POOL-0144-2023 ~^^
I, MtN&POOL---- Office Use Only
E C k 2 W7 E ]Permit#: Fc)o t- e; i L(q 9000
Town of Queensbury Permit Fee: Invoice#: :51:il
742 Bay Road,Queensbury,NY 12804 if APR 0 5 2023
BUILDING 6, CODE'S'
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Project Location: ^� ��.~,~ ��v� ��
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SWIMMING POOL INFORMATION (please fill out completely):
TYPE: CHOOSE ONE:
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ABOVE-GROUND UNHEATED
IN-GROUND (inc. partially) HEATED (pool cover heater, R-12 na''d.\
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COST OF [O0STRUCTI ���N� ��'��« ����^65
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SIZE OF POOL: u_4v^5-r
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MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPU ):
Steel/Vinyl X Fiberglass Gunhe Poured Concrete Other_______
| acknowledge no construction activities shall be commenced prior to issuance of valid permit.
| certify that the application, plans and supporting materials are a true and complete state nnent/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. | acknowledge that | have read the
application and plot plan requirements and |, or my agents, will obtain a certificate of compliance before use
of the pool.
| have read and agree to the above:
�8�'�|^ ��� John
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PR|NTNAK�E� ~~ `~
SIGNATURE: DATE:
Swimming Pool Packet Revised Jmr20o
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): William St John
Mailing Address, C/S/Z: 4 Boss Road, Queensbury, NY 12804
Cell Phone: _( )518-791-9698 Land Line: _(_)Same
Email:wstjohn3@gmail.com
• Primary Owner(s):
Name(s): Jeffrey MacPherson
Mailing Address, C/S/Z: 54 Bardin Drive, Queensbury, NY 12804
Cell Phone: _(518 )538-5716 Land Line: _(518 )792-0734
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): Professional Pool Installers LLC
Contractor Trade:
Mailing Address, C/S/Z: 405 Hop City Road, Ballston Spa, NY 12020
Cell Phone: _( ) Land Line: _(511424-1609)
Email:
"Workers' Comp documentation must be submitted with this application"
Contact Person for Compliance in regards to this project: William St John
Cell Phone: ( )791-9698 Land Line:
Email:wstjohn3@gmail.com
Swimming Pool Packet Revised July 2022
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o I ATTENTION HOME OWNER
Please assure you are familiar with the Pool
TOWN OF Q U E EN S B U RY z � Enclosure requirements specific to your pool.
BUILDING & C O E S D E PTo You are required to meet all applicable codes
Reviews Bye regarding swimming pools, spas & hot tubs
o Date. �
at the time of inspection.
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance k
with our comments shall not be construed as v
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.