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2014-205 TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 �� Q rY, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20140205 Date Issued: Monday, June 16, 2014 This is to certify that work requested to be done as shown by Permit Number P20140205 has been completed. Tax Map Number: 523400-296-012-0001-003-000-0000 Location: 9 BAYBERRY Dr Owner: DAVID & LORRAINE GRAVES Applicant: DAVID & LORRAINE GRAVES This structure may be occupied as a: Fireplace By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (DJ 4 property owner of the responsibility for compliance with Site Plan, \ Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY ` . 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140205 Application Number: A20140205 Tax Map No: 523400-296-012-0001-003-000-0000 Permission is hereby granted to: DAVID & LORRAINE GRAVES For property located at: 9 BAYBERRY Dr in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: DAVID &LORRAINE GRAVES Fireplace 9 BAYBERRY Dr Total Value QUEENSBURY NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans &Specifications 2014 Fireplace insert for gas stove $0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 30,2015 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town f Quee sbu A F '.i y Ji! . 0,2014 SIGNFf BY for the Town of Queensbury. Director of Building&Code Enforcement •, \I V \ Office Use Only V Town of Queensbury Building & Codes Received: c6 ji '1.. Tax Map0 •;S��pq`1p, I . -)-3 FUEL BURNING APPLIANCE & CHIMNEY APPLICATION Permit No.: ----6-.0'.::: Permit Permit Fee: $ Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the NYS Fire Prevention & Building Code. The applicant or owner agrees to comply with all applicable laws, ordinances, regulations, and all conditions that are part of these requirements and also will allow all inspectors to enter premises to perform required inspections. Important Note To Applicant: Rough-In and Final Inspections Are Required: Date Owner A AV i 1b C,IC✓t S Installer/Builder iii A yA)c= C,eA uJ i o ,e) Address 9 4.1-y 6 e2 r'c y be Address / 7 G.i I- C H Ki S r P../,'c_r_ rC.D 6z4.tc.1vS 6uALy f/.l .CTr=oK b iod8. S1 Phone '79_3 - y .A'7 Phonep _ 9.3.) - y e,3`r'• 9 Location of proposed construction and for installation: 9 4a..c .G-v-u. OA . Contact Person for Building&Codes Compliance: 0 /9-,(,,49C Subdivision Name: Fuel Burning Appliance Information Wood Coal Pellet Gas Oil Stove K Fireplace Insert X Fireplace,factory built* Fireplace, Masonry Furnace, (Garage Only) *If Factory Built, Please Provide: Manufacturer Name: Model No. Listed By: Number: Chimney Information Masonry** ✓check one _Block _Brick ' _Stone Flue ✓check one Tile Steel Size in Inches Material ✓check one _Double Wall _Triple Wall _Insulated _Direct Vent _Chimney Liner I **If Non-Masonry,please provide: Manufacturer Name: Model No. Signatures: Print Name: •b.q V i b C7/?A✓6S Signature: Date: e .j'/AO7Y ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS. Town of Queensbury Fire Marshal FAIT 742 Bay Road Queensbury,NY 12804 761-8205/761-8206 fax 745-4437 Factory Built Fireplace Gas Insert Inspection Report Notice: New York State requires that all UL Listed, factory built appliances be installed according to the instructions and specifications contained in the Installation Manual accompanying the appliance. No deviation from the manufacturer's instructions or specifications is allowed. ;Jar,- 2.0 Permit#deal 1I-A o> Schedule Inspection Time am pmt anytime Name G i?n,1 1::5 Address " :_ - : r Inspector Appliance Manufacturer tl we Model # Flex Liner Rigid Liner Liner Size` _ Dual Liner Single Liner Yes No N/A Comments Installed per Listing/Manual Clearances to combustibles provided by existing fireplace construction Directly Connected to Flue Flue gases prevented from mixing with room air Damper Clip/Hold Open Damper permanently open �. Liner Termination \/-' Liner extends above existing chimney; ,;'\ weather cap installed Gas Shut-Off Valve Witness Operation Tank Placement (if LP) Combustion Air White—Building Dept. Yellow Customer Pink—Fire Marshal