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POOL-0483-2022 SWIMMING POOL Office Use Only PERMIT APPLICATION Permit#: Town of Queensbury Permit Fee:$ Invoice#: 742 Bay Road,Queensbury,NY 12804 � P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:� Project Location: zd4 s e��. /�Gcs C��✓/ U'v�e�f � � Tax Map ID #: �� /3 -2 3 Subdivision Name: i Proposed Install Date: �- SWIMMING POOL INFORMATION (please fill out completely): ` TYPE: CHOOSE ONE: AUG 2022 TOVIi�,`CIF.' s� I - ABOVE-GROUND _ UNHEATED b�tjf Et t+.? r'��RY tyING r c,,,,,_ t,"I-N-GROUND (inc. partially) ✓4EATED (pool cover heater, R-12 req'd-T— COST OF CONSTRUCTION: -!! O,,Oov SIZE OF POOL: MANUFACTURER: MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl ✓ Fiberglass Gunite Poured Concrete ✓ Other 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: " SIGNATURE: DATE: e/ A.'17- Swimming Pool Packet Revised July 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: / / Name(s): v e� �- 6 h hy6� Mailing Address, C/S/Z: Cell Phone: ( - 6 9 3 Land Line: Email: QIZ&1cl4e .1627 ca/,21 • Primary Owners Name(s): - � i/ Mailing Address, C/S/Z: Cell Phone:_( 571 ) ,�,(o r lf?17 Land Li de: _( ) Email: ❑ Check if all work will be performed by property owner only Installer/Contractor: (List all addditio al contractors on the back of this form) Contact Name(s): �^a s AD S Contractor Trade: fob/ hdf hz Mailing Address, C/S/Z: 3V d R1-oq W wa�► T02'� �i��d9 �/y /Z S Z� Cell Phone: _(-67r ) 71/'7 - 9a '7o Land Line: _( ) Email: "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: Cell Phone: 5/4- ) 3o`7 ' a� SQr Land Line: Email: Swimming Pool Packet Revised July 2022 ---ArTE Y NTMN-HoMEOWNE RLiiLDILd oEPARTMENT ban6_-, koAse'essiure'yoo are familiar with ft Pool a ol be construed as • �E "clasurwrequirementS HE; J- ations-are, �a Iding Codes�of i Du-ar6.re(julred-td-m6et --- min V n p•ools, sna 6 fiibir- a th 0 Of lr!specfiqn. .... ...... `',�a!?�_�a'=z 1e!�-.1.�':-';.'�.;''t�.�!'r,,':�i}ftc7-=;'`.�''��'�',I�I�I I.,+.Y�L�.p.1�ma,','c�._u::e;_�1�'',!'te•Y:ij�_{�y-�"• 100 4'.Tt JK, kt 4. Oj 14 f 0 V F.71 'y "IN 00, V jz FILE -G" OPY 1 T�P 4N I-x X" i— T 4'1�' t U-9 L Y: A .1 . 301.13-2-53 POOL-0483-2022 71� Bengle, David & Colleen Abbale-Bengle 0 12 Whispering Pines Way In ground heated pool ........... Capped/ran Rod Found — — y ZONEVCREQUIREMEN/S• 1V �J Zoned._................................MDR Lot Size...............................2acr.s Minimum Lot Width.........100' Mmimum Setbacks WhisperinpPines W y Front..........._........_......30' pe3 Side...............................25' QlRear................................Z' t 560.0'ht Cappedlron Rodfomzd Rod Set 5831500" PIS '� table TV G/ectricBaz 140.00' Rod Found — Pedesta! Telephone WaterShuf 6�+ y� U 3 DEAD Pedestal REFERENCE.• .Off m Wood Stockade Fence tLlap Reference 2 v C ? \ Crvered �q earbyl.l4 \ '� L Conveyance to Patten PropertyDevelopmeny LLCbydaed datedluly 07,1116,bled in the Warren County Cl l,,Office © 2=Conaele Q 375 onju/y71,2016in hWkM87ofDeeds at Page 68. Parch CasMeter N06 4500E. NGamge MAPREFERENCF, Lands Now or Formerly of 150.00 Electric 70 Waod6iockade L Map enh'tled"MAPofSecvhnr3 ofLwd Opines Meter s James Baldauf&Lorraine Goudy Wood Frame N Fence alangProperfy Subdivision"preparedby Cou/terandMc{'atmack dated BlecRhip ' Residence O A/C Line Demmber01970,8ledin the Mnren Cozmty Clerk's 066.e Un t Ddrmway;. on December23,1970. Book 399E Page 144 `a � Lands Now or Formerly of Driveway Corner 0.35' 54.0' ti 901.19-2-54 CearofProperiyG'ne`: 41.8' O 2 Map entitled'iYfAPofScch'on No.S,Land Opines; Cldmney h IrMiam Mulready, Jr. & Tma Strong pmparedbyCoulterandMcCormactidatedFebmar Overhang IM,filed in the Ket en County Cerk's Office on De Mher WoodStvd do Book 1176 Page 283 18,1984. Fence Cearby 0.55' Tpo Septic Area 301.13-2-5P (aPprox.Per Centrado-) Shed Comer MAPNOTES AREA=21,000ts ft. Cearby0.9 r WoodShxkadeFence `nR�, 9• � 1. Boundaryinformallon.shorvnherenn was compiledhnm an vcivalfreldsurvey comerCearbya75' 'ound Cppedlron condudedon November6,2012mdMapRefe oe J&2 Eristingimprovements N83Ii500"W Rod Set- shown hereonperfielddato rollededon October 13,2016. 140.00, Shed Comer — — 2 North orientation and bearing basepe Mep Referemcs 1&2 S19Iron Pipe Found, hvmCme 128' Cearbyl.7t 3. Warren County laxparcel301.132-93. from Comer © 4. The Io don ofundergmundimproveuzm&oreav chmen&i(myexfs4 oral shownhercon, renotcertified. Theremaybeotherundergrounduh'lifies,the existence of whldh are un.(azorvn.Size and location ofall underground utllftiesmmt Qbeverbled by the appropriate authorities.The UndcrgroundFadlf6e Fmtoctive Organization must benohfied prior to ronducting testborings,exmmtion and Lands Now or Formerly of Lands Now or Formerly of I Lands Now or Formerly of mnstmctr'on. Robert Randall James A Drerel, Jr. Frannie E. Frenette 5. lhls vrveywaspmpamd;t!Moutthebenefitofmuptodateabst-ctoftido. Book 656 Page 996 Book 700 Page 844 I Book 375E Page 285 6. Repmducdon ormpying oftivs don mtmaybea violation ofcopyrightlarvunl peruzission oftheauthorandlormppr otholderfsobtained. 801.17-2-5 301.17-2-8 901.17-2-7 7. A ropyofthis doaunent Wthoutapmperapplicadon ofthesunn'yorsemboesed Allp Reference 1 seal should he assumed to be an unauthorirrd ropy. I Map ofa Final Survey s� /"^a•NmrarrnnrrayN Pinrhedlron o=e Patten Property Development,LLC Pipe Found Pmrhedl on r.�m w v�...ro zue -' — — — Pipe Found M;PN0F0UWVSflVRY W1""CCl ,,NewznRx me Damah—R-,I rveyfrrpPLLC 16028-2 ray.Na s�aut .v64NarfhSl�or—(318;Y84 Nn.-Yo k72Als _ Phmie�(SrR)7�t691 .4aE].` IOFt mu�orxavmvcroxe �.' . DAlB':)aDnR /T.O/AV2 IX4r