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Office Use Only |Permit pop L-O 20 7 220 Permit Fee:$2S -Anvoice #:_ASCO} Notes: Town of Queensbury 742 Bay Road,Queensbury,NY 12804 18-761-8256 www.aueensbury.net Project Location;_16 Farmington Place,Queensb Tax Map ID #:Parcel ID:289:12-I-31 subdivision Name:Richard P.Schermethomn CONTACT INFORMATION: ©Applicant: Name(s);Shawn and Jessica Rossetti Mailing Address,C/S/Z:_16 Farmington Place Queensbury,New York 12804 Cell Phone:_(585_)330-5841 Land Line:_(518)366-4656 Email:_shawnwzrossetti@gmail.com «Primary Owner(s): Name(s):_Shawn and Jessica Rossetti Mailing Address,C/S/Z:__1 Farmington Place Queensbury,New York 12804 Cell Phone:_(_585__)_330-5841 Land Line:_(_518:366-4656 Email:shawnw.rossetti@gmail.com O Check if all work will be performed by homeowner only ssent in already +Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):Bret Vanderwalker Contractor Trade:Poo!Installation Mailing Address,C/S/Z:_16 PO Box 791,Glens Falls,NY 12801 Cell Phone:_(__518-793-9063 Land Lin Email: **List all additional contractors on the back of this form Contact Person for Building &Code Compliance:_Bret Vanderwalker Cell Phone:_(518-793-9063.Land Line:_() Emai ‘Swimming Pool Packet Revised February 2018 ‘1 ®Sending seen+Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):__Colvin Electric Contractor Trade:Flectrician Land Lin Email: k Sending Seo? +Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):Hoffman Stamped Concrete LLC Contractor Trade:Concrete Mailing Address,C/5,PO BOX 347,Hadley,NY 12835 Cell Phone:_{_518-696-2552 Land Line:_() Email: * Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: +Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s): Contractor Trade: Mailing Address,C/S/Z: Cell Phone:_().Land Line:_() Email: +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: Swimming Pool Packet evsed February 2019 SWIMMING POOL INFORMATION: CIRCLE ONE:ABOVE-GROUND IN-GROUND_) size oF poo:__1°Rx 36 MANUFACTURER:__LATHAM International _ MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): xStee!Vinyl_*Fiberglass Gunite Poured Concrete Other Declaration:|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.|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. Ihave read and agree to the above: PRINTNAME:Shaun Rocsebhs SIGNATURE:—Haun Ponebl pate:5-15-20 ‘Swimming Pool Packet Revised February 2019,