applicationOffice Use Only.
Received:
SWIMMING POOL PERMIT APPLICATION ‘Tax Map ID:ApermitmustbeobtainedbeforebeginningconstructionPermitNo:fooL-0259-2020
PemitFee:—$_\DFD7
Site PlawVariance No.:
Town of Queensbury Building &Codes
4.Date:5)28|2020
2.Tax Map ID:302.Nor 1-14
3,Pool Location Address:rninrineyLn,Qusensbury,WY 12804
4,Zoning Classification:
5.Site Plan Review,Variance or Subdivision Approvals (list)
6.Property Owner:+Shut Wendell phone:518-200-4297
Mailing Address:Qui ln.
City:
7.Contractor's Name:I r +S por Phone:5]$85-1131
Mailing Address Zi oul;Ve Sc
City:all 12020 wae rermain1a
8.Contact Person for Building &Code Compliance:OSGrunig Chaer,DY
(2833
‘ABOVE-GROUND OR INGROUND?above Qround
SIZE OF POOL:Ai 52
MANUFACTURER:Summerfield
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
HEC
A cel lo
TOWN OF QUEt
BUILDING &ay
Steel/Vinyl_X Fiberglass Gunite Poured Concrete____Other.
Declaration:|acknowledge no construction activities shall be commenced prior to issuance ofa valid permit.|cerlfy 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 NY State Building Codes,local building laws and ordinances,and in conformance with local zoning regulations.|
acknowledge that |have read the application &plot plan requirements and I or my agents will obtain a cerifcate of occupancy before use
ofthe pool.
Print Name:Court
Courtney
Wendellndell
Signature
“Cknynda
pamer Date Q)28|20.20er
Tow of Queensbury Building &Codes Swimming Poo!Permit 518-761-8256