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POOL-0252-2021 SWIMMING POOL Office Use only PERMIT APPLICATION Permit#:FOCA--- b252--r:�Q2) ay oa , ueensbury,NY 12804 Permit Fee:$ 0� Invoice#: �� P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By: Project Location: Tax Map ID#: Subdivision Name: 309, Proposed Install Date: Ju NE- 41? J SWIMMING POOL INFORMATION: CHOOSE ONE: ABOVE-GROUND IN-GROUND SIZE OF POOL: J' � Ne a81 MANUFACTURER: D MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): APR 16 2021 Steel/Vinyl Fiberglass Gunite Poured Concrete Other TOWN OF QUEENSBURY BUILDING&CODES ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans prior to or during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If,for any reason, the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100%of the fee is retained. 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. 1 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:��A leer) / [ , BurT 64 SIGNATURE: DATE: Q Pt i X/ 0?0I Swimming Pool Packet Revised December 2020 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Ent o-wJ �oAleeA Bu I'�ii Mailing Address, C/S/Z: lha rb 1 )— a,n e- lCell Phone: -mrctt-trre: 41 Email: W bctr bn &1 S-0 Rukv-psbury qmcei ©,� • Primary Owner(s): �-Q 3 Name(s): _ 9 (U i' Mailing Address, C/S/Z: ��� - �,� 6 �a Cell Phone: Land in Email: Check if all work will be performed by property owner only • Installer/Builder: (List all additional contractors on the back of this form) Contact Name(s): --r� (IS F Contractor Trade: -TOOLS i � Mailing Address, C/S/Z: `1 ��b� 15 0✓1 Cell Phone: Line: Email: o -M 0-P b U r/ "Workers" Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: Cell Phone: Land Line: V` / 1 Email: F ��1 C)� 'F ) 5 US Swimming Pool Packet Revised December 2020 h � � .,jt.'- ".•:�'•,x p}^5'ys'n .n _..r' ,F 1„n��,2m Y `' 21 a e. a S c t:,fir k ,�rr`ciny,"1�Y u S j� j.�'5 .h^ x w btu f ,:5,A •j i,-� •... Y�^«t f-.,� •u a.V aaw aiY 1,'. .,`t'7'� .,?� 'S°� �=Y'� �:. . -oaf-,r},•'3i 5 " ''yi.`"' !S .*"v r. m'ti ns�'-"d ,a f �-t 'c z''�,`�, 4. 7' "tr+>. f. t• "��.. �i. ��S'�" ✓ (a.'.. ;�}� 'ti' w� (i' •.... � la�'' q a`C�X':.EG• j{`�'��:�t�'Pd.( �+f - i �yMS'�::'�1;` �iFdfi' .4�. ?.. ,. �';,yi+ x t;r4•• ( T ,;+`• C.(r..;Y,�,^� �•f �. C r,J a ,<,.ic=J• �r,,.," .-.+ >� .ir '�S7" Y �4� � r �, fk �� ?r`�4 Y'�+t���a 4 ki` c .-•s ,cl ..s1 Yr - """ ...F{' ��?�i t�"�:=n. :✓ ,r.- SO -o Y*+t,�. , --F.Jf2 r..,,�k c.- t:Y 4•- y'^•''�c -4j :iitir =,e;;�,aa •...-�.�ar -.�-s M -:;" a...i Kr•. " ry ,c.,. 4'>y `i-�,c,� y7 -ewy'�y:�'.y`�' ,,6,.sj�-'a"y{•}.-+``�`' a s-.r..� .a sl'.. �. 3 c ice-.,.M:.K r.-�;. t...1 yY S'`..- {.'� n..�::5.r�tf3-. �� a., s'S K'b 4'zs.. _�� �•rd:.ems.�... �-t� � '�;'r44��7 .^s` �.�.;`"r�-c'•�' - f fit, ' Y � �- �,�J:c� �t Ti cr�,�,i�t.. i4 si,5 "rc - .+..,. w2 -y 'F ''r, .c- i ?-, �. •.r. �-"t s ♦a... •Y`•G�- ., E" �:i� ; y' g 'L`�?zF=�' 11�.W Y a • , • 41w � - i 1 t r r J • f 'x •r � 7 i _ f / ow WSJ i4R�A •. __� WOOD FRAMED CS C6 94,602.92 sq. ft. HOUSE ----� � 0.34 acres CRUSHED STONE DRIVE O cb / / UTILITIES �CIO Z 0 L.OT 2 C9 Lt 1 00 308.6-2-4 POOL-0252-2021 ® o Burton, Kathleen & Eric ' 11 Charlton Ln In ground pool