POOL-0398-2022 S
t ~
`A5, SWIMMING POOL office Use only
Po,&L- 03q T, ;6
PERMIT APPLICATION Permit#: �a
Town of Queensbury d
742 Bay Road,Queensbury,NY 12804 Permit Fee:$ Invoice#: fir' 1 n 4
P:518-761-8256 www.gueensbury.net
Flood Zone. Y 3-N Reviewed By.dl�
Project Location:
Tax Map ID #: 3 0q L5--- 1`dL Subdivision Name:
C EBY E n
Proposed Install Date: q g lx�
ill
JUN 24 2P02- �
SWIMMING POOL INFORMATION: _-- -�
TOUVN OF&E. s,IF'=<Ui2Y
CHOOSE ONE: YABOVE-GROUND _IN-GROUND BUILDING&���_
UNHEATED _HEATED (pool cover heater, R-12 req'd)
SIZE OF POOL•
MANUFACTURER: SMdSk_jj-LR-
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl 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 If,for any reason;the building permit application is withdrawn, 30%of the fee is retained by the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.
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,4Q the above:
PRINT NAME: a�
SIGNATURE: DATE: (0)931�Q
Swimming Pool Packe Revised March 2022
ATTEN-710 N' HOME
Please assi.,re you arn, familiar with the Pool
specific to your pool.
You are, to rneat all applicable codes
pools, spas & hot tubs
at the time of inspection.
L-0398-2022
309.5-1-24 Poo
Hoffer, 3eff 8L Bf'tany
lo 'Wintergreen Rd 27 ft.
Above ground Pool
TOWN OF QUEENSBURY
BUILDING & CODES EPT.
Reviewed BY:
Date:
TOWN OF QUEENSBURY
(Z' BUILDING DEPARTMENT
Based on our limited examination,-c mpliance
with our comments shall not be con trued as
indicating the plans and specificatio s are in
full compliance with the Buildina odes of
New York State.