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POOL-0559-2021
`T " SWIMMING POOL office Use only r='ti �•.. 2' PERMIT APPLICATION Permit#: !„s;, <; c>uc•c•,:a:•ir` Permit Fee:$ 1�tD ; Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 Flood Zone? Y N Reviewed By: Project Location: aq rhojA�p Tax Map ID#: Subdivision Name: Proposed Install Date: P4W4 ZCr2,1 SWIMMING POOL INFORMATION: CHOOSE ONE: ABOVE- GROUND IN-GROUND JUL 23 2021 TOWN OF QUEENSB SIZE OF POOL: l� x J(v BUILDING& COD`SRY MANUFACTURER: MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): teel/Vint' 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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury.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: — I Sarya l() SIGNATURE: DATE: 114`4 Swimming Pool Packet Revised December 2020 i CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: L�rn c�vlo Name(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Primary Owner(s): Mailing Address, C/S/Z: a(� rm(()501 br Q2CAS" Uy 12�b Cell Phone:51 6- Land Line: I Email: a3-lq Kw—mov-dock ( Vmccll an, 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: LIS lryl6n Sfi Cell Phone: Land Line: 618_-M_2g29 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 December 2020 ., • i n!!y- �r"7� a MMjttiYp9RRlAn@QRRIIIRM/MpIMeRgAZ'.MMNNenIMageM/n[id9n9aISCRIgmQAMHC_Q'-•Cw^.�uS.ir'faAV9CGG71:78A4f.KNYiA'JYOAYSIM�➢YY41ge;]Nf,{?]AvaCCAi7q.^,.q473AngROWRgMnTdRYNRMRYORlYSHIHHKM7SRR Ira RA7R'dm2C.t7©CgGG7:AE7C'IESOCHFLB'AOWWQpCCtRC!!RGaW3H NYRMC.tAntlllfBAgOdHdAgt¢HMRRRWNgRVRROYvgG1@A RMRtdRANHMAT.v'tin"I AYYnumils $GS'Nnw ue(law OnRQAgvCQ@iigg9Y¢YArRn:idG^.¢Gd4vOG oYaCC'@dddAGARRGgDHgNnHHYWeirY@MdN@GA11@Gd1iIWRe/G91dH11C4P¢Cq@MddlvgR@lggIDHddA3RGSAg6e!7GG8CMNq maM/RRM7rYlurmYR@v@HRRNAaROv6t:CtlMYAuGADW^:IYA&O@HBllmmgtlAammmun ACandatl6iR�7.3S§IYdQ@7dAUM,dn7ADWmWGAUx@MG9DvoRG•ldgRMeIDo[vPInnEECdaS Gi13R@Gdvfii]IgFYN6setl]IdGYnNtigo'46a'IdACLieGR21[R8W®S�M•JgGigSSIEtAI�LFL°GWGBGtlGG^.±flF�gf3gR6@06R0@!1 eCIDveebaq\Hdr R16mCRHvaCd.�Eei•EAACG'.iYeMYeltiitRgtld RID3CdAr79YGgKFvtlgKRAi'a4wlOgd•�YLpAUR18�YRYIMR1AYi1HGIDRL'gm CG.caMN!]dGKYg RgmaMA7CSCH4i QMGHRAnMFSalVS7tlL1DaR'RCg8MRfl71@GiI�BR¢@B:7®RMM/Hq@tL VB156n7g5IrRARRpIOIMCIHHriig36i1329Hi'NRNCCSYP@6A rfiG■gRrYRAAMRNYYON\GdR]:fl RAQQA@Rga7Yq/GCQRIYarRr+dGYdeaACHrn@m YAYoIIPRn lCgM9pCHAGIDSW@NIAXmmvdFlYH/dYdmtl♦;Iv3xlA?!1 :q 'Iq�'gAnWWYNRk$GdIIgm H7,�gwnldRG.'f6i]£A+C551IT.•Rt MRMAam"a Smd2GM9ggqNGR�4HHla�r AIAIwC]ZRYt".l'IggGCqBHHDG6�EmH9 AMYAIIRRGe7nCr YRDAHnHGAn.^.RYgv rCd@WRR7YQt'u'SRMRv9nflIHCBtdDaGti3.1g91gm52d@¢A'..AdY2IL.^.@ CGN'Jdfl'm YQSCtlIAAmwGllg¢^y„PCSQaC'P{.tRYfiN.7Y]IAQ[^9PRRR.gga R9YNgd6fY•imPRnRIDROGRlyMNItANHA•IfGG've1.�G'921H7CIF.Z.A."11CA'.i..sJd7.C+89b",]gGC�aMmC..y�dWi".7RGig6p AMNHDvtl ARASRMNAm'q RAIiIIIMRARIDau RARRw0iCa0.tIDNO;nNga Ga IAAY@N!ARdA['P.RmaG IN •..._•- iIaMAA[gm^`!'74.QRae6@WrdAttOl l9HJf1 tJ@LaSIiCAiiCa3Y9�Y"JmDGU125mr RP1Ha18iYpgr IJM9WAAp R'Agd J:Rg Hmd@RmDildKgdlfCffidM�nMi30(49RG:9....0'II951GIss..'7C G.vmt'e4inYSIb^.2En9 RHm RHe RdGRwrSagPaullRNRmRQ1]RRAARLYRRay�.Y(fRn RegR.'iW!in0nCR_S'Hn RL`1YGYgnliaM,� Rai@II]to@3ht]!Mi]in an g•:onadSgR9ltavd Rmnq 7fiLCF«T.O'eZ9.]a.d�a•]RrnvvnmaagRn RIDgNFJYgYAIO_9ggflRHr2@97�]].�f&SCT17CrO¢G2a dm'J!]1.O0 ARM%maidPNgH rmnRrAltlnrr MYYRG 4aCGRCR.F.p3vII:37LQW ddmnnnW.^.N■Md/adq RC31u¢4v�4"_]tlGYFNN^• :RYeWrtICPCSSdAd QRd790f]9FLNy7rdg0kHdt319MHa6d^9An.IgwN ^:iSEd R5ii4'9"u'."�iag AYR6lRL'RRRRgdYGER9av1¢KRIIIISSnYMY NMimi9"JHRG$M4Bv'a i7ffiRJSCGKd2q ¢ggRY\RYAARARNC■HWd:IRnROCCRWCQCQIDdgDH■OANIIq¢@dagmkkHDgQRAYNmraGHnad" CYR@CHNPeatARC9tlaBCCOC:.'7CCCO�SGDG7t]GInOOagq .^ISIDSJO9mfIllRGYou+IY{Yi'gYYGi➢OCCG7CQ1_'GOCC7'!!7HHHCeG^_HC7CC^_Cd7GCRCkGHHNGCRQgGGBG= ID'"ae9 nngnumgRMRAMRmnqlnS'F■NerwreeAN■rNa■rrrrlllruu���u�rrl��rrereelon, N�Nmmmmm \e■ANNr1NrNNNrNruINNrNNrNONrerlrNlrr\rA■■rw■Nrr1Nw■r■rrA\rwNNO\urNArrruulerueur■rr■raNrrNrlulrrrNrr�■AN NMHAggqnrmetl/Adrvl:c\'!lrlrrrrrrrMruuulu,F'•, - -' -■ew1NwNNNNwe■■N■rwNlruwlueewwuw■eeereeeeeuwwuewl/wrNNluwuewuNwuN lwe/uwurwwNNNOuruluerewuN/rue all 'low lwwwlrrrrrlN/wNAwNNUN■r/rrwrrNrNN■NeNr■■e■N\NN\r\■rr/r■NNrNrrreeNNNNUNe\■//uwllNw!■A■■N■uurArAwwNrNrrurr pq@OO61iQadOap911llmf1O11t�MMM����e � r���nrir•��������.�.e....���tN � � ����'��\�Ur ,e � ����u���������ri\������\��taN �/■■��t����������wmum:m:: MH4M0igIN]c9114DR,, Ym 711l�IrIM�111� nM:: ifiiiiiirlrruuururlruuuurrl��r��lillliii'iiiiiilrliiiiAiiiiirl�l HIw1��U�����m����/iii�Nii�ririiiii����111i�81HU �iINIC��������i������ir��� aRRHRYMeRwgrClnnnL'RiNrrr■rrurrNNreurNUNINN ewwNr rrrlrlMrrw!!r■erullll■wwur/uwNlNNrrue�NulN■rwurrulu/ewwr/ewrrurweNe/■uuNNeer■■rwNwuwereeuuNrrue wugdumRNrewlrw¢OOltleruerrurN/wNl■N1Nwlwltwr■■! 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