POOL-0231-2020SWIMMING POOL PERMIT APPLICATION|o%co se ony
vce POOL =0231-2
:woo tee 5 I2E*tance #BRE782BayRoad,Queensbury,NY 12808
P:518-761-8256 wow
a Note
|
Project Location:23 Rase In.Quucnsbury ,VY
Tax Map 10%:308-(Q-2-69 Subdivision Name:He iE
CONTACT INFORMATION:
*Applicant:
Name(s)Saran Kile
Mailing Address,c/s/z,__Z3 Kase ln.Queensbury NY goy
Coll Phone (518 )33%-Fo Ly Land Line:_{)
rma Sarahkile@msn.com
:—Sarah Kile
Mailing Address,c/s/z 23 Rase Un.Quen steitiy.AYlhoCellPhone:(SI8_)33¥-FoF Land Line --Email Savah kile Umsn.Com
O Check if all work will be performed by homeowner only
.amine (°)Workers’C Baker must be submitted with this application
Contact Name(s)Northern Yaol.cca res Brett|veneraliyContractorTrPoo]insiqmatingieeeci?1 WTOW Se Souma GlensTall,IW12803
Cell Phone:(518 )Z22-517 “Land Line:_(
Email Bipoolscapes Ogmai!.com
**List all additional contractors On the back of this form
nus Coe Companies Brett Vandevwaliev"gif 222-U519 won tw
Bvpoolscapes®g@mai |-@m
+Installer/Builder:Workers’Comp documentation must be submitted with this application
contsctnianes)—COlVin Electric Terry Colvin
Contractor trade Electric
Mailing Address,C/S/Z:
CellPhone (SI)Fa1-3044 Land tine ()
Email
+Installer/Builder:Workers’Comp documentation must be submitted with this application
Contact Name(s)Precision Concrete
Contractor Trade:concrete
Mailing Address,C/S/Z:
cetlPhone (519)423 —F414 Land Line:_()
Email
+Installer/Builder:Workers’Comp documentation must be submitted with this application
Contact Name(s)..
Contractor Trade:__Mailing Address,C/S/2
CellPhone:()tand Line:()
Email.
+Installer/Builder:Workers’Comp documentation must be submitted with this application
Contact Name(s)
Contractor Trade
Mailing Address,C/S/Z
Cell Phone:_()Land Line:|)
Email
+Installer/Builder:Workers’Comp documentation must be submitted with this applic
Contact Name(s)
Contractor Trade
Mailing Address,C/5/Z
Cell Phone:(___)
Email _Land Line:_(
SWIMMINGPOOL INFORMATION:
CIRCLE ONE ABOVE GROUND IN-GROUND
sve or eon,(OK 3b
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY)
stecviny |Fiberglass Gunite Poured Concrete _other
Declaration:|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,repulations.1 acknowledge that |have read the
application and plot plan requirements and |,or my agents,will obtain a certificate of compliance before use
of the pool.
Ihave read and agree to the above
prinrname —Savah Kile
ome 5[z0[z0SIGNATURE
saan gead wa ina Vee ary 2009
i i
TOWN OF QUEENSBURY
ad BUILDING &CODES DEPT.
BRRDING BEPANTENT 308.10269 POOL-0231-2020
Baged on our limited examination,cor 5megamomenKile,Sarah
indicating Plans and sf tions are in
{ul Gomplance wih the Bulding Codes of 23 Rose Ln
‘New York State.In ground pool