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applicationSWIMMING POOL PERMIT APPLICATION Office Ise Only Permit tt:-OlO4-2020 Town of Queensbury Permit Fee:$IL&D _;invoice :2540 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Notes:iProjectLocation:(9 Atevieus Nrive Gyeensury _ taxmap ivi:284.8 -1-5 4 Subdivision Name: | CONTACT INFORMATION: ©Applicant: Name(s):TOG Staple Mailing Address,C/S/2:) Cell Phone:(S18).Land Line:)Zz Email:Vangie “Fapley @ qendid Com *Primary Owner(s): Name(s):“Taner Stapley Mailing Address,C/5/2:joebadevilsDiveGuceasigerMY1St0]Cell Phone:_(S78_) = land Line:(S79)F@5-3G/yEmailttate!hop lees gmail.Conn check if all work will be performed by homeowner only Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/2: Cell Phone:_()Land Line:_() Email: **List all additional contractors on the back of this form Contact Person for Building &Code Compliance: Cell Phone:_(___)Land Email Swing Pool Packet Rewed February 2018 SWIMMING POOL INFORMATION: CIRCLE ONE:ABOVE-GROUND 7 1 size oF poot:|(p'x22 MANUFACTURER:Loydue aj MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl Fiberglass Gunite __Poured Concrete other_K Gyinu SDeclaration:|acknowledge no construction activities shall be commenced prior to issuance of a valid permit. {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.|acknowledge that I have read the application and plot plan requirements and |,or my agents,will obtain a certificate of compliance before use of the pool. Ihave read and agree to the above: PRINT NAME: SIGNATURE:batt spfao- swung P00!Packet Revised February 2019