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SWIMMING POOL PERMIT APPLICATION Office Use Only Permit #;POOL 0251 - Ton of Qocenshary Permit Fee:$'2>_invoice ts 264A ‘742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Notes: Project Location:2.9 [Uw Rea.Inetatl\Dates #Any Sve Tax Map ID #:523400 295,/8 -)-54 Subdivision Name: : The.Pines CONTACT INFORMATION:|JUN 15 2020 ©Applicant: Name(s):Leisre nce Vos. Mailing Address,C/S/Z:_2:‘ Cell Phone:_(.5/8_)_260 -Yoz8 landline:(_5/@ )798 -0422 Email:___Yo she toadrunnere COM *Primary Owner(s): Name(s)Lawrence gude Vosh. Mailing Address,C/S/Z:DT (sez Abou Cell Phone:_()Land ine:_() Email: O Check if all work will be performed by homeowner only * Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):rer essona/fol Lwszallerns Le Contractor Trade:Peol_sasrillezion Mailing Address,C/S/2:_40S HoP Cyry Ra alsa _Spx Ay (2020 Cell Phone:_(y=ian Line:_(_576 )735-7762Email:,= **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:rence Vos Cell Phone:_(51¢)260 -Y02§Land Line:(_578)778 -ov7zEmail:__Yosh @ (nadfunper.Com ‘swimming Pool Packet Revised February 2013, * Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):BM Elere LLC Marr Jing Contractor Trade:ecressan Mailing Address,C/S/2:__49 eqay Ana RE COuansbury WY 12804 Cell Phone:_(.578 _)_€15-YI93/"Land Line:_( Email:gbmelectricalta@ outlok.com « 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 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 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 application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_() Email: Swimming Pool Packet Revised February 2019 SWIMMING POOL INFORMATIOI CIRCLE ONE:ABOVE-GROUND IN-GROUND size or Poot:LF y¥.30 oval MANUFACTURER:Sf ackline Zslanper Pools ) MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): steelWinyl__K Fiberglass Gunite Poured Concrete Other Declaration:|acknowledge no construction activities shall be commenced prior to issuance of a valid permit. \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.|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: PRINT NAME:L tore nce Vosk. ‘SIGNATURE: ‘Swimming Pool Packet Revised February 2019