application S
SWIMMING POOL PERMIT APPLICATION office Use Only
Permit#: ?00 _ _O 3 ' 2(6 2 3
Town of Queensbury Permit Fee:$ t- ;Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Notes:
Project Location: 1 Dartmore Drive
Tax Map ID#: 295.19-3-8 Subdivision Name:Fox Hollow
CONTACT INFORMATION: D E ( p ' IE -,
• Applicant: JUL 2 0 2020 j
Name(s):Ronald Lamy -�
Mailing Address, C/S/Z: 1 Dartmore Dr,Queensbury,NY 12804 TOWN OF QUEENSBURY
Cell Phone:(518)944 4624 Land Line: ( ) BUILDING& CODES
Email: ron.laure@hotmail.com
• Primary Owner(s):
Name(s): Ronald F and Laure A Lamy
Mailing Address, C/S/Z: 1 Dartmore Dr,Queensbury,NY 12804
Cell Phone: (518)944 4624 Land Line: (518)338 3540
Email: ron.laure@hotmaiLcom
❑ Check if all work will be performed by homeowner only
• Installer/Builder:Workers' Comp documentation must be submitted with this application
Contact Name(s): Pools Plus I Dave Barlow
Contractor Trade: Pool Installation
Mailing Address, C/S/Z: 45 Main St,Queensbury,NY 12804
Cell Phone: ( ) Land Line: ( 518)793-2929
Email: mypoolsplus@yahoo.com
**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.
Swimming Pool Packet Revised May 2020
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SWIMMING POOL INFORMATION:
CHECK ONE: ❑ABOVE- GROUND MIN-GROUND
SIZE OF POOL: 18'x 36'
MANUFACTURER: Platinum/Imperial Pools
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl ® Fiberglass ® Gunite ❑
Poured Concrete Z Other ❑ (Explain:
Declaration: I 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. I acknowledge that I have read the
application and plot plan requirements and I, or my agents, will obtain a certificate of compliance before use
of the pool.
I have read and agree to the above:
PRINT NAME: Ronald F. Lamy
SIGNATURE: Click or tap here to enter text. DATE: 07/16/2020
7.4r
Swimming Pool Packet Revised May 2020