2014-652 TOWN OF QUEENSBURY
ova
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140652 Date Issued: Thursday, January 07, 2016
This is to certify that work requested to be done as shown by Permit Number P20140652
has been completed.
Tax Map Number: 523400-309-014-0001-048-022-0000
Location: 38 RICHARDSON St
Owner: ROBERT & RENEE STARK
Applicant: ROBERT& RENEE STARK
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 r���jjjYVV`/ 45te
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
9."
Joys 742 Bay Road,Qucensbum,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140652 Application Number: A20140652
Tax Map No: 523400-309-014-0001-048-022-0000
Permission is hereby granted to: ROBERT& RENEE STARK
For property located at: 38 RICHARDSON St
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: ROBERT& RENEE STARK Fireplace
38 RICHARDSON St Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans &Specifications
2014-652
Fireplace woodbuming
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, December 31,2015
(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 u sbu ; W..i i e i`a December 31, 2014
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
Fuel Burning Appliance & Chimney Application Office Use Only
Received
DATE: /2-31- / y Tax Map DC 3J Mit _
TAX MAP ID: 5220) 30c- of q-pc,k_o 4S-ezz-dvoe Permit No.
Permit Fee
ZONE:
OWNER ecr L _ J- Revvee S-Lit PHONE/E-MAIL / q3 _ SZ
ADDRESS it Sy I=Lis� l, Sed !00
INSTALLER/ & T s-}G`r f/,K PHONE/E-MAIL t'.S S.k.z/M,q _Iitc,(ox,
BUILDER
CONTACT PERSON FOR BUILDING &CODE COMPLIANCE:
PHONE/E-MAIL BUILDING ADDRESS _Saint A‘DoVc
ROOM OF INSTALL: L j vi nq II n oor . PLANNED INSTALL DATE: Jcxnvpry 2 O j 5
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL Nom: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
FIREPLACE, FACTORY BUILT* NOTE:
MANUFACTURER'S
FIREPLACE, MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY)
MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: tueod3loe k L, ne ; Model #: 2 c3 t 41-rwrew
Listed by: U L Number: ( V?Z
CHIMNEY INFORMATION
Masonry** (check one) BLOCK BRICK STONE
Flue TIE t/ STEEL CSize in inches LiGV b{e lUu i k d_Aon I ASS444
Material 1/DOUBLE WALL TRIPLE \VALL 1------INSULATED
** If non-masonry provide manufacturer name: eo'Ve...f ; Model #: 4SC..teewsk
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. 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 inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAME: !`6L,4-- S-Lrk DATE: /2 -3/_/V
SIGNATURE: i DATE: -3(-(
Town of Queensbury Fire Marshal
742 Bay Road
164
F O Queensbury,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
rr�� instructions or specifications is allowed.
Permit#ao''_'I L 5? Schedule Inspection �,�j� i ``_Time_ 1 am m anytime Inspector`
Name 1 �1G� Address 37) (AY(t1 �`v Rough In Final Jc
Appliance Manufacturer ki ba % m(C Model#
r[C
Masonry Chimney Factory Built Chimney Flue Sizeb Double Wall Triple Wall Insulated_
Yes No N/A Comments
Floor Protection S t hrn J;% £9-
Clearances to Combustibles (all sides) / T1
Safety Strip Installation (fireplaces only) X
Firestop(s) Vertical Chase
Wall Penetration x
Chimney Clearances to Combustibles
Chimney Termination ` '
3 feet above roof penetration; 2 feet above y
any combustible construction within 10 feet /1
Combustion Air
Hearth Extension
Mantel (height above f/p opening) X
Fireplace Doors /Screen (required)
Carbon Monoxide Detection
White—Building Dept. Yelton—Cost mer Pink—Fire Marshal