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applicationSWIMMING POOL PERMIT APPLICATION Office Use Only permit #:POOL —D230 -2A0=permit Fee:$_'2 invoice #: 742 Bay Road,Queensbury,NY 12804 P:518-761-6256 www.aueensbury.net Notes: Project Location:15 Kylians Way Queensbury N.Y.12804 ‘Tax Map ID #:308.8-1-38 Subdivision Name:Click or tap here to enter text. CONTACT INFORMATION: ©Applicant: Name(s):Wayne R.Farmer Mailing Address,C/S/Z:15 Kylians Way Queensbury New York 12804 Cell Phone:(518)409-5100 Land Line:()lr Email:wrf7612801@aol.com I *Primary Owner(s):{|||JUN 02 202 0}| Name(s):Wayne R.Farmer .jyMailingAddress,C/S/Z:15 Kylians Way Queensbury New York 12804||”:Y | Cell Phone:(518)409-5100 Land Line:()~aEmail:wrf7612801@aol.com OO Check if all work will be performed by homeowner only +Installer/Builder:Workers’Comp documentation must be submitted with this application Contact Name(s):Michael J.Germain D/B/A (Upstate Enterprise) Contractor Trade:Pool Installation Mailing Address,C/S/Z:1004 Locust Grove RD Greenfield Center New York 12833 Cell Phone:()Land Line:() Email:Click or tap here to enter text. **List all additional contractors on the back of this form Contact Person for Building &Code Compliance: Cell Phone:()Land Line:() Email:Click or tap here to enter text. ous SWIMMING POOL INFORMATION: CHECK ONE:BIABOVE-GROUND ClIn-Grounp SIZE OF POOL:20’round 54”tall MANUFACTURER:Sharkline MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl &Fiberglass 0 Gunite O Poured Concrete C]Other (0 (Explain: 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.1 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: PRINT NAME:Wayne R.Farmer ‘SIGNATURE:DATE:06/01/2020 ‘Swimming Pool Packet Revised May 2020,