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POOL-0000-2021 SWIMMING POOL PERMIT APPLICATION office use only Permit#: FOOL- b DOO -2021 Town ofQue�s q Permit Fee:$12 ;Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Notes: Project Location: Queensbury New York to p\ejo-4,cm-k Tax Map ID#: 302.17-3-16 Subdivision Name:Hidden Hills CONTACT INFORMATION: • Applicant: Name(s): Thomas &Ann Ryan Mailing Address, C/S/Z: 10 Pleasant Lane Queensbury N.Y. 12804 Cell Phone: (260)0927 Land Line: (518)7450973 Email: taryan@roadrunner.com Primary Owner(s): Name(s): Thomas & Ann Ryan Mailing Address, C/S/Z: 10 Pleasant Lane Queensbury N.Y. 12804 Cell Phone: (260)0927 Land Line: (518)7450973 Email: taryan@roadrunner.com ❑ Check if all work will be performed by homeowner only • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Sprague Mermaid pools c/o Michael Brancati Contractor Trade: Pools & Spa Sales &Installation Mailing Address, C/S/Z:300 Broadway, Suite#1 Fort Edward NY 12828 Cell Phone: (518)3076258 Land Line: ( 518)7479270 Email: SpraguePools @outlook.com "List all additional contractors on the back of this form Contact Person for Building & Code Compliance: Thomas & Ann Ryan Cell Phone: (518)2600927 Land Line: (518)7450973 Email: taryan@roadrunner.com Swimming Pool Packet Revised May 2020 t, • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Hoffman Stamped Concrete LLC Contractor Trade: concrete walkway for pool perimeter Mailing Address, C/S/Z: 3727 North Shore Road Hadley NY 12835 Cell Phone: ( ) Land Line: (518)6962551 Email: Click or tap here to enter text. • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Stanton Fence c/o Bill Stanton Contractor Trade: Fence sales & installation Mailing Address, C/S/Z: 97 Crawford Lane Hudson Falls NY 12839 Cell Phone: ( ) Land Line: (518)7928147 E m a i 1: Click or tap here to enter text. • Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): GBM Electric c/o Matthew Wing Contractor Trade: Electrical Contractor Mailing Address, C/S/Z: 22 Fox Hollow Lane Queensbury NY 12804 Cell Phone: ( ) Land Line: (518)6154931 Email: GBMelectricalco@outlook.com Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Simons Heating& Cooling Contractor Trade: Gas Line Contractors Mailing Address, C/S/Z: 47 Main Street Queensbury NY 12804 Cell Phone: ( ) Land Line: (518) 9551051 Email: suppot@simonshvacny.com Installer/Builder: Workers' Comp documentation must be submitted with this application Contact Name(s): Commonwealth Electrical Inspection Services c/o Ron Mumble Contractor Trade: Electrical Inspection Mailing Address, C/S/Z: 175 Doe Run Road Manheim Pa 17545 Cell Phone: ( ) Land Line: (518) 7980905 Email: Click or tap here to enter text. Swimming Pool Packet Revised May 2020 SWIMMING POOL INFORMATION: CHECK ONE: ❑ABOVE-GROUND ®IN-GROUND SIZE OF POOL: 29ft x 15ft MANUFACTURER: Imperial Pools Inc MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl ® Fiberglass ❑ Gunite ❑ Poured Concrete ® 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:Thomas Ryan SIGNATURE:Th m yan DATE: D ber 31,2020 Addl Attachments: • AV 41-2020 Ryan Resolution & Compliance Letter 11.18.2020pdf • Updated property survey conducted by Van Dusen & Steves LAND SURVEYORS dated September 29,2020 (Proposed Pool location Included) • Morning Star Excavation & Septic drawing actua/stone/pipe drain field dated 8/13/2020 Swimming Pool Packet Revised May 2020 518-793-2290. Fax#518-793-2115 E-mail:momingstarseptic@hotmail.com www.morningstarseptic.com Tic $UMVICSi Date: '' 107 Jewel Road,Gansevoort,MY 12831 TO: � s'a �r,�ry, M A P 1 F e 1 � k EE� $ i ' 3 f / � ` � Y swvr/'or~�r,-•a".ratxrw'v3u..mYaw•"cam �r _- •`1 gg A A. h