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POOL-0325-2022 r SWIMMING POOL Office Use Only Town or Z b-' PERMIT APPLICATION Permit#: idt l_ 6 32S - 2a ZZ 742 gay Road,Queensbury, P.518-761-8256 sNY 12804 Permit Fee:$ ;Invoice#: 4°115 �^'Ww. ueensbur .net Flood Zone? Y Reviewed ByC ______4) Project Location: -j C a -e-utb tml Tax Map ID #: Subdivision Name: Proposed Install Date: I Z O Z Z -� , E c E tl VI 11.... \) , SWIMMING POOL INFORMATION: D tINY 2 6 �,022CHOOSE ONE: ABOVE-GROUND -GR UN UNHEATED • N 0 � }���, s HEAT D (p.Pa 199.91 ` SIZE OF POOL: 7 0 �( 1 1 MANUFACTURER: 1(Y��Q y�j(L` ROC)\S MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl / Fiberglass / Gunite Poured Concrete / Other Linter 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 If, for anyreason, the buildingapplication30% by permit is withdrawn, of the fee is retained the Town of Queensbury.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: '� U-k_ ULL �iorre iGL DATE: S- Z(SIGNATURE: Q—Z.Z Revised March 2022 Swimming Pool Packet CONTgCT IiVF®ItMATIOIV: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • A licant: Name(s): -44- 0I-e. r Mailing Address,C S I , (� (vN I ZZoLi/ � 3 Mi ihaP1C I�r- , � �.tPP h,Chi Cell Phone: S► ) 7-142- () I Land Line: ( Email: COrrei vtcti I • Primary Owner(s): Name(s): Mailing Address, C/S/Z: i3 ►��C.1�tii \ fir. auf.e.vv,b l - oLf Cell Phone: _( 517 ) - 0 13-3- Land Line: _( Email: ❑ Check if all work will be performed by property owner only • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): \�s Contractor Trade: p_ CAq„ "Pc)(-) . Mailing Address, C/S/Z: L 5 NoOv\ ,5 - (\ AA I Cell Phone: ( ) - Z9 Z1 Land Line: ( u ) Email: 1(\c\ _! VD(11 S 1 (� cvinoo. COY I **Workers' u5 Comp ddcumentation must be submitted with this application** Contact Person for Compliance in regards to this project: -- H uu..1 at- '- °-- Cell Phone: (SI3 ) 1c4 Z. -0137- Land Line: ( 4 Email: \'1 . (0YY-eicL . tc < cQ . o Swimming Pool Packet Revised March 2022 - I • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): 'V5Contact Name(s): Tc-dAS Contractor Trade: No ©� Mailing Address, C/S/Z: 45 1\4a I 1AOQ (2-36 c Cell Phone:_(5 l ) 3 ' 2.9 2-9 Land Line: _6 ' . ) Email*my cnn1sv��a@�u. Workers Comp documentation must be submitted with this application** • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): LStrio-ktn .YI( 4 Contractor Trade: --Qnc'►1q Mailing Address, C/S/Z: 9 J C✓cuW-covc.l LYI,, 1-.iA 8,SOn Wt_IIS '4 (2g31 Cell Phone:_(5$ ) 9-9 Z-"814/7- Land Line: _( ) Email: **Workers' Comp documentation must be submitted with this application** • Installer/Contractor: (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/Contractor: (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 March 2022 TOWN OF QUEENSBURY BUILDING DEPARTMENT ja �� """' Based on our limited examination,compliance FI copy D E �,' °_ ' E with our comments shall not be construed as indicating the plans and specifications are in full compliance with the Building Codes of MAY 2 6 2022__,_ _ New York State. TOWP! OF OGUEERISBURY L Bl11LDIi�C& CODES ��-(,� A R1-ef- -( t C1�Yo- e U� l. T ...) / -..-- • s..."..--- _________----"---) So F A NTIO-N HO I E OWNER (� r to y Please assure you are fa' iliar with other Pool Enclosure requirements s ecificlicable codes 0 0�S s?. You are require mtn meeti.11 spas & hot tubs . \A regarding swim g P at the time of Ins.-ctIon. � a V 'il 1 iv, l i i t 'pp( ' Io N F QUEF SBUR\( -_ .gib r 1 IG ES E�Te - ;, 9'(\ ReviewetY.: -- - —.------,:: :,:,,;',_..,,.''-';-:44,'-k:,,::;,:'::,i-:. G :R1--\ C Date: : , -:::-, % •,;_,r-,,,;',45,, :;-i-7',, 3 .., 08.6-1-19 POOL-0325-2022 1` • Cornea, Hayley &James O'Brien 13 Michaels Dr ' In ground heated pool