FMP-0641-2018
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: FMP-0641-2018Date Issued: Thursday, January 10, 2019
This is to certify that work requested to be done as shown by Permit Number
FMP-0641-2018
has been completed.
266.3-1-44
Tax Map Number:
112 SUNSET TRL
Location:
Dennis MacElroy
Owner:
Dennis MacElroy
Applicant:
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.
illillik 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-0641-2018
Tax Map No: 266.3-1-44
Permission is hereby granted to: Dennis MacElroy
For property located at: 112 SUNSET TRL
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: Dennis MacElroy Solid Fuel $0.00
Owner Address: 112 SUNSET TRL 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: Friday,October 4,2019
(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 expiratio i •:to 1
Dated at the Town uee ury; 4
Th-r•s,". October 4,2018
f
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
a
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION P r
(Aiermit#: t� o -Zoo(
ECEE1 WEE PrmitFee:$ 7-5-6) - f�Town of Qucensburv „�
742 Bay Road, Queensbury, NY 12804 I voice:#: b 3-7P: 518-761-8256 www.queensbury.net OCT o 20�$ .�
TOWN OF QUEENSBURY
BUILDING& CODES
Project Location: 117 � - dvi iL. Tax Map ID #: .?j— a—4-H
Room of Install: Lt v t Tyt Planned Install Date: c cT. 5 20 t e.
**ONE APPLICATION PER APPLIANCE**
CONTACT INFORMATION:
• Ap licant:
Name(s): ' t-t't1 'ZeNf
Mailing A dress, C/S/Z: 11 Z -S,APa i`T 1... Q.t.A.QE are-'I'i NY
Cell Phone: ( S 18 ) , 76,-,-- +44e5 Land Line: (5 18 ) Z--Bloc
Email: trcoycam., 2S I 1 p. C..4=.rY1
• Primary Owner(s): •Afri€
Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Installer/Builder:
Business Name: F Lt..,Ac.�,
Contact Name(s): 1-4,4- r L_v_,c,,.�tp
Mailing Address, C/S/Z: M 1 L,o.K•E >c . LA.VGE GAT" `1 We 1 as...4�
Cell Phone: _( ) Land Line: _( %8 ) 8--. ,t1D4n)
Email:
Contact Person for Building & Code Compliance: 1 A-1T L.X..t.J t.
Cell Phone: ( ) Land Line: ( )
Email:
Fuel Burning Appliance &Chimney Application Revised March 2017
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
hove Fireplace Insert Fireplace
p p
Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
Fireplace,factory built**
(**Manufacturer's name: e/A1s Model#: )
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION:
Masonry(require plans to be submitted):
block brick stone
Flue:
tile ./steel kz. size, in inches
Material*:
/double-wall triple-wall o/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 NAM E: 1-4 MAC,
SIGNATURE: ��1� — DATE: tics—Z—'1$
Fuel Burning Appliance &Chimney Application Revised March 2017