AST-000618-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
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Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: AST-000618-2017 Date Issued: Thursday, December 7, 2017
This is to certify that work requested to be done as shown by Permit Number AST-000618-2017
has been completed.
Tax Map Number: 301.7-2-38
Location: 14 SYLVAN AVE
Owner: JACOB LOEB
Applicant: JACOB LOEB
This structure may be occupied as a: Wood Insert
Living Room By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, 4
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: AST-000618-2017
Tax Map No: 301.7-2-38
Permission is hereby granted to: JACOB LOEB
For property located at: 14 SYLVAN AVE
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
Tyne of Construction
Owner Name: JACOB LOEB Fuel Burning&Chimney $0.00
Owner Address: 14 Sylvan AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
The Fireplace Company
2951 Lake Shore DR
Lake George,NY 12845
Plans&Specifications
Wood Insert
Living Room
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 3,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of QueWQueen ;
ration ksctober
Dated at the TownT 3,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
•
FUEL BURNING APPLIANCE & office use only
CHIMNEY APPLICATION Permit#: PrS - ID 113 • ?A \�
Permit Fee:$
linen ul (Zuccn.hun'
Invoice:#:
742 Bay Road, Queensbury, NY 12804
P: 518-761-8256 www.gueensbury.net
Project Location: N S' &Ig ,1 At-( 1Z Tax Map ID #:
Room of Install: vr','� rU�M Planned Install Date:
**ONE APPLICATION PER APP I
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CONTACT INFORMATION: OCT O 22017
SOWN OF QUEENSBURY
• Applicant: BUILDING
&CODES
Name(s): SC01VUL
Mailing Address, C/S/Z:
Cell Phone: Land Line: � )
Email:
• Primary Owner(s):
Name(s): -`�,cjk S L(,e10
Mailing Address, C/S/Z: 'I S vtin. Givt 4�P�s� 2-et�`l
Cell Phone: _( S116 ) q'i _ J 74 Land Line: _( )
Email: -y fb p
• Installer/Builder:
Business Name: Tyc abate Crr'-ne'.y7
Contact Name(s): i tjt, L-ek iS
Mailing Address, C/S/Z: 2 tlS 1 LN Kr S'ti"'t 0!- I`'I� y� A/�L.' fZ�yS
Cell Phone: _( ) Land Line: _(
Email: M Lel` !-cC iJ,Y nC/JM
Contact Person for Building & Code Compliance: c I )
Cell Phone: ( ) Land Line: _( )
Email:
Fuel Burning Appliance &Chimney Application Revised March 2017
. F
A
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
—Stove Fireplace Insert — Fireplace
— Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
— Fireplace, factory built**
(**Manufacturer's name: ye MUvf' C65 Lrt l Model #: VL —111,9,y'r P6A )
SOURCE OF HEAT:
,k Wood —Coal — Pellet —Gas
CHIMNEY INFORMATION:
— Masonry (require plans to be submitted): Flex ps r5 6 S' SS
block brick stone A
_ Flue: — — — I'"S'4ll//'/
—the —steel —size, in inches �''�h S ON�� G�►r Mn.P�
_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:
PRINT NAME: I ACG S L �
SIGNATURE: DATE: (U Z
Fuel Burning A pliance &Chimney Application Revised March 2017