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2014-535
TOWN OF QUEENSBURY 11,7*.y 742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20140535 Date Issued: Friday, March 13, 2015 This is to certify that work requested to be done as shown by Permit Number P20140535 has been completed. Location: 82 MELDON Cir Tax Map Number: 523400-289-020-0001-039-000-0000 Owner: MICHAELS GROUP Applicant: MICHAELS GROUP This structure may be occupied as a: Fireplace By Order of Town Board Garage Attached TOWN OF QUEENSBURY Townhouse Issuance of this Certificate of Occupancy DOES NOT relieve the property ( 444° 4 lOt owner of the responsibility for compliance with Site Plan, Variance, or other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement 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: P20140535 Application Number: A20140535 Tax Map No: 523400-289-020-0001-039-000-0000 Permission is hereby granted to: MICHAELS GROUP For property located at: 82 MIELDON Cir 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: MICHAELS GROUP Fireplace SUITE 1 Garage Attached 10 BLACKSMITH Dr Townhouse $220,000.00 MALTA,NY 12020 Total Value $220,000.00 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2014-535 Townhouse 1,746 sq.ft. w/Garage 444 sq.ft. 1 Fireplace $349.20 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, October 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 To f Que sbu • 4 T i ;' i o ctober 30,2014 i .- SIGNED BY for the Town of Queensbury. Director of Building& Code Enforcement o� (� OFFICE USE ONLY TAX MAP NO.O2 � Sq •ad - I-3 ! PERMIT NO. i t�I 53 FEES: PERMIT yiS, J QECREATION A.)/0 ENGINEERING Z�14 C� Fp t 0" � (If applicable) PRINCIPAL STRUCTURE: APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION. APPLICANT/BUILDER: -THS M}�►�.EaS C{izot,P OWNER: ADDRESS: 10 EIL.PK_V-SV11T-4 1R, 1-1A-LTA ,NY 1Zozo ADDRESS: " PHONE NOS. S 1S-Scket- �'>>� PHONE NOS. " CONTACT PERSON FOR BUILDING & CODES COMPLIANCE: "T Lo t o PHONE: a51 -31 4 4- LOCATION OF PROPERTY: 'Et,2- h-A Ca•- tAOi c SUBDIVISION NAME: 44LptVD Ltz[DSSI1vCtS I I PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW: CHECK ALL THAT APPLY TO YOUR Occ o F- PROJECT O Q O . i O LL w w 0� OJT w �_ _ LL U Lu z Q Q a-� NQ OLI- OLL 0-= o5 SINGLE FAMILY TWO-FAMILY MULTI-FAMILY(NO. ) i TOWNHOUSE 11144-LOCP Z^�'_�j_ 1 BUSINESS OFFICE RETAIL- MERCANTILE FACTORY OR INDUSTRIAL ATTACHED GARAGE(VD) X . 444 41 OTHER a, Town of Queensbury • Community Development Office . 742 Bay Road, Queensbury, NY 12804 IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: ESTIMATED CONSTRUCTION COST: Lam) 15 C>i1 FUEL TYPE: C1 irs HEAT TYPE? P *HOW MANY FIREPLACE(S) AND/OR WOODSTOVES(S): ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? IS THIS A HISTORIC SITE? PROPOSED USE OF BUILDING OR ADDITION: 5►1' L-E Fprt,.Itt-`r 1z-esio c_.e- ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? ARE THERE EASEMENTS ON PROPERTY? 'Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office 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 NY State Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to ' above. Signed Director of Building & Codes: 761-8256 (for questions QUESTIONS? CALL 761-8256 OR EMAIL regarding Building Permits, construction codes or septic codes(a,queensbury.net systems) VISIT OUR WEBSITE FOR MORE INFORMATION Zoning Administrator: 761-8218 (for questions regarding www.queensburv.net required permits, the permit process, application requirements or to schedule an appointment) This application / proposed action described Permission is hereby granted to the above herein is found to be in accordance with the Applicant to erect or alter the building described zoning Laws of the Town of Queensbury. herein in accordance with said Application: (1}-4j 2-g Gi- ZONING APPROVAL DATE BUILDING & C DES APPROVAL ATE I CITown of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 04 Fire Marshal's %i" Office ,. . ; : �.J. . . ! •�. Town of Queensbury • 742 Bay Road • Queensbury, New York •12804Date + Michael J. Palmer, Fire Marshal • Gary Stillman, Deputy Fire Marshal APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the New York State 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. OWNER: -11.4 , -QP-t�S C� -' 'LLC INSTALLER/BUILDER: 1--6, 11-. ADDRESS: ADDRESS: 1-7(0C) C •t_ /=•••141 .b.t te•.t4c--r, N•-f PHONE NOS. SI$• 9 •(03 11 PHONE NOS. 518• eby. c komc, LOCATION OF PROPERTY: SUBDIVISION ` ANAME: -i1�A�LD LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION: V2 1'�is Cwec.A.E CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: T, ac> PHONE: `:'$.e6-51• 3W 4 ✓ FUEL BURNING APPLIANCE I WOOD COAL PELLET I GAS OIL INFORMATION STOVE FIREPLACE INSERT }C FIREPLACE, FACTORY BUILT* FIREPLACE,MASONRY FURNACE (GARAGE ONLY) *IF FACTORY BUILT, PLEASE PROVIDE: MANUFACTURER NAME: H T-N,- Ck1A MODEL NO. b"/3-73Z-Std 1. LISTED BY: NUMBER: QUESTIONS ? CALL 761-8205 or 761-8206 CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL: firemarshal(a7queensbury.net MASONRY** CHECK ONE ✓ VISIT OUR WEBSITE SIZE IN FOR MORE INFORMATION TILE STEEL INCHES www.queensbury.net FLUE CHECK ONE ✓ DOUBLETRIPLE WALL INSULATED + DIRECT VENT CHIMNEY WALL LINER CHIMNEY MATERIAL CHECK ONE ✓ **IF NON-MASONRY, PLEASE PROVIDE: MANUFACTURER NAME: MODEL NO. ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION &BUILDING CODE AND/OR MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS. bs ,vn of Queensbury (C '3 0 -f`I / Michael F. Travis Highwa4y Highway Superintendent g Y3 Home (518) 798-0413 Department \LA) 742 Bay Road—Queensbury,NY 12804 Thomas R. Van Ness Office Phone: (518) 761-8211 Deputy Highway Superintendent Fax: (518) 745-4466 Home (518) 745-0929 DRIVEWAY PERMIT DATE: lof 14i 1 a APPLICANT NAME: M IcS TELEPHONE NO.: 5N`a•`'3c19 -'311 ADDRESS TO BE INSPECTED: SZ M+ ( Gtu RETURN ADDRESS: Applicant must show exact location and width of driveway(s) to be connected to the highway by placing stakes at the specified location. The Superintendent of Highways of the Town of Queensbury has reviewed this application. The following action has been taken: STEP 1: ( ) Preliminary Approval NEED: ( ) Slight swale ( ) Deep swale ( ) Level with the road ( ) Level with the top of the paved wing Size culvert pipe to be used (if necessary) ( )12" ( )15" ( )18" ( )24" ( )36" Preliminary inspection completed by: Date: Approval by Highway Supt: Deputy Supt: Upon completion, please resubmit this approved permit for a final approval. STEP 2: ( ) Final Approval ( ) Rejected Date: Michael F. Travis, Highway Superintendent Thomas R Van Ness, Deputy Highway Superintendent Town of Queensbury Fire Marshal 742 Bay Road Queensbury,ueensbu NY 12804 /'� 761-8205 761-8206 fax 745-4437 Factory Built Wood Burning Fireplace/Stove 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. Permit# �� —43-'3 Schedule Inspection ?:"I 1 Time,l j am pm anytime Inspector '2 // Name 1 Or r.A.C\' Address S L W&ck;,G/y-N Rough In Final y Appliance Manufacturer Model# Masonry Chimney Factory Built Chimney Flue Size Double Wall_Triple Wall Insulated_ Yes No N/A Comments Floor Protection Clearances to Combustibles (all sides) Safety Strip Installation (fireplaces only) Firestop(s) Vertical Chase Wall Penetration Chimney Clearances to Combustibles Chimney Termination 3 feet above roof penetration; 2 feet above any combustible construction within 10 feet Combustion Air Hearth Extension Mantel(height above f/p opening) Fireplace Doors/Screen (required) 'J Carbon Monoxide Detection White—Building Dept. Yellow—Cushmer Pink—Fire Marshal Queensbury Building & Code Enforcement - Residential Final Inspection ;_1,,•-1-0 1 Office No. (518) 761-8256 Arrive: am/pm Depart: am/pm Date Inspection request received: '3111-115 Inspector's Initials: NAME: il\C'k'Ctr,'' CYVO u,i) PERMIT#: 14-r-D,3 LOCATION: Ze_,1 c .girl DATE: 31151 TYPE OF STRUCTURE: "Tcwvnl^z-uSe� Comments: Yes No N/A 4" Building Number Address visible from road ,- r- - L - 6 5 3 Ill- Chimney Height/"B"Vent/Direct Vent Location V Fresh Air Intake 3 inch Plumbing Vent through roof minimum 18 inchesl✓ Roof Complete/Exterior Finish Complete ✓ Platform at all exterior doors ✓ Handrail 4 or more risers ✓ Guards at stairs, decks, patios more than 30 inches above grade 1✓f Guard at stairwell at 34 inches or more V- ` Guard at deck, porches 36 inches or more l/ Handrail Termination at Newell Post or Wall ✓ Interior/Exterior Railings 34 inches to 38 inches ✓ Deck Bracing/Handicapped Ramp Compliant17- _ Grade away from foundation 6 inches with 10 feet 6 inch clearance to sill plate ✓ Gas Valve shut-off exposed/regulator 18 inches above grade Interior privacy/trim/doors I main entrance 36 inches ✓ Bathroom/Kitchen watertight 1/ Safety glazing/Window in stairwells safety glazing ✓ Interior Smoke Detectors/Carbon Monoxide Detectors Every level: ✓ Every Bedroom: '/ Outside every bedroom area: ✓ Inter Connected: ✓ Battery backup: ✓ Attic access 30 inches x 22 inches x 30 inches(height)in accessible area 1,,- Crawl ✓Crawl Spaces 18 inch x 24 inch access, 1 sq.ft.-150 sq.ft.vents ✓ Bathroom Fans,if no window tZ Plumbing fixtures Foundation insulation to floor/Sticker on Panel V Duct work sealed properly/Blower Door Test Certification Floor truss,draft stopping finished basement 1,000 sq.ft. ✓ Emergency egress below grade ✓ Gas Furnace shut-off within 30 feet or within line of site t✓ Oil Furnace shut-off at entrance to furnace area ✓ Furnace/Hot Water Heater operating Low water shut-off boiler Relief Valve(s)installed/Heat Trap/Water Temp 110 V. Enclosed Stairs Sheetrock Underside minimum W Gypsum ✓ V Basement stairs closed rise>4 inches Garage Floor Pitched V Garage fireproofing/3/.hour fire door/door closer Gas Logs in Sealed or Glass Enclosure ✓ Final Electrical; Energy Saving Light Bulbs 50% tZ Final Survey Plot Plan ✓ Arc Fault Breaker Habitable Spaces/Tamper Proof Receptacles Flex Gas Pipe Bonding ✓ , f i, ,0 4t, 0)(4d- As Built Septic System/Sewer Dept. Inspection Sticker_ ✓ {� Site Plan /Variance required V Flood Plain Certification, if required / ✓ Okay to issue C/C or C/0[Temporary/Permanent] t/ P.1:216br 'np,toer -1ru.S5‘,. S.v:NviikAte. L:\Building&Codes Forms\Building&Codes\Inspection Forms\Residential Final Inspection Form_revised_100405.doc; Revised January 7,2008; Revised 6/26/08; Revised 12/22/10, Revised 04/13/11 a Air Leakage Property Organization HERS Unknown Grajny Consulting. LLC Confirmed 82 Meldon Circle 518-221-3240 03/05/15 Queensbury, NY 12804 Stan Grajny, PE Rating No:0129151 Rater ID:5609922 Weather:Albany. NY Builder 82_Meldon The Michaels Group Mac haelsG roup_82MeldonQueensb ury_NYESH_T2_030515.big Whole House Infiltration Blower Door Test Heating Cooling Natural ACH 0.15 0.12 ACH ® 50 Pascals 2.76 2.76 CFM @ 25 Pascals 869 869 CFM @ 50 Pascals 1363 1363 Eff. Leakage Area (sq.in) 74.8 74.8 Specific Leakage Area 0.00015 0.00015 ELA/100 sf shell. (sq.in) 1.08 1.08 Duct Leakage Leakage to Outside Units Ducting CFM® 25 Pascals 0 CFM25 / CFMfan 0.0000 CFM25 / CFA 0.0000 CFM per Std 152 N/A CFM per Std 152 / CFA N/A CFM® 50 Pascals 0 • Eff. Leakage Area (sq.in) 0.00 Thermal Efficiency N/A'. Total Duct Leakage Units CFM25/CFA Total Duct Leakage 0.0662 Ventilation Mechanical Exhaust Only Sensible Recovery Eff. (%) 0.0 Total. Recovery Eff. (%) 0.0 Rate (cfm) 66 Hours/Day 24.0 Fan Watts 30.0 Cooling Ventilation Natural Ventilation ASHRAE 62.2 - 2010 Ventilation Requirements For this home to comply with ASHRAE Standard 62.2 - 2010 Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential Buildings. a minimum of 65 cfm of mechanical ventilation must be provided continuously, 24 hours per day. Alternatively, an intermittently operating mechanical ventilation system may be used if the ventilation rate is adjusted accordingly. For example, a 130 cfm mechanical ventilation system would need to operate 12 hours per day, as long as the system operates to provide required average ventilation once each hour. REM/Rate- Residential Energy Analysis and Rating Software v14.5.1 This information does not constitute any warranty of enemy cost or savines. © 1985-2014 Architectural Enemy Corporation. Boulder. Colorado. Final Survey Inspection Dept. of Community Development Town of Queensbury 742 Bay Road Queensbury,NY 12804 I Date received: 3 1 tG f )-G I S NAME: ‘ ;rS 6,--23-ttf) LOCATION: ?"r3- Me PERMIT#: c2_01 -5733" Final Survey Plot Plan Approved Denied The attached final survey has been received by the Dept. of Community .� Development. Upon review the survey has been: Craig Br• n, Zoning Administrator Notes: L:\SueHemingway\Building.Codcs.Inspection.FORMS\Final Survey Zoning Administrator.doc c lvs� to / Z / O - (2_ Foundation Inspection Report Office No. (518)761-8256 Date Inspection request received: ` S Queensbury Building&Code Enforcement Arrive: am/pm Depart: 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: , ,$ NAME: C S G r"0 LipI PERMIT#: LOCATION: 5j 7,- J/ \�° (� C `re-le INSPECT ON: 2/2-0 TYPE OF STRUCTURE: t7 C V` Comments Y _ N/A Footings Piers Monolithic Slab Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site. Foundation/Wallpour Reinforcement in Place Footing Dowels or Keyway in place Foundation Dampproofing Foundation Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval Plumbing Under Slab PVC/Cast/Copper Foundation Insulation Interior/Exterior R- - - Rough Grade 6 inch drop within 10 ft. L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc Last printed 12/9/2014 1- 3 pr- Foundation Inspection Report 0,00-1) Office No. (518) 761-8256 Date Inspection request received: 1 t'y Queensbury Building&Code Enforcement Arrive: am/pm Depart: pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: k NAME: 1,1o44,1A6612 PERMIT#: °-0111L" 1 � LOCATION: g II�� r, C(!`r°,C.e INSPECT ON: TYPE OF STRUCTURE: /,.�i,Gl Comments Y N N/A Footings Piers Monolithic Slab Reinforcement in Place The contractor is responsible for providing protection from freezing for 48 hours following the placement of the concrete. Materials for this purpose on site. Foundation/Wallpour Reinforcement in Place Footing Dowels or Keyway in place Foundation Dampproofing Foundation Waterproofing Footing Drain Daylight or Sump Footing Drain Stone: 12 inch width 6 inches above footing 6 mil poly for wet areas under slab Backfill Approval I Ging Under Slab .J PV /Cast/Copper Foundation Insulation Interior/Exterior R- Rough Grade 6 inch drop within 10 ft. L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc Last printed 12/18/2013 2:44:00 PM Rough Plumbing I Insulation Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building & Code Enforcement Arrive: am/pm Depart: m ,.� ni/pm 742 Bay Road, Queensbury, NY 12804 Inspector's Initials: '; h, 1 :.- NAME: (U4 4—C 1, / 2 c��' PERMIT #: b1 - ,,-- LOCATION: y: i,kc.. INSPECT ON: nig TYPE OF STRUCTURE: • Y N 14) Rough Plumbing /Nail Plates Plumbing Vent/Vents in Place 1 % inch minimum Drain Size Washin• Machine Drain 2 inch minimum Cleanout every 100 feet I change of direction Pressure Test Drain /Vent Air/ Head 5 P.S.I. or 10 ft. above highest connection for 15 minutes Pressure Test Water Supply Piping Air/Head 50 P.S.I for 15 minutes Insulation /Residential Check/Commercial Check Tyvek or Similar Exterior Sealant Pro•er Vent, Attic Vent , / Door/Window Sealed (No Insulation) Duct/ Hot Water Piping Insulation If required unheated spaces Combustion Air Supply for Furnace Duct work sealed properly/ No duct tape 7 r COMMENTS: ( '%• '" ) •i (/:> L�L q: _7 - Rough Plumbing Insulation Reportrevised Nov 17 2003, revised February 15,2005, revised January 7,2008 huhu lb-1.1 Rough Plumbing / Insulation Inspection Report Ctr3D) Office No. (518) 761-8256 Date Inspection equest received: Queensbury Building & Code Enforcement Arrive: �`J._ am/pm 742 Bay Road, Queensbury, NY 12804 Inspector Initials: NAME: i\C\ u��Qo_Q.N. PERMIT#: / "53 S LOCATION: I M ttA. INSPECT ON: V\r-zsi--\\c— TYPE OF STRUCTURE: S F b Y N N/A Plumbing under slab Rough Plumbing /Nail Plates 4./ Plumbing Vent/Vents in Place 11/2 inch minimum Drain Size Washing Machine Drain 2 inch minimum Cleanout every 100 feet/change of direction Pressure Test Drain /Vent Air/ Head 5 P.S.I. for 10 ft. above highest connection for 15 minutes Pressure Test Water Supply Piping Air/ Head 50 P.S.I. for for 15 minutes Insulation /Residential Check/ Commercial Check Window Sealing Tyvek or Similar Exterior Sealant Proper Vent, Attic Vent Door/Window Sealed (No Insulation) Duct /Hot Water Piping Insulation % If required unheated spaces Combustion Air Supply for Furnace Duct work sealed properly/ No duct tape Blower Door Test Air Sealing COMMENTS: Rough Plumbing_Insulation Inspection_02 05 13 Town of Queensbury Building & Code Enforcement f +` r'S Office No. (518) 761-8256 ( ;3 z7) Framing / Firestopping Inspection Report Inspection request received: Name: t Inspected on: I— ` Location: a .0_12id—c•r\. 1 Arrive: N.Ac.. a.m./p.m. Permit No.: /'/•-53.5 Inspector's Initials: Mak TYPE OF STRUCTURE: S !� N NIA COMMENTS: Framing• V Attic Access 22"x 30"minimum Jack Studs/Headers Truss Specification Provided Bracing 1 Bridging Joist hangers Jack Posts/Main Beams Exterior sheeting nailed properly 12"O.C. Headroom 6 ft.8 in. Stairwells 36 in.or more Exterior Deck Bracing Headroom 6 ft.8 in. Notches 1 Holes/Bearing Walls Metal Strapping for Notches Top Plate 1 '/2(w) 16 gauge(8) 16D nails each side Draft stopping 1,000 sq.ft.floor trusses Anchor Bolts 6 ft.or less on center Ice and water shield 24 inches from wall Fire separation 1,2,3 hour Fire wall 2,3,4 hour -FI iopPing Penetration sealed 16 inch insulation in cavity min. Garage Fire Separation House side'/2 inch or 5/8 inch Ty.• X Garage side 5/8 inch Type X Ceiling/wall Windows Habitable Space/Bedrooms 24 in. (H) 20 in. (W) 5.7 sf above/below grade 5.0 sf grade Design Professional Sign-off, if required Framing / Firestopping Inspection Report --ilk is-J elirial. Town of Queensbury Fire Marshal fW 742 Bay Road Queensbury,NY 12804 761-8205/761-8206 fax 745-4437 Factory Built Gas Fireplace/Stove 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. j Permit# /1-53 5 Schedule Inspection kiAa_j Time ,\r.`6\ �m pm anytime Inspecto 1\4-T7 Name \ U.\1 o jh Address s el cit n7 Rough In)&Final_ Appliance Manufacturer '' * --\\ Model# 'i 2�.;3-12-- Direct Vent Factory Built Chimney Flue Size Double Wall Triple Wall Insulated r Yes No N/A Comments Floor Protection V Clearances to Combustibles(all sides) V Firestop(s) Vertical Chase 7 d Wall Penetration Vent Clearances to Combustibles .V Vent/Chimney Termination /' Chimney height must be 3 feet above roof V/ penetration;2 feet above any combustible construction within 10 feet Gas Shut-Off Valve Combustion Air Hearth Extension(if any) V / Mantel Height above f/p opening Witness Operation // Tank Placement(if LP) CO Detection / 14 ,,�� 10 CSST Bonding 1,,V White—Building Dept. Yelloss—Cust nner Pink—Fire Marshal