POOL-0412-2022 Oil
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SW1MMI G-W0L ]--�----• -•�Office Use Only
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Qu PERM
" Permit#: AooLJla
Toxin of ecnsbury
742 Bay Road,Queensbury,NY 12804 JUL 01 2022 Permit Fee:$/7 :Invoice#:
P:518-761-8256 www.clueensbury.nel,
TOWN OF QUEENSBURY it
Flood Zone? Y Reviewed B
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BUILDING€:CODES
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Project Location: 1Pbhnei,
Tax Map ID M a?�s,If- 5.a Subdivision Name:-Vo ricn 160nncr:1 r v,e-
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Proposed Install Date:
SWIMMING POOL INFORMATION:
CHOOSE ONE: '/ABOVE-GROUND LN-GROUND
UNHEATED ✓ HEATED (pool cover heater, R-12 req'd)
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SIZE OF POOL: a �Nd
MANUFACTURER: 190o1.5
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl V 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the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:_ A ICAceI j��iYmG�
SIGNATURE: / DATE:.7//4622,
Swimming Pool Packet Revised March 2022
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