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POOL-0443-2021 SWIMMING POOL Office Use only PERMIT APPLICATION Permit#: Town Qf Queens Uy 2 Invoice#: 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ �R� ; rJB P:518-761-8256 www.queensbury-net Flood Zone? Y N Reviewed By: Project Location: Tax Map ID#: �� I� Subdivision Name: Proposed Install Date: `� Zo Z rp SWIMMING POOL INFORMATION: SUN 0 9 2021 T CHOOSE ONE: ABOVE-GROUND IN-GROUN 8U�Ql14'�USS�SBURy & cODcS SIZE OF POOL: 20 MANUFACTURER: premier I S 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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury.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. 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: p I n rte4 �trfard SIGNATURE: DATE: �l Swimming Pool Packet Revised December 2020 V CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): ftwindo &(rurd Mailing Address, C/S/Z: ( TL)th l l 1 1 00,01 Cell Phone: ( f O ) Z 3 2^S9S� Land Line: Email: Q.VYIarl hI CPmigI'l-(100 • Primary Ownerlsl: Name(s): Mailing Address C/S/Z: I I JTh i I I fz o Cell Phone:_( ) Z�Z- S9S(o Land Line: _( } 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): PQQIS P1 US— So {'1dmi Ba-acml Contractor Trade: Mailing Address, C/S/Z: +5 mot t1 sTree A Cell Phone: _(.u. S— 21 z9 Land Line: _( } Email: **Workers' Comp documentation must be submitted with this application** Contact Person for Compliance in regards to this project: Sandrol barlc� Cell Phone:) qb,- 2-g2R Land Line: �) Email: Swimming Pool Packet Revised December 2020 rn -4D � CEov � N �_ c JUN p g 21V1 MAPN0ILS m -o • r= '•'� 0 0 0 (p O Z O 1. Boundmyand Topographiclnformabonshown hennas wesmmpRedfromMepRe(—_I, LJ' 0 C �p�j L �O an actual BetdsmveycanduchdonApril16,20he % 2L -" 8 m Z WN OF�UEENSBU 2. North adentation andbaaringbaseperMapRef.l. m —n BUIL©IN St� R 0 ze"'t'7 & COLltS 3. Warren Countytaxpan:&M7.-1,8. ID eN C M�yy n 9. 7heloratloo ofundergrormdimpmvemmds or encnechments,ifanye%is4 orasshown < G — T ) �00 C Q. hercort,are notcertifed.7heremaybe other underground utigtiey,lheepster+re ofwhich 1„ 3 0 O are unknown.Size endfowdm ofaRunderSmmd ut&tre mustbe verified by the 0 rn (p A appropriateauthoritles.The Underground Facilities Protective Organimtionmustbenodfled 3 �C Qj-•°•O O �� prlorioronductingtestborings,ezcavallonandronstmedon% I 7��C CO i�'D�_•r� Ihissumeywaspmparedwithouttheh—,6,ofan upto/teabstractoftitle. vi '1 T �ry V' CD O� �g q'v' � y��;ZQ S06°10'41"4V G7evationsmJative Maassua+eddatum ;/ 0 �'• 0 tfr n�T 295.68' 0 Horizontal roordbumeand elevation units ere U.S surveyfeet. 3 ��41 V S O•g g mm ® Reproductimorropyingofthisdac mtmaybe'aviolattanofropyrlghtlawunlas 0 0 n M yy O 3•Dm perm&sionaftheauthorand/ormpyrightholderisoh&ined. 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N81°39'52"W _ ^ boas Plpe hon Pipe lever Pipe 213.63' Found Found Found —— N81°40'33"W Found 272.38' FORPREMOVARYREVIEW ­^ eoa"A° DniE G LD^�RE"DaDiDE DF ER Map ofa Topogr2hicSurvey Dso �rmaa,otr.,w r�ity^t rtoa JosephL.&AmandaM.Bernard APPRaysQ • rotm�aF QUR611 VU WARRWcMW7Y, YORK o DarrahLandSurveylrrg;PLLc k21093-1 no�� UI lood pu Mz aaxs Pa WWI tt . WOW� epuewb `paeuaa8 ZZOZ-Etiti0-10Od S'T-'LOE