POOL-0317-2022 SWIMMING POOL office Use only
PERMIT APPLICATION Permit#:-
Town of Queensbury Permit Fee:$l�10'J Invoice#: '97-7 1
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Flood Zone? Y DN Reviewed By
Project Location: ZO �eft7n�� AV4. ` %aai5 r� 'iA/Y T28 �
Tax Map ID#: Subdivision Name:
q-3--5f D
Proposed Install Date: /j�'LOZ'Z, MAY Z 3 2022 •
SWIMMING POOL INFORMATION: TOWN OF OUEENS13URYBUILDING& CODES
CHOOSE ONE: ABOVE-GROUND IN-GROUND
SIZE OF POOL: tS k Z9
MANUFACTURER:
MATERIALS USED IN CONSTRUCTION (CHECK ALL THAT APPLY):
Steel/Vinyl Fiberglass Gunite Poured Concrete Other
ADDITIONAL IMPORTANT INFORMATION:
1. Any changes to the approved plans.prior to or during construction will require the submittal of
amended plans, additional reviews and re-approval.
2. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
Declaration: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit.
I certify that the application, plans and supporting materials are a true and complete statement/description of
the work proposed, that all work will be performed in accordance with the NYS Building Codes, local building
laws and ordinances and in conformance with local zoning regulations. I acknowledge that I have read the
application and plot plan requirements and I, or my agents, will obtain a certificate of compliance before use
of the pool.
I have read and agree to the above:
PRINT NAME: 1
SIGNATURE: DATE: 5,;rZ 31 ZoZz
Swimming Pool Packet Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): C-4 -
Mailing Address, C/S7Z: '69'S%.C444. AV4- qu4e4 4VrYr Nr 28C1q
Cell Phone: Land Line:
Email: tl$-
• Primary Owners :
Name(s): Jew, t 4eat.,J
Mailing Address, C/S/Z:- ?,6
Cell Phone: Land Line:
Email: VF '
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): r7c,M J %,V -
Contractor Trade: i?w1r, ptlq
Mailing Address, C/S/Z: Ll$7 tila� ��r ( httncAtM7 �Y IZ
Cell Phone: Land Line: s-tv_ Zq 2 I
Email: My. f7colc p�ttis ,4,, • C...
"Workers' Comp doc'umentalion 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
J?ra
,..�._ � ..y 5 , .a,_.._,_:a_,_...F/ .'r—•- • _g�-:a c..a_•2'1._, J::•.•• ::r._L. :�rl""•. c —
.
- � � FIL COP@�
C� • 4� pi�i)
-ra
rr
I
C E . ,
$ ETOWNEN
2022 I
TOWN OF QUkENSBURY
Based on ouriliUmit'ING e a�AR ton,complianSBURY
TMENT Co
ar with our comments shall�not be construed as
6 indicating t '
a � 9 he plans ands eclfications are in !�
.. � full compliance with th � p
New York State. Building Codes of
_ f j
ATTENTION HOME O
WNE ,s
Please assure you are familiar witch In
EnGosure requirementsPecffic to
s th® oa
You are required to meet all appll i�ooi,
cable your }}
regarding swimmings `---f
It the time of ins pools, spas & hot ubs
pecti on. •=r
¢
;�5
1� TORN 5
OF QUEFNSSURY
BUILDING & CODE
Reviewed F''•
Date; y� � {
S
302.14-3-31 POOL-0317-2022 '
Kyle & Katelyn Leonard
26 Jerome Ave. :
v
In-Ground Pool
-�';.-;r'----.,.•._�.._..r�.--�._i..---_---��.__"E•-..---;q �r— _ __....��._._ _,�:___ _ _.-'�jt�j' /` J�(jC)„E 0aF �_..__ r
tJJh