POOL-0485-2021 SWIMMING POOL Office Use only
PERMIT APPLICATION Permit#: pbn L'O`lg5
Permit Fee:$I EFO-vp :Invoice#: slfo&
ay oa , ueensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y Reviewed By:
Project Location: (oj
Tax Map ID#: Subdivision Name:
b°$. '*-1 --3b je
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Proposed Install Date: JUAI Z$
. 2o21
SWIMMING POOL INFORMATION: T BUN ILDINGQ
&�ENS COOSY
BUR
CHOOSE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: % k Ll O
MANUFACTURER: H P2'L
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
<teelD/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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the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:
� � t4i0.� I.1Cut'.,G S
PRINT NAME:
ASIGNATURE: /`l/ , DATE: oc(, 0
Swimming Pool Packet Revised December 2020
-A . �.
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mai ' dress, C/S/Z:
Land Line:
Email: �,•, 1(, , l oa I1o4,1 e s @ 3 Alt
• Primary Owner(s):
Name(s): S� cz5 ci�av�
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Check if all work will be performed b property owner onl
p Yp p Y
• 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"
Contact Person for Compliance in regards to this project: rN
Cell Phone: Land Line: 't-i S - :�-75 -17 q
Email: hoa, s 0 G- r^-
Swimming Pool Packet Revised December 2020
308.7-1-36 POOL-0485-2021
- POOI Size: 20' X 40' Barnes, William
Cardinal P I h RECTANGLE
oo S ape 63 Westberry Way
` ^\S ..... Pool Number: PRT26627 In ground pool
250 Route 61 South,Schuylkill Haven,PA 17972 a 570-385-4733•fax:57b-soo-to ro
Bill of Materials
PART NO, QUANTITY DESCRIPTI❑N
'A' FRAME 12 'A' FRAME ASSEMBLY
CS902SA 2 90 DEG CORNER ANGLE
CS902SB 2 6' RAD CORNER FILLER 'BIG VEE'
CSYOCSPXXXDY4X2 1 20'-0' POURED STEP/SUNDECK W/LINER TRACK/SCREED EDGE
5S42174XXXO 2 - Straight
5S4260OXXX1 2 ra
5S42800LCN2 i ra
5S42800SCN2 2 ra
5S4280OXXX2 6 ra
20'
$' `�i------- ------- $' OF "
03:
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4' --1 12' 4' wc0
a-2'
--------+------ -i _NTl N HONI ®WN R 8' o
Phase reyou are famll r ` the Pool z
E r�lrements s c t�your pail.You are tired to meet all ble code4 z 3 D
o regard) s 1 Mming pools, as hot tub% w
U
of Inspection. %` $' 0
U)
/ O
iNN OF QUEENSBURY Q
WILDING & CODES DEPT.
8, TOWN OF Q ENSBU�Y we By:
BUILDING D PARTME T
Based our limited xamination compliance
with ou comments hail not be nstrued In
indic the pia and sppecific tions are in
1'-7 DAIMo Hance ith the Buildi g Codes of i'-7 1/2'
New
I
20'-0" POURED STEP/SUNDECK 3'-4"
W/LINER TRACK
SCREED EDGE FILE COPY
CSYOCSPXXXDY4X2
Date: 3 8 2021 Perimeter: 120'-0"
Drawn By: KPA Area: 800.0 SQ. FT.it
Scale: 1 8 = 1 -0 Notes: TOM P E R K I N S 2 0 X 40 CardinalSystemslne.com
This Information Is the confidential property of Cardinal Systems,Inc.Disclosure or duplication without proper written approval Is strictly prohibited.Acceptance and use of this
drawing constitutes knowledge and acceptance by the user of the terms and conditions set forth In the notice and warning which accompanied this drawing Is Incorporated
herein and made part hereof and Is found on Cardinal Systems,Ines webslle at www.CardInalSystemsine.com
-- •--- 145.81 ` •
NO CUT ZONE
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I PROPOSED / 1
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S83052'05"E L=56.43
46.95' P 8=275.00