BOTH-000823-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000823-2016 Date Issued: Wednesday, December 14, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000823-2016
has been completed.
Tax Map Number: 301.5-1-4
Location: 771 WEST MOUNTAIN RD
Owner: Liesl Haviland-Fleming
Applicant: Michael Fleming
This structure may be occupied as a: Gas Stove
By Order of Town Board
TOWN OF QUEENSSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the r ) _�wvlylX�// 4 k�
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 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000823-2016
Tax Map No: 301.5-14
Permission is hereby granted to: Michael Fleming
For property located at: 771 WEST MOUNTAIN RD
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 tiled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tvce of Construction
Owner Name: Liesl Haviland-Fleming Fuel Burning&Chimney $0.00
Owner Address: 771 West Mountain RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
First Flame
475 CORINTH RD
Queensbury,NY 12804
Plans&Specifications
Gas Stove
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 2,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before the ex . ati on dak, m5er
Dated at the Town o ueensb rid 2,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Fuel Burning Appliance & Chimney Application `-- Office Use only
Itece�Jed
DATE: u- / I(a �xM'bpID
TAX MAP ID: Sa 3 x/00 30 f . �- 1 -- `� le'finiNo.
CSo a3�o��
ZONE: PermiQFee J� 3
OWNER i e ( PHONE/E-MAIL
ADDRESS 7 We s7_MT Rd Qirens,kwi-Z , V ,V i sao 4rl
INSTALLER/ Firs7_ F_/QMe'_ P ONE/E-MAIL
BUILDER -7q,?- ,2 aaO
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: M i Lk0.t I F
PHONE/E-MAIL 955- Y! S�f BUILDING ADDRESS 771(CV.
i
ROOM OF INSTALL: LI U 1 LN P-006\ PLANNED INSTALL DATE: I �L ZI 3 .Zl&
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE k 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: Em pi rL ; Model#: DY P 3 o C C 30
Listed Number: 7 qg= a2 n-Q,O
CHIMNEY INFORMATION
Masonry** (check one) BLOCK —BRICK _STONE
Flue _TIE STEEL(p Size in inches
Material DOUBLE WALL TRIPLE WALL INSULATED
** If non-masonry provide manufacturer name: ; Model#:
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:
PRINTNAME: M ic.(1ae 1 e- DATE: 12- 11 (p
SIGNATURE: �ig �t , , DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014