POOL-0351-2021 !1. l
SWIMMING POOL office Use only
PERMIT APPLICATION Permit#:1i
Permit Fee:$ '�' :I voice#:
7�42 Bay Roa ,Queensbury,fUY 12804 —T—
P:518-761-8256 vfwvf.Queensburv.net Flood Zone? Y eviewed
Project Location: 49--FJ kk6&0'
315. --V_2_cl -2-- 2
Tax Map ID#: Subdivision Name: D 15 C E 4
Proposed Install Date: MAY
12 2021
TOWN OF QUEEN
B SgURY
SWIMMING POOL INFORMATION: BUILDING& CODES
CHOOSE ONE: ABOVE- GROUND IN-GROUND
SIZE OF POOL: /6'k ?6� 1
MANUFACTURER: C press
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
feel/Vin I Fiberglass Gunite Poured C�_ oncre etO Other
ADbIITIONAL 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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the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 1, or my agents, will obtain a certificate of compliance before use
of the pool.
I have read and agree to the above:
1
PRINT NAME:
SIGNATUR . f _ DATE:
r
r
Swimming Pool Packet
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: `
Mailing Address, CIS/I:
Cell Pho e:,"jr�-�•
Email: svt R-( a „ �w^
• Primary Owner(s):
Name(s): ►3-S �) b a v z--
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): &t,t P-v� �L.-1 , V°'12.
Contractor Trade: ti �sS �7�� S
10
Mailing Address, C/S/Z � f'`""`jf !`��L
Cell Phone: land Line:
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 December 2020
• Installer Builder: (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade: �, .�r✓ka 1 �J'�t�-
Mailing Address, C/S/Z:
Cell Phone: =4!4,
Email: ' )ly'-e 6 b 0 el C'7L" /rv\ C-,::)irL^-
Workers Comp documentation must be submitted with this application**
• 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:
Email:
**Workers' Comp documentation must be submitted with this application**
• 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:
Email:
**Workers' Comp documentation must be submitted with this application**
• 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:
Email:
**Workers' Comp documentation must be submitted with this application**
Swimming Pool Packet Revised December 2020
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance �„'„ •.
with our comments sh Il not be construed as
r�, p indicating the
�epanspd specifications a irk" i,�
D full Yorls . with Build s of F I C COPY
MAY 1 2 2q i
TOWN�QUE r ,
BUILDI
ATTENTI&A E OWNER
assure yo are familiar with the P ! = j: �•°` . o Sc ��"
o
n l ure requlrem nts specific to your.p®0
ou are required to eat all applicab es �•
ardin swimming ools, s pit tubs
at a timb of inspects
µ �l1 eaJ, f, . .. t ;14� 4 ® 3a
{ �' �_�D\`�$`\\ •' � ter. -_�__.,,.._ - I
1,54
TOWN C) lE B
BUILDING
Reviewed By: 'r
Date: 2,1
cry►""•`� = 1 � �==f�tiC,-'i'� ==-�����a�`�
315.7-2-92 POOL-0351-2021 -- —�-
Sinclair, David - _�---_ - _ - -- —TOR
i :135 Hudson Pointe Blvd � =
In ground poolvcc- = tsy