FMP-0183-2018 '1111111K
• " TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
- ;
Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: FMP-0183-2018 Date Issued: Monday, July 9, 2018
This is to certify that work requested to be done as shown by Permit Number FIVTP-0183-2018
has been completed.
Tax Map Number: 300.-1-1
Location: 122 TUTHILL RD
Owner: Heidi Laramie-Adams,Edward Miller
Applicant: Heidi Laramie-Adams
This structure may be occupied as a: Wood Fireplace (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,
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.
s i= TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: FMP-0183-2018
Tax Map No: 300.-1-1
Permission is hereby granted to: The Fireplace Company
For property located at: 122 TUTHILL 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 filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: Heidi Laramie-Adams Solid Fuel $0.00
Owner Address: 122 TUTHILL RD 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 Fireplace(living room)
$ 250.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,April 20,2019
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of befo he pira,'o die.)
Dated at the To of Q e April 20, 2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION o
Permit#: � �{_ 0 1 S3-2�0'1�
\ ` Permit Fee:$ `LbO
Town of Queensbury
742 Bay Road,Queensbury, NY 12804 Invoice:#: Z---
P: 518-761-8256 www.queensbury.net
Project Location: Vf-l'a it Rd- ieepisP. Tax Map ID#: 3 O0A--1— )
Room of Install: L;sy;, r \-a C m Planned Install Date: ' 0 Ell 4/92..��G r
c7Av
**ONE APPLICATION =ER APP =1,ANSEM
APR 19 2018 il
CONTACT INFORMATION: �' 3
• Applicant: BUILDING CODES
Name(s): H 1 -' C� L c PA,;1P, AC_Ci.li C/( ,)c rcf (I tJ e
Mailing Address, C/S/Z: 'MO u -'h; Lek qv n,e_11 v IV\j ia,3014
Cell Phone: ( `71(, ) ‘-')'7 I - 9 3 C Land Line: (
Email: wreck .C?1Qrceri6e. 1 -; ( ®rrc.d1 9 Corn
• Primary Owner(s)-:1
Name(s): E 8, 3c d u I a i t1E'.X
Mailing Address, C/S/Z: a-3. \i va,sai1S tnt Aly )5-O
Cell Phone:_( ) l)\-- oc S-esvo c.-e_ Land Line: _(
Email: Ov'�miv‘-v6 - ►�� �'eJ w c c cIL.r 1011 k t\0A-8 r In\;1 > r1NOU1 1
• Installer/Builder:
Business Name: 0, - c' \ • Ak
Contact Name(s): f ' , RA` '_ ems, o r
Mailing Address, C/S/Z: ° j � e.06e ' t Q jar;-,`tee Lake 6 ' 1 a if 5
Cell Phone: _( 51% ) 6 6C.-R3 0D Land Line: _( )
Email:
Contact Person for Building & Code Compliance: N) ick,F /—Cte`69_, ��� ,1l/li ►
Cell Phone: ('71 (, ) `7)/—)9 5 Land'Line (®)
Email: c ar.— ((hi .cioa/ylri(:co r
Fuel Burning Appliance &Chimney Application Revised March 2017
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FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
's/ Stove Fireplace Insert Fireplace
Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
Fireplace, factory built** •
CfiCW
(**Manufacturer's name: Va)c-mo - CrAS rl --J� /Model #: 000l �O I )
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION:
Masonry(require plans to be submitted):
block brick stone 3i\
Flue: �, �t
tile 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:
PRINT NAME: .12 i, (; t .GZ�`GL((WI ACiankS
SIGNATURE VAApaIi" Alva DATE:_57Lar
Fuel Burning Appliance &Chimney Application Revised March 2017