27.9" 4.7" 2.75" 10.5" 10.9" 50 GPM
BS PRC120DB 31.8" 4.7" 2.75" 10.5" 10.9" 70 GPM
rr
BS PRC150D6 39.3 4.7. 2.75 10.5 10.9 100 GPM
,y
BS PRC180DB 43.2" 4.7" 2.75" 10.5" 109" 120 GPM
www.bluetorrentpoolproducts.com Base box-box 2of2
0 2015 BlueTorrent Pool Products/Asia Connection LLC Patents Pending SPCSHT16-BLKDIA
5
'DO.-MI -NICA
. IN POOL A-FRAME RESIN LADDER .
Fits Above Ground Pools From 48 to. 54
Wide, Non-Slip Platform
Internal Safety Barrier Conforms to ANSI/
JI
APSP Barrier Standards
Flip-Up Outside Barrier
Prevents Entry To Pool Area
x
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WHAT.-BROUGHT-YOU IN: LOCATION:
❑ Repeat Customer El Albin
❑ Referral S18 4 56-0958
PO -LS &-SPAS 1NC ( )..
Internet , Balls,to..' ; ..
n Spa'
ake,Sta ing Home Fun!"
• '- � TV/Radio
SWIMMING:POOL CONTRACT 17 'Newspaper
NAME:: DATE:
w ►.
:.
ADDRESS: > '' SOLD-
',
CITY: : :STATE:.. ZIP:
:Q+ KN
PHONE.# . CELL:.'.. .:g --HOME. -WORK: '
E-MAIL ADDR':.
�:
0
BRAND: I hat lcline, D Radiant
SIZE: .. .'.. :i. .:. ..' ... ." .. .
7 52" ❑'84" MODEL:
LINER:; k.Boulder O,Liberty p Marquis $
INSTALL::Above; Ei:Semi 0 Inground ;._COPING:,.. $
FILTERSYSTEM; . Cartridge. ''Sand (] DE' ❑ Pump ❑ Timer ❑ 2$peed $
PLUMBING fCIT; ❑Std._Corrugated 'Clamped:' Deluxe PVC W/Valves . . $
LADDER: o.Safety' XLadder%Step ❑,Double Step: ❑ 'Deck - 0 Step 0 Wedding 0 Inground'
START=UP CHEMICAL,KIT:` ❑ Chlorine ❑`Simple Blue X Simple.Salt.: $ ilyU
ACCESSORIES: : A Skimmer. A Cleaning Equipment; ❑ Auto Chlorinator �
Liquid Solar Cover ❑'Solar Cover- D(Winter-CoVer, ❑ Rock Stopper $
AUTOMATIC VACUUM:. 0-Active 10 ❑ C 11�'P tN ESL 1' $
LIGHT: ❑ Smart Lite ❑ "Radiant Tfiru Wall 1 / 2 w/Remote ❑ Other: $.
HEATER: ❑ Gas: Pro /_ Nat ❑ Heat Pump:. $ .
OTHER; - . _ �• t
ALARM: ❑.'None ASTM Approved Alarm„ $. .
•
The NYS pooi.alarm requlrement has been-explained to me. I understand that I must'have an•ASTM.approved alarm MATERIALS
installed to meet cede:I have opted.6ai'to purchase this required safety device and will meet this requirement on my own.
.Sub Total
CUSTOMER SIGNATURE DATE. .
Tax _°/D
INSTALLATION.: Estirna' te-Only- Not Included in Price of Pool Materials
installation'done,by an.indeperident irtstallerand,as such,fee is paid,directly to that installer. LABOR Total
INCLUDED _ NOT1 CLUDED ` , Pool Install $ , �!
Sand&-Blocks &'Refnoval of Dirt from Yard :
�'..up.to 6"Expavation �..11Vatetfd Fill Pool Balance
Fence if Needed . " Balance,—DUe ,$
Q.Removal of.Bozes. _ � _
A ectlristallation On orAbout:. G� 1a. See Reverse
Must be paid l o days prior to.detwryl
(Weather PerrtMttln
In addition to any right'othe"rwise to revoke an offer;owner may cancel home Improvement
Contract until midnight of the thud business day,after which contract Is.bi iding:Cancellation V.
occurs when Written notice Is'received.The terms on.the reverse side are part of this contract. '
J" customer;SG tdre
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. -WHITE+BOOKKEEPING' GREEN-CUSTOMER _ YELLOW.-BINDER PINK-DELIVERY. - - GOLD-SILLESMAN '