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oe SWIMMING POOL PERMIT APPLICATION|otfice use Only Permits:POO)=O228 “DBZaPermitFee:$12_;invoice #: 742 Bay Road,Queensbury,NY 12804 P:518-761-6256 www.queensbury.net Notes —— Project Location:_23 Hidden Hills Dr Tax Map ID 302.17-2-46 ____Subdivision Name:__Hidden Hills CONTACT INFORMATION: *Applicant: Name(s):_Jason and Kent Nelson Mailing Address,C/S/Z:__23 Hidden Hills Dr,Queensbury,NY 12804 Cell Phone:_(518 _)709-4256 Land Line:_()|Email:jasonandkent@nelson518.com ©Primary Owner(s): Name(s):_Jason and Kent Nelson Mailing Address,C/S/2:__23 Hidden Hills Dr,Queensbury,NY 12804 Cell Phone:_(_518_)709-4256 Land Line:_() Email:___jasonandkent@nelson518.com O Check if all work will be performed by homeowner only +Installer/Builder:Workers’Comp documentation must be submitted withthisapplication Contact Name(s}:Sandra Barlow Contractor Trade:Barlow Pools inc_d/b/a Pools Plus Mailing Address,C/S/2:_45 Main St,Queensbury,NY 12804 Cell Phone:_(land Line:_(_518)793-2029 Email:__mypoolsplus @ yahoo.com ‘List all additional contractors on the back of this form Contact Person for Building &Code Compliance:_Jason and Kent Nelson 518 )709-4256 Land Cine:_¢D Email:___jasonandkent@nelson518.com Ssemming ot Packat Ina etry 2038 my SWIMMING POOL INFORMATIOI CIRCLE ONE:ABOVE-GROUND SIZEOF POOL;12x24 MANUFACTURER:Imperial Pools _ MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Stee//Vinyi_X Fiberglass Gunite ____Poured Concrete Other Declaration:|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 |have read the application and plot plan requirements and |,or my agents,will obtain a certificate of compliance before use of the pool. "have read and agree to the above: PRINT NAME:Jason P.Nelson NelsorhkT=owe.5/20/2023‘SIGNATURE: vd ebroay 2019