POOL-0496-2021 SWIMMING POOL office Use only
PERMIT APPLICATION
s Permit#: Fool-- 4474'-.go,—(
ay oa , ueensbury,NY 12804 Permit Fee:$ tq'0.0-: Invoice#:- 3,q i L
P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By:
Project Location: /✓f� j� ��� ��j�
Tax Map ID M Subdivision Name:
Proposed Install Date:
SWIMMING POOL INFORMATION:
CHOOSE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: 1 L-2 X 3�Z
MANUFACTURER: 2 U IE
4
MATERIA USED IN CONSTRUCTION (CHECK ALL THAT APPLY): JUN 3 O 2021
Steel/Vinyl , iberglass Gunite P�on_cre__t�e . Other — --
TOWN OF QUEENSSURY
BUILDING& CODES
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 If, for any reason, the building permit.application is withdrawn, 30% of the fee is retained by the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 ce+rtify 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:
SIGNATURE: DATE:
Swimming Pool Packet Revised December2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
e Applicant:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Primary Owner(s):
Name(s):
Mailing Address, C S/Z:
Cell Phone: Land Line:
Email:
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):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line: 5- 7,6- 2.7
Email:
"Workers' Comp documentation must be submitted with this application"
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
Swimming Pool Packet Revised December2020
T4W :taF>QUEENSBURY
:w -TO
BUILDING DEPARTMENT
Based on our limited examination,compliance
A EN`�ION NOME`OWNER1 —with our-,comments shall not be construed as
N Ahdicating,!,the'plans'Snd-'s•ecifications are in
` `` i full compliance with thefuildin
Please assure you are familiar With the pool;.; g `Codes of;
Enclosure requirements specific to bur ` {:3'= New York State. ;
„ :
You are required to meet all applicabetcod&; {
regarding swi n9 p
reg 9 mmi pools spas hotrttii ,s
at the time of nspactlon: mw . k
TOW 'OF QUEENSBURY
BUIL INN & C � S EPTa
Revii%.e ed By,
DateYl
Rf
'.•7
i., ;a
3 0 2021
SUN-
TOWN OF QUECNSBURY I{.,
BUILDING. COD
302-8-2-76
McGrath, Nicole POOL-0496-2021 _
37 Meadowbrook Rd
n ground pool
r