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POOL-0436-2020 e' SWIMMING POOL PERMIT APPLICATION Office Use Only Permit#: PcOu - pi (0- 202-0 Town of ry Quecnsbu Permit Fee:$ 125' ;Invoice#: 2656 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net Notes: Project Location: /1 V© vei /�p Tax Map ID#: 5o� 3 q{Q, 4 /ry/ -/( Subdivision Name: CONTACT INFORMATION: • • Applicant: Name(s): Re_heO 0 4 4- flh i`Lhae l 3 )a Lk rne r - Mailing Address, C/S/Z: 4 /1/t) Vel Cell Phone: ( 5181 ) ,310 / 'J56 '7 Land Line: (5'/i ) 79,3 - a5 Email: .6e c.ey, h/ark nere COi • Primary Owner(s): (/ Name(s): J7l Abe 00a m i'chae! I Lk me r- Mailing Address, C/S/Z: ij Al VI? A Q /7-r- Cell Phone:_( S l f ) 3 Co / - 7 56, 7 Land Line: _(5/g ) 79,3-a Cia Email: 6Ccky, b lath e rero-ma%i,-Co n-) • Installer/Builder:Business Name: (,'pYl CO rri 'Poo )5 a.jy A Spo .S Contact Name(s): 7)v''yei ri b A-in b v Mailing Address, C/S/Z: 1 3 Cv Se,)411 -13 r,iod iJa y S a r-cl1o9G ccpr,`r,q5 Af / i184, Cell Phone: ( 51 Er ) aa/ 7,3 9_" Land Line: _( I k ) R7- Email: bel,neicimhr()�'g Concor-J Too 15, rr% Contact Person for Building & Code Compliance: P1i Cell Phone:_( ) Land Line: _( ) Email: Town of Queensbury Building&Code Enforcement Revised December 2018 I Zi SWIMMING POOL INFORMATION: CIRCLE ONE: ABOVE-GROUND IN-GROUND SIZE OF POOL: la x a 6 MANUFACTURER: Let-1-h n m -P i O 1 • MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl Fiberglass X Gunite Poured Concrete Other 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: R6O IQ Cicrne i SIGNATURE: DATE: Town of Queensbury Building&Code Enforcement Revised December 2018 Z# J07 . ,of' • •Now NO3 • ' SJVYLL ... .. ,!o sr/N. SQxv • • . . • ..•4aI 1 .. • gt ID t :ova............ ' OO qt. '. 8`0u'' 'SHOO ... •• .0 / n� sty 1.:. w ,' • • II S 03 .�••- 1 o.o w �.• • Z# ZO7 A".- , rii vi z • • 41, e ..4.g.i . . ... co ,, ,,. re„ %,.. . . .... ....0 414.2 .6 gi -0 _70 c Ta. .. 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