NO. ________
VILLAGE OF DANSVILLE
TOWN OF NORTH DANSVILLE
Livingston County, New York
APPLICATION FOR SWIMMING POOL
PERMIT
DATE: ____________
APPLICABILITY:
The swimming pool procedure shall
be required for all below ground swimming pools and all above ground swimming pools with a diameter of twelve
(12) feet or greater.
INSTRUCTIONS:
A. Two (2)
COMPLETED copies of this application to be filled in by typewritter or in ink
and submitted to the Code Enforcement
Office. Any application which is missing information will be denied by the Code
Enforcement Office.
B. A Plot Plan showing location of the
swimming pool and of building on premises,
relation to public streets or
areas, and giving a DETAILED description of the layout of the property to be
drawn on the diagram which is a part
of this application.
C. Two (2) COMPLETE sets of plans showing proposed construction.
Plans shall describe the nature of the work
to be performed, detail of pool structure, mechanical, electrical, and drainage
installations. [If possible attach pool manufacturer's specification
sheet]
D. The work covered by this application
shall not be commenced before the issuance of
Pool Permit.
E. Upon approval of this application, the
Town Clerk will issue a Pool Permit to the applicant and return one (1) set of the plans and application. The
permit shall be kept on the premises during the progress of the work.
F. The Building Inspector shall have the
right to enter upon the premises for the purpose of inspection and construction covered by this application
at any time during the construction period without notice.
G. NO Swimming Pool shall be used for any
purpose whatever until a CERTIFICATE OF COMMPLIANCE has been granted by the Code Enforcement Office.
H. All wiring must be inspected by an
approved agency. All wires and fixtures must be exposed for preliminary inspection. Power Company must
be contacted for application.
I. Contact Code Enforcement Office for
inspection when [#1] pool is staked
out, [#2] at the time the water is being put into pool, [#3] when work is complete. Allow
twenty-four (24) hours for inspection.
J. TO
OWNERS: As a homeowner, you are
completely responsible for this permit. Read the Swimming Pool Ordinance. Read your Permit. Your
contractor can not be held liable by the Village of Dansville or the Town
of N. Dansville. The Building
Inspector will not be held responsible for any infraction of the pool ordinance
or this
permit.
APPLICATION IS HEREBY MADE to the Code
Enforcement Office for the issuance of a Swimming Pool Permit, pursuant to the
Dansville Town/Village Ordinance, as
herein described. The Owner agrees to comply with all applicable laws,
ordinances and regulations.
_________________________________________________________________________________________________
Signature of
Owner Address
1. Owner Name:__________________________________ Co-Owner
Name:____________________________
Owner
Address:________________________________ Owner
Phone#: _____________________________
Contractor:____________________________________ Contractor Phone#:
__________________________
2. Location of land on which the proposed work
will be done:________________________________________________
3. Tax Map
No.:____________________________________
[can be found on tax bill]
4. Make of
Pool:___________________________________________________________________________________
5. Type of Pool: In Ground:_____________ Above Ground:________________
Cement: _____________ Plastic:
________________
Other
(describe): ____________________________________________________
6. Pool Size: Length:
_______________ Width:
_____________________
Depth: _______________ # Gallons Water: _____________
7. Type of Original Soil:
_________________________________________________________________________
8. Type of Backfill:
_________________________________________________________________________
9. Type of Sidewalls:
_________________________________________________________________________
10.
Type of Bottom Base:
_________________________________________________________________________
11.
Type of Drainage around pool (describe):
_________________________________________________________
12 Type of Backwash: _________________________________________________________________________
13.
Drainage into: Storm
Sewer: _____________ Sanitary Sewer:
____________
Onto
Ground: _____________ DryWell: ____________
Other
(describe): ______________________________________
14.
Type of Filter: __________________________________ Filter Capacity:
_________________________
15.
Motor Size: HP: _________ Amp.: _________ 110______ 220
______
16.
Fence: [If not commercial fence, draw
section to scale, give gate detail]
Type:____________________________________________ Height:
___________________________
Distance of Fence from Pool:
_____________________________________________________________
17.
Gate: Width: ___________________ Height: ______________________
18.
Locking Device: Hinge
Type:_______________ Size: ______________________
19.
Post Set: Dirt_____ Cement________ Other_________
20.
Concrete Apron Base: Sand ____ Gravel
____ Bankrun ____ Thick _____ Width ______
Weight of
Mix:__________________________
Finish
___________________________
21.
Deck Above Ground:
Length________ Width________ Lumber type:______________________
Finish ___________________________________________________________________
Capable of holding _____________________
pounds.
22.
Ladder to pool: _________________________
Describe:_____________________________________________
23.
Estimated Cost of Project: $___________________
24.
On page four (4) of this application or on separate drawings, draw side view of
Pool giving shape, depth, length of base, sidewalls and liner.
25.
Name of Compensation Insurance
Carrier:__________________________________________________________
No. on
Policy:______________________________
Date of Expiration: ________________________________
26.
Name of Disability Benefits Insurance Carrier:
______________________________________________________
No. on Policy:_____________________________ Date of Expiration:
________________________________
27.
FEE(S): Pool:$___________ ZBA Pub.:$______ Varience:$_______ TOTAL:$_____________
_____________________________HEREBY
CERTIFIES THAT
HE/SHE IS THE applicant and owner named above; and that all statements
contained in this application are true to the best of his/her knowledge and
belief, and that the work will be performed in the manner set forth in this
application and in the plans and specifications filed therewith.
CONTRACTORS
CERTIFICATION: I hereby certify that
all items in the Pool Ordinance will be enforced.
_____________________________________________
Signature
of Applicant
_____________________________________________
ญญญญญญญญญญญญญญญญ Signature
of Contractor
ญญญญญญญญญ___________________________________________
Date Code Enforcement Officer
APPROVED DISAPPROVED_________________________________________
Code
Enforcement Officer
Application
is hereby made to the Code Enforcement Office for a Certificate of Compliance
for the use of the pool and premises as described above for which an application
for a pool permit has been filed.
Signed
in my presence
__________________________________________
Signature
this
___________ day of _______________, _______
____________________________________________
Code Enforcement Officer
Office
Use Only:
CERTIFICATE
OF COMPLIANCE issued on _____/_______/________ ________________________________________
Code Enforcement Officer
SITE PLAN
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