application;SWIMMING POOL PERMIT APPLICATION|office
Use
Only
pene:POOL O124-2920eeePermitFee:$_|1®5";invoice #:
742 Bay Road,Queensbury,NY 12804 ”®P:518-761-8256 www.queensbury.net notes 2460 __
Project Location:14 BLACKBERRY LANE,Queenbury,NY
TaxMapiD#:1 \I-\-29:2
___subdivision Name:
CONTACT INFORMATIO!
*Applicant:
Name(s):__Done Ficht Pools &SPas,inc.
N
|
Mailing Address,C/S/Z:_709 Columbia Turnpike,East Greenbush I
Cell Phone:_(518__)_461-4951 land Line:(518 _)_479-7946
Email:__JACOB.YELLEN@GMAIL.COM.
*Primary Owner(s):
Name(s):JACOB YELLEN
Mailing Address,C/S/Z:_14 BALCKBERRY LANE
Cell Phone:_(518 __)_791-3414 land Line:_(j
Email;_JACOB.YELLEN@GMAIL.COM
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);JOHN WARNER DONE RIGHT POOLS &SPAS,INC.
Contractor Trade:SWIMMING POOL INSTALLER
Mailing Address,C/S/Z:EAST GREENBUSH,NEW YORK 12061
Cell Phone:_(518__)461-4951 Land Line:_(_518-479-7946
Email:__POOLS@DRPAS.COM
**List all additional contractors on the back of this form
Contact Person for Building &Code Compliance:_JOHN WARNER
Cell Phone:_(_s18_)_461-4951 Land Line:_(_518 )461-4951
Email:
‘swimming Pool Packet Revised Febeuary 2019,
‘swi IMMING POOL INFORMATION:
CIRCLE ONE:‘ABOVE-GROUND
SIZE OF POOL:_14*30
MANUFACTURER:_Leisure Pools and Spas Manufacturing NA
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass _*Gunite Poured Concrete Other
Declaration:|acknowledge no construction activities shall be commenced prior to issuance of a valid permit.
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.
Thave read and agree to the above:
PRINT NAME:ohn 8 Warmer
‘SIGNATURE:QuBl ont pare:2924/2020
‘Swen Poot Packet etued February 2019,