BOTH-000556-2017 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-000556-2017 Date Issued: Thursday, September 21, 2017
This is to certify that work requested to be done as shown by Permit Number BOTH-000556-2017
has been completed.
Tax Map Number: 296.49-1-8
Location: 36 BAYBRIDGE DR
Owner: ELAINE MADISON
Applicant: ELAINE MADISON
This structure may be occupied as a: Gas Insert
Regency LR13E By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the J4 4 t
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
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BUILDING PERMIT
Permit Number: BOTH-000556-2017
Tax Map No: 296.49-1-8
Permission is hereby granted to: First Flame
For property located at: 36 BAYBRIDGE 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
Tvpe of Construction
Owner Name: ELAINE MADISON Fuel Burning&Chimney $0.00
Owner Address: 36 Baybridge DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
First Flame
475 CORINTH RD
Queensbury,NY 12804
Plans&Specifications
Gas Insert
Regency LR13E
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,September 5,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenrueensb
a the ex r tion ate.)
Dated at the Town of ues tember 5,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION
Permit#: 2-C) 1
Permit Fee:$
Tom,Or Quecusbury
Invoice:#:
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensbupt.net
Tax Map ID 7
Project Location:
<:
Room of Install: 'A* JV14qi aOm Planned Install Date:
Ej
**ONE APPLICATION PER APPLIANCE"
CONTACT INFORMATION:
9 Applicant: SEP 01 2017 1I.
Name(s):
Mailing Address, C/S/Z: -j V'e
Cell Phone: 6 i"7 Land Line:
Email: 0M(LI 66in
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
9 installer/Builder:
Business Name:
Contact Name(s):
Mailing Address, C/S/Z: 624Z eez) LV3- C
Cell Phone:_(
Land Line:
Email:
Contact Person for Building & Code Compliance:
Cell Phone: J 1;�56-> Land Line: J
Email:
Fuel Burning Appliance&Chimney Application Revised March 2017
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
a
Stove �' 7Fireplace Insert _Fireplace
Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
_Fireplace,factory built**
**Manufacturers name: Model#: ^.. -.
SOURCE OF HEAT:
Wood Coal _Pellet �� Gas
CHIMNEY INFORMATION:
_Masonry:
block brick stone
_Flue:
_tie _steel _size, in inches
_Material*:
_double-wall _triple-wall insulated
(*Manufacturer's name: Model #: )
ADDITIONAL INFORMATION:
1. Two inspections are required. A rough-in inspection, prior to installation and a final inspection, after
installation.
2. Manufacturer's installation manual must be available at the time of inspection.
3. Masonry fireplaces & chimneys require plans to be submitted.
4. Twenty-four(24) hour notification is required for inspections.
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 the inspector to enter the premises to perform the
required inspections.
I have read and agree to the above:
r`/
PRINT NAME: Ci�r;'f's 1!�Fs C'i
SIGNATURE: t /°' )` ; '� DATE: `
Fuel Burning Appliance&Chimney Application Revised March 2017