POOL-0292-2021 ' SWIMMING POOL office Use oniv
PERMIT APPLICATION Permit#: 0 Zg2
Town of Queensbury
742 Bay Road,Queensbury,NY 12804 Permit Fee:$� ; Invoice#: ��
P:518-761-8256 www.gueensbury.net Flood Zone?, Y N Reviewed By:
Project Location: 98 Richmond Hill Drive Queensbury NY 12804
Tax Map ID#: .308.7-1-75 Subdivision Name:Berringer Heights
Proposed Install Date: 5/17/2021.
SWIMMING POOL INFORMATION:
CHOOSE ONE: IN-GROUND
SIZE OF POOL: 18 X 36
EZE0VE
MANUFACTURER: Royal Swimming Pools D
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): APR 2 8 2021
Steel/Vinyl Poured Concrete T�15WNOF QUEENSBURY
DING&.CODES
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the-approved plans prior to or during construction will require theL 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 If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the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:
Swimming Pool Packet Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Nick&Justine Ameden
Mailing Address, C/S/Z: 98 Richmond Hill Drive Queensbury NY 12804
Cell Phone: 518 3214971
Email: amedenn@gmail.com
• Primary Owner(s):
Name(s): Nick&Justine Ameden
Mailing Address, C/S/Z: 98 Richmond Drive Queensbury, NY 12804
Cell Phone: 5183214971
Email: amedenri@gmail.com
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):
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 ���cc�►^1 '
project: Cell Phone: 518 3214971 Land Line:
Email: amedenn@gmail.com
Swimming Pool Packet Revised December 2020
308.7-1-75._ POOL-0292-2021
Ameden, Nicholas '
98 Richmond Hill Dr
In ground pool
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TOWN OF QUEENSBURY /iance
/
BUILDING DEPARTMENT /
Based on our limited examination,co ': APR .Z 2021
with our comments shall not be consindicating the plans and specificatio
full compliance with the WV OF QUEENSBURY.
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