City of Madison Building Department
100 Hughes Rd Madison, AL 35758
Phone: 256-772-5644
Fax: 256-772-5601 SWIMMING POOL PERMIT APPLICATION
www.madisonal.gov ePermitting: www.buildportal.madisonal.gov
*Incomplete applications may not be processed. Valuation of Work: $ Date:
LOCATION OF WORK / CONSTRUCTION Residential: ___________ Commercial:____________
Other:
Construction Address: Lot#: Block: Subdivision:
Property Owner Name: Phone:
Current Owner Address:
DESCRIPTION / SCOPE OF WORK (please choose): NewConstruction Repair In Ground Above Ground
Salt Chlorine Type of Filter: _________________ Gunite: Alteration Type
Applicant Signature: Date:
Chief Building Official: Date: Not Approved
Engineering / Floodplain: Date: Not Approved
Zoning Administrator: Date: Not Approved
CONTRACTOR INFORMATION Owner/Builder
City of Madison License#:___________________________
Email:___________________________________________
Contractor Name:_______________________________________________
Phone:___________________________________________
Business Address:_________________________________________________
Homebuilders License#:____________General Contractor’s#:______________
WHO IS PERFOMING THE FOLLOWING?
Fence:_______________________________
Electrical:____________________________
Plumbing:____________________________
Grading:_____________________________
Drainage:____________________________
~If this is a chlorine pool, has notification been given to or approval received by MU for plumbing connection to City sewer
system? Yes No
Design to be submitted to the City for approval prior to construction. Grading and drainage post construction to be
inspected by Engineering Department to ensure what was submitted was built and no easement or adjacent properties are
negatively affected.
I hereby acknowledge that I have read this application and state that the above information is true and correct. I agree to
comply with all City Ordinances and State Laws regarding pool construction. As a pool contractor / home owner (whichever is
applying for this permit), I hereby agree to protect all public improvements and public utilities adjacent to or serving the
property on which the structure(s) covered in this pool permit are located, whether or not the said improvements or utilities
are the property of the City of Madison. I further agree to make or cause to have made repairs, satisfactory to the City of
Madison, to and for any damage to these public improvements or utilities resulting from the actions, misuse, or lack of care on
the part of any of my employees, agents, subcontractors, or suppliers of materials of said public improvements or utilities or
~Excavation Dirt Hauled Off? Yes No ~Retaining Wall to Be Part of Construction? Yes No
~Cut to Fill Construction? Yes No ~Patio/Other Structure to be Included with Pool Construction?
Yes No
~Approved design of pool, pre and post grading & drainage changes/redirection, electrical and plumbing submitted to City of
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signature
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