2024-0268 SWIMMING POOL Office Use Only
PERMITI rc ���Permit#. ,2`f - 4.76 8
Tom]of Qm bury � sM L�� �} aC�->c b5
II Permit Fee:$ s'J`�b —;Invoice#: ya
742 Bay Road,Queensbury,NY 12804 MAY 31 � �t U P:518-761-8256 www.queensbury.ne: Flood Zone?. Reviewed By: C
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TOWN OF QUEENBBURY
BUILDING&CODES
Project Location: 13 L..ip ne Let ( fec456&y
Tax Map ID #: 3oa- I-1- I - /7 Subdivision Name: did 6c A��- -
Proposed Install Date: Ø / D2n
SWIMMING POOL INFORMATION (please fill out completely):
TYPE: CHOOSE ONE:
ABOVE-GROUND UNHEATED
/NGROUND (inc. partially) /HEATED (pool cover heater,R-12 req'd.)
COST OF CONSTRUCTION:,1"oodD
SIZE OF POOL: I f%CI\ )C 301
MANUFACTURER: Leis v!t foo IS
MATERIALS USED IN CONSTRUCTION ((CCHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass V 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: cr
PRINT NAME: Ce..n/ tr.R. Abri-54-rwTan
SIGNATURE: � • DATE: 5/;1 lLdi
Swimming Pool Packet Revised March 2023
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Pe-3440
Mailing Addres6, C/S/Z: I(S 1,.•de 10 I J o-n iVY /2/f0
Cell Phone: ( ) rj Land Line: ( 5-1g ) 1 3 ^ 5%2 32.
Email: Co? Ciro,pod(3 0 .sp0.i.coM
• Prima;x Owner(s):
Name(s): 4454 n w f T
Mailing Address, C/S/Z: 13 1.4«e 1-et ave. nsh�'y
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): C,�(�r�sS PocJ
Contractor Trade: l( Peel o,i4i€t
Mailing Address, C/S/Z: 115 w tovfLes ArY 1210
Cell Phone: _( Ste ) 1 o — 7'3 Land Line: _( ) -1 3 ^ S 2 3�
Email: Go47 g EyPfss O gpa6,Corp
**Workerg' Comp documentation must be submitted with this application**
Contact Person for Compliance in regards to this project: y /kdre- 34-tia00
Cell Phone: ( gig ) r./30 -1t Land Line: ( el g ) 83 — s2 32.
Email: axiytCypte55 peeig cu#450 . co,vn
Swimming Pool Packet Revised March 2023
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__- ; : _ _ Please -sure you are familiar w the Pool
Enclosu requirements specific • our pool. '
- - You are •:quired to meet all appii •le codes
- regardin 'swimming pools, spas ' hot tubs
' _ .at the ti of inspection. '
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� ' " O A 'S 302.17-1-17 2024-0268
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,.1' I ; 13 Lupine Lane
In ground heated pool
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