POOL-0415-2021 121
SWIMMING POOL Office Use Only
PERMIT APPLICATION Permit#:
Permit Fee: $ ; Invoice#: 56`\
742 Bay Road,Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:
Project Location: 13 Briggs Ct
Tax Map ID #:3o1.1s- Subdivision Name: queensbury forest PTOWN
1-36
Proposed Install Date: mid august 2021 2021
ENSBURY
SWIMMING POOL INFORMATION: COD`S
CHOOSE ONE: ABOVE- GROUND
SIZE OF POOL: 18X36
MANUFACTURER: Imperial Pool
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass Gunite Poured Concrete Other
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
2. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
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: Kemm E. Pemrick
SIGNATURE: DATE: 17 May 2021
Swimming Pool Packet Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Kemm & Dan Pemrick
Mailing Address, C/S/Z: 13 Briggs ct
Cell Phone: 518-744-Land Line:
6291
Email: kemmpemrick@gmail.com
Primary Owner(s):
Name(s): Kemm Pemrick
Mailing Address, C/S/Z: 13 Briggs Ct
Cell Phone:518-744-Land Line:
6291
Email: kemmpemrick@gmail.com
Check if all work will be performed by property owner only
Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s): David Barlow-Pools Plus
Contractor Trade: pool instillation
Mailing Address, C/S/Z:45 Main st Queensbury NY 12804
Cell Phonebl8-955-11tand Line: 518-793-2929
Email: MypoolsPlus@yahoo.com
"Workers' Comp documentation must be submitted with this application"
AJS
Dave Barlow
Contact Person for Compliance in regards to this project:
Cell Phone:180 955 1Land Line: 518-793-2929
Email:
mypoolsplus@yahoo.com
Swimming Pool Packet Revised December 2020
301.15-1-36 POOL-0415-2021
Pemrick, Kemm & Dan
13 Briggs Ct
In ground pool 1 �a
pECEOWIE spa
JU � ��d
N 0 1 2021
TOWN OF'QUEENSBURY
BUILDAG & CODES
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TOWN OF QUEENSBURY
I TOWN OF QUEENSBURY ��F� BUILDING DEPARTMENT
BUILDING & CODES DEPT. Based on our limited examination,comp ance
with our comments shall not be const.,, d as
indicating the plans and specification; nr6 'n
Reviewed By: I full compliance with the Building Co s of
Date: Z\ New York State.
I
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�gC
ATTENTION HOME OWNER
Please assure you are familiar with the Pool
Enclosure requirements specific to your pool. i
You are required to meet all applicable codes
regarding swimming pools, spa"_b9t tubs PRda
at the time of inspection.
3
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