Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
POOL-0490-2022
• e*a SWIMMING POOL Office use Only Permit#: POOL-- pdr 0.20 ZZ PERMIT APPLICATION Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ ;Invoice#: P:518-761-8256 www.queensbury.net Flood Zone? Y61) Reviewed Bye., Project Location: 6S 4( z1ti Cewite Sekt, ,, Tax Map ID #: 2$0 . I'} ' I ' Subdivision Name: Proposed Install Date: Z Z�- [ jj - SWIMMING POOL INFORMATION (please fill out completely): AUG 04 2022 TYPE: CHOOSE ONE: I C�ir�diy UE::: �Y BUILDCNG& CODES ABOVE-GROUND _ UNHEATED VIN-GROUND (inc. partially) HEATED (pool cover heater, R-12 req'd.) COST OF CONSTRUCTION: ?Ci9 / 000 SIZE OF POOL: ig) X ZO P MANUFACTURER: art / &o'�A/6/'Jnrnci- [�I6SS MATERIALS USED IN CONSTRUCTION (CH CK ALL THAT APPLY): Steel/Vinyl Fiberglass i//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 t e above: PRINT NAME: ---Priy, h 9 SIGNATURE: K-ge4eC Cfit� rt # \IN- DATE: SI 14 2_2— Swimming Pool Packet Revised July 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: "�,, Name(s): iBc,nii J /jam 1dl t Mailing Address, C/S/Z: 5 a ` owl •4 50le. au2enjhuai 6Alf Cell Phone: ( 51S ) 7-nlf '3��'f i and Line: ( 5V Z ) 2 —Zs7f- " /e-8'cy Email: 4744 /6/le +G telAilele f c /Ye er • Primary Owner(s): Name(s): �©')/4 . i 'h f aired igea}ezcet Mailing Address, a/Z:®,'ari ats a rvie, Cell Phone: _( ) 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): fir / pre( Copprfpmice s Contractor Trade: Mailing Address, C/S/Z: '®j Sloretees / ra 4/. / fV/ Cell Phone:_( '. ) / / ; Land Line: _( Email: aobi ce74 re, !Ha/ ea/ **w• rkers' Comp •ocumentation must be submitted with this application** Contact Person for Compliance in regards to this project: ans- Cell Phone:,,(. `) 'o ,� g'S;�- Landline: ( ) Email: s�, olri Cer la 'Ey14Cd/C rw Swimming Pool Packet Revised July 2022 v r, ...,. SAL �► • /` j J pan03 v ONiaime 8 ono 40 NMOl *+ .•�� ' �•g�i w � tog 3AI3 •lea® 3a lmla W ® N t6616 it l�C j ... t LO 3 = 0 s' � ro CL �, m1,7 e� C 3 W �' 3 ffiy ,� =CD ci f 3 0ca �?S QD ID N 6 n a e sCL cr m - 8