application ,.,— ", SWIMMING POOL PERMIT APPLICATION office use only
Q
,., Permit#: (POD i - c)-�"-1 -,)-C l q
Town off 3eerasbirr Permit Fee:$ t ;Invoice#: i,4 3
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Notes:
Project Location: 39 Glenmar Drive
Tax Map ID #: 290.6-1-51 Subdivision Name:
CONTACT INFORMATION: (-
1I ; APR 252019 Ili
• Applicant: 1 L m!
Name(s): Jeffrey Soldato / Erica Soldato € "y xY-� --��
Mailing Address, C/S/Z: 39 Glenmar Drive u s o I N/ /'&11 €3i iLDiNG& c;o ,AE
Cell Phone: (413 ) 347-7793 Land Line: ( 518 ) 636-5563
Email: jeffsoldato@gmail.com
• Primary Owner(s):
Name(s): Same as applicant
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
❑ Check if all work will be performed by homeowner only
• Installer/Builder: Workers' Comp documentation must be submitted with this application
Contact Name(s): Adirondack Pools &Spas
Contractor Trade: Pool
Mailing Address, C/S/Z: 5 Boulevard
Cell Phone: _( ) Land Line: ( 518 ) 798-5552
Email: info@adirondackpool.com
**List all additional contractors on the back of this form
Contact Person for Building & Code Compliance: AcQ dc.e�.Y,�
Cell Phone: ( ) Land Line: ( ' )
Email:
Swimming Pool Packet Revised February 2019
SWIMMING POOL INFORMATION:
CIRCLE ONE: ABOVE- GROUND IN-GROUND"
SIZE OF POOL: 20'x 40'
MANUFACTURER: Latham Steel
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl X Fiberglass Gunite Poured Concrete X 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: Jeffrey Soldato
SIGNATURE: 7 • DATE: 4-24-2019
Swimming Pool Packet Revised February 2019