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POOL-0345-2021 SWIMMING POOL office Use Only PERMIT APPLICATION Permit#: 7blvil of Qycensljury Permit Fee:$ � V ; Invoice#: 742 Bay Road,Queensbury, NY 12804 P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By: Projec Location. -3� 7 �- -�T Tax Map ID#: Subdivision Name: ,fl �Q�,fry 1 l=?:= 'Proposed Install Date: _ -7/2021 - SWIMMING POOL INFORMATION: CHOOSE ONE: ABOVE- GROUND IN-GROUND SIZE OF POOL: 2 Z) MANUFACTURER: D E C E Q V E MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): MAY O 9 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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury.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. 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: ► � �-� � � SIGNATURE: DATE: 0 �,5� l Swimming Pool Packet Revised December 2020 f of r CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: � , �� nn �( Mailing Address, C/S/Z. O ;r. dte✓1�X Cell Phone: Land Line: Email: ,;?- / en Y)-,e s I- qy�\Ck I o iv-� • Primary Owner(s): Name(s): y 1 r i L Z�e C--` Mailing Address, C/S/Z: —70 ®nd Cell Phone: Land Line: 51�� J-3p go 3Z Email: Check if all work will be performed by property owner only • Installer/Builder: (List all additional contractors on the back of this form) f; _Contact Name(s): >0 • ��ItA Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: "Workers' Comp documentation must be submitted with this application" Contact Person for Compliance in regards to this project: Cell Phone: Land Line: Email: Swimming Pool Packet Revised December 2020 . .. .: . -4 N W 1 c� —' TOWN OF QUEENSBURy O p 1 DING DEPARTMENT i °D'V Based on ourilimited examination,compAar,ce C z ind c our comments shall not b v O � '. r indicating the Iptans and a construed 1 �,� W full compliance with the pecifications 3 n I O C o New York Stat , uilding Codes�©f c® �` Q°m c= om - 7M, OZ N ` I oCf) C ! Cl)c 10,n u R oaf a a _ Plea" Air weM*dmd al �:z-_ 'y0U we i $paste at im = IAli ni jJ �C. A J -7- f TOWN OF QUEE SBUR BUILDING & CO '.ES DEPT. ti� p•; Reviewed y: Date: 1 Y; i rry r^ f; k! v MAY 17 20?_1 1 c or-�, e n VnQ i N TOWN OF QUE CODGB Y �` d, Vim;rri i n� /�� J ( i�t S�a��-e G(l BUILDING I . I I r2 C ,Z c