POOL-0315-2021 SWIMMING POOL office Use Only
PERMIT APPLICATION Permit#: PO® L " 0 zv1�j Z�Z
Town of Quccnsbury
742 Bay Road,Queensbury,NY 12804 Permit Fee:$ �Invoice#:3 O '
P:518-761-8256 www.gueensbury.net Flood Zone? Y N Reviewed By:
Project Location:
Tax Map ID#: Subdivision Name: g.TOWN
E vProposed Install Date: ��- o a k AY U 5 2021
OF QUEENSBURYDING&CODES
SWIMMING POOL INFORMATION:
CHOOSE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL:
MANUFACTURER: Co,,rVl✓��a�I
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl:)Fiberglass Gunite Poured Concrete Other
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 If,for any reason, the building permit application is withdrawn, 30% of the fee is retained by the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.
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 ther,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: � o^ LerI7
SIGNATURE: DATE: ��Sla1
Swimming Pool Packet Revised December 2020
Y .!A
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): �Q,grir, 1� �✓�y
Mailing Address, C/S/Z: 1 �- GAY-- T �-'
Cell Phone: Land Line: (etkkk
Email:jbte.rl y 2-(s,5 Nto.t l. covv,
• Primary Owner(s):
Name(s): '�. a'-J--e te_✓1 -j
Mailing Address, C/S/Z: lS Et1(��Z�dtg�-���u{- Q`4ue-vabcx� , Q `a4u
Cell Phone: Land Line: Ue.11� fe 1`t- 'P ' --- °t -T-+
Email:�b,��y1����;
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): %ak S w e-6-
Contractor Trade: -p w\
Mailing Address, C/S/Z:
Cell Phone: Land Line: SaS-1
Email: KU � (-aa.dr-canvier, co-v\,
"Workers' Comp documentation must be submitted with this application"
Contact Person for Compliance in regards to this project: ,�Q,[
Cell Phone: Land Line: } -
Email: bl.{-rly��Jcntio,,l c�cn
Swimming Pool Packet Revised December 2020
• Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line: Sl Sr— :� y a.— 3 S Lj ,
Email: w wA A-r N e 1 tc+rj cc l vu l . c.ovk,
**Workers' Comp docuAentation must be submitted with this application**
• Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
Swimming Pool Packet Revised December 2020
301.15-1-64 POOL-0315-2021
Bierly, Jason
I 15 Elk Ridge Rd
TOWN 0 QUEENSBURY Above ground pool
BUILDIN 37DEPARTMENT
Based on our limitc d examination,compliance
with our comments shall not be construed as
indicating the plar s and specifications are in
full compliance ith the Building Codes of
New York State.
f
MAY 0 5 2021
TOWN OF UEENSSURY ;
BUILDING 8. CO ES EPT. TOWN
O &
FQEEOD CRY
Reviewed ES
Date: I
I
ATTENTION HOME OWNER f
Please assure you are familiar with the Pool
Enclosure requirements specific to your pooll
You are required to meet all applicable 00de4
regarding swimming pools, spas & hot tubf
at.the time of inspection. I
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$ I+ ( IN FEET ) IRS IRON ROD SET
1 inch = 50 1L 'v UTILITY POLE
2 orpoo STONE WALL
—X—WIRE FENCE
I B —o=CHAIN LINK FENCE
—o WOOD FENCE
LOT 3 I a POINT
I LOT 15 F.P. FENCE POST°
h.— OVERHEAD WIRES t'
undcrero°nd n/( NOI'1 OR FORMERLY
Ilias Lands 9L/f
° b"I N8320'35"{y Peter A Osgood �"�M' l\ �k`. �; 1
$ r� 287:80 L. 1450 P. 202 6"'cl e'.. B Ii(l LT
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3s.' _ \\ MAP REFERE1SION y
34.6 loco cM sErnc TMiK�
r 1)'MAP OF A SUBDIVISION OF LAND MADE FOR FOOTHILLS BUILDERS LLC'
0I�fii'+sri-
LOT 4 !ti a ter r iond frmni _' 3 DATED URVEYO14,PREPARED BY BOLSTER AND ASSOCIATES PROFESSIONAL-
1.� Paul°Ir j ..,+• w,;n•,. msnilBunoR eox o h LAND SURVEYORS.
LOB' 94
MOTES:
w
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W 1)BASE MAP PREPARED FROM A JULY 2017 FIELD SURVEY.
p r. ABSORMON 7WICHES _ Lands 7L
`J +v 420'r '°6�EACH0.86.* AC SE " A Ha Ch¢9 2)NORTH DAIENTATIQN IS BASED ON MAP REFERENCE 1. .�
I J6.o' _— L. 1261 P. 284 3)THIS SURVEY WAS PREPARED 1M1ITHOUT THE BENEFIT OF AN ABSTRACT
OF TITLE AND IS Z 25' COVENANTS
SIDE emtDwc s£TBgp� J� OR RESTRICTIONS THEREFORE
REFCORD ANY STATEMENT OF AO ANY CTS SUCH DOCUMENT 0'
_ WOULD DISCLOSE.
N837 4)SUBJECT TO APPLICABLE LAWS AND APPROVALS OF THE TOWN,COUNTY MID STATE
w 287.86 86 REGARDING DEVELOPMENT OF LAND.
5)UNAUTHORIZED ALTERA11ON OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND
LOT 5 NEW SURVEYORS
S EALATE IS A VI DNTIION OF SECTION 7209,SUB-DIVISION 2,OF THE
YORKLOT 13 6)ONLY COPIES FROM THE ORIGINAL.OF THIS SURVEY MARKED WITH AN ORIGINAL OF THE
Lands n/f LAND SURVEYORS SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES.
Marlene F. Healey 7)UNDERGROUND UTILITIES,STRUCTURES AND FACILITIES HAVE BEEN SHOWN FROM
L. 758 P. 273 SURFACE LOCATIONS AND MEASUREMENTS OBTAINED FROM A FIELD SURVEt
THERE MAY BE OTHER UMUTIES WHICH THE EXISTENCE OF ARE NOT KNOWN.SIZE.
TYPE AND LOCATION OF ALL UTILITIES AND STRUCTURES MUST BE VERIFIED BY
PROPER AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION.CALL DIG SAFE PRIOR
Ne TO ANY EXCAVATION.
J CIEN'tER,
MAP OF A SUBVBY MADE FOR
�.; 7bwn of QueOn56ury Cotcaty of W'armn State of New York
SEPTIC SYSTEM - AS Y NACE ENGINEERING
8/2 4/2®1 F C� 34P Main Street Hadean Faita, New York 12839
Russell Pc. ftaward, PLS N.Y.S. Lie. No. 50640 1 pate; 07/31/17 1 Sheet 01 of 01
Data Seated: Scale. 1 %ach= 60 ji et Revised: 1,Dmwing J:13074L14FA
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