POOL-0236-2021 SWIMMING POOL office Use Only
PERMIT APPLICATION Permit#:
Town of Queensbury Permit Fee:$ ;invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By:
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Project Location: ? 4 I �� 1,
1
Tax Map ID#: Subdivision Name:
Proposed Install Date: "-if
SWIMMING POOL INFORMATION: E CC �_q,
CHOOSE ONE: ABOVE- GROUNDS`, IN-GROUND `� FE
SIZE OF POOL: EA
y 2f`2I L
MANUFACTURER: �tiil'1tY1 t.i� (, ICE
TOWN OF QUEENSBURY
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): _ BUILDIN G CODES
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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the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:
SIGNATURE: �vl t}6VV DATE:
Swimming Pool Packet Revised December 2020
T i �
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): �Y1�C� aS Qv�1N
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
j Primary Owner(s):
Name(s):
Mailing Address, C/S/Z: 5 iir
�Ce Phone- Land Line: ;I —L{ i
Email: D
i CI e�'
J
Check if all wor� will be performed by property owner only
Installer/Builder: (List all additional contractors on the back of this form)
Contact Name(s): !1 la,x I I
ice-; i t✓v
Contractor Trade:
Mailing Address, C/S/Z: ? �r. ��� c� I�L «<� I I'-;cd Is r-c,-1 Z.
Cell Phone: Land Line:
Email �c I, C- --' I=G is . L)
**Workers' Comp documentation must be submitted with this application**
Contact Person for Compliance in regards to this project: J- ►-A; ) ^t.
Cell Phone: Land Line: ;I s - S
Email:
i
Swimming Pool Packet Revised December 2020
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315.10-1-42 POOL-0236-2021
Denno, Jason & Jaime
30 Alessia Dr
Above ground pool
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APR 16 2021
U TOWN OF QUEENSBURY
BUILDING&CODES
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PAGE 03
RON MUMBLO
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10/13/2021 17 79815$435 '
COMMONWEALTHEI.EC'ti lCAI.INSPECTION S ,RVICT,INC.
`� I o9sitl.UiFtee 176 Doe Run Road-Manholin,PA 1754+• ;; h
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fit, i MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL �k
f Permit No................ �crt.N° 5 0.0 21 cut-ill Card ilo................,....................
.
i i Owner
Location................... t?. .-:.. ?!. .t -.............,....,.....,.......,......,................................ ,s ti;
InstallationC;onsistingof...................................................................................................................................
.............................:..................................
....,......4...... ,. +,r.:.,..:..............
.......................................................
Installed By............. '.i't'!.Cie:...................:;....,..,........................Lie, No. ., ............................
The conditions follpwing,gyverned tha issuance of this certirteaw,and any c4rtilleare previously issued is
,. cancelled:- ,•;''�:;r}�
This certificate only cover. tNe elcctTical equlpR)i;nf emt{ inswllntirni e'eindu9ons . o af chit:. Upon the i;,�•r
? : introduction of additional cquipWi,t Or. ad4 for ins(?Cction.
lnspccmrg oF.this'f.'oinpany shall have the pr;vil� v of making iaspeetioii; ru sun• tine, and if AS ^�a
V, ! rules arc violated,the Company shall have the right to rovokc this ceititicotc.
Date........ .��.��;orb..}..:............... lN3PECTURxzk'a��.
OCTLC VIE
13 2021
T B(wj LD1G&FCNSBURY
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