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POOL-0381-2022 poll SWIMMING POOL office Use Only f PERMIT APPLICATION Permit#: 9OQ�- Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Permit Fee:$ �� ; Invoice M P:518-761-8256 www.aueensbury.net Flood Zone? Y Reviewed By:e-&-k� Project Location: I G N►pn ���I' /� Tax Map ID M Subdivision Name: LEG rE O V S� o7c�� Proposed Install Date.. � / JUN 15 2022 P11,11 SWIMMING POOL INFORMATION: TOWN OF OUEENSBURY BUILDING e CODES CHOOSE O I D _ NE: _ABOVE-GROUND N-GROU .p _UNHEATED _HEATED (pool cover heater, R-12 req'd) r �o SIZE OF POOL: 32 MANUFACTURER: MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY): Steel/Vinyl f 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 If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.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: /'- L-- DATE: x Swimming Pool Packet Revised March 2022 • Installer/Contractor: (List all additional contractors on the back of this form) Contact Name(s): Qr tlf— balloci Contractor Trade: P o o f S p/C1S Mailing Address, C/S/Z: i ;fr .51 a uego,56uJ N 2�o Lt Cell Phone:_(r) Y - I d Land Line: Email: "Workers' Comp documentation must be submitted with this application" • Installer/ Contractor: (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" • Installer/Contractor: (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" Installer/Contractor: (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" Swimming Pool Packet Revised March 2022 r i ATTENTION HOME OWNER Please assure you are familiar with the Po Enclosure requirements specific to your pool. You are required to meet all applicable codes j .SUN ' 5 2 regarding regarding swimming pools, spas & hot to s 1 1 at the time of inspection. ±. TOWN' OF QUEEiNSBURY BUILDING&CODES Ul - ---, TOWN OF QUEENSBURY i BUILDING DEPARTMENT (° Based on our limited examination,compliance with our comments shall not be construed as © indicating the plans and specifications are in i(� full compliance with the Building Codes of �✓ �� �� � tiew York State. , V1, pa ell TOWN OFF QUEE ISDURY I 308.7-1-50 POOL-0381-2022 BUILDING CODES DEPT. UAJ G3 � I Maille, Nicholas F�- iewed SV� 59 Richmond Hill Dr Date, In ground pool (16 x 32) __ Ic