FMP-0067-2018 . TOWN OF QUEENSBURY
>e o 742 Bay Road,Queensbury,NY 12804-5904 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: FMP-0067-2018 Date Issued: Wednesday, December 26, 2018
This is to certify that work requested to be done as shown by Permit Number FMP-0067-2018
has been completed.
Tax Map Number: 296.9-1-3
Location: 1063 State Rte 9
Owner: Wood Carte
Applicant: Wood Carte
This structure may be occupied as a: Wood Fireplace (showroom floor)
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.
TOWN OF QUEENSBURY
`` 7
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: FMP-0067-2018
Tax Map No: 296.9-1-3
Permission is hereby granted to: Wood Carte
For property located at: 1063 State Rte 9
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: Wood Carte Solid Fuel $0.00
Owner Address: 1063 State Rte 9 Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Wood Fireplace(showroom floor)
$ 250.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday,February 16,2019
(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 the expiration date.)
Dated at the Town Quee uryp 4Fri I: ,F�► . -' 16, 2018
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SIGNED BY: if \ for the Town of Queensbury.
Director of Building&Code Enforcement
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION Permit#: F'MP - Orb - 201lb
Permit Fee:$
lown of Qucen%bury
742 Bay Road, Queensbury, NY 12804 Invoice:#: O\
P: 518-761-8256 www.queensbury.net
Project Location: id 63 12 9 Q b/ Tax Map ID#: Z 3 06 2 c , - 1
Room of Install: SL O>e✓tOC Planned Install Date: 4-s P
**ONE APPLICATION PE PPLIANCE**
ECEGY �
CONTACT INFORMATION: FEB ) 4 2018
• Applicant: TOWN OF QUEENSBURY
Name(s): --� �" � � BUI
Mailing Address, C/S/Z: 14 . /2% °1 QA7 N
Cell Phone: ( ) Land Line: ( S/' ) 7 1 -
Email: 4 JCa +e i/-B�.9Ma°! cot-,
• Primary Owner(s): {
Name(s): CL r, s tOFt.e" Carte
Mailing Address, C/S/Z: Sa
Cell Phone: _( ) Land Line: _( ) vatic
Email: (',C C 7 ? e. & oc/cc e <�
• Installer/Builder:
Business Name: / al,is Cact-e
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(
Email:
Contact Person for Building & Code Compliance: Warsil ,ser'e/t Cc i-e
Cell Phone: ( 3 t 8 ) 7 s4-5 c1( ,s' Land Line: (5(ff ) - 7qr - ?G.3 S
Email:
Fuel Burning Appliance&Chimney Application Revised March 2017
t
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
1( Stove Fireplace Insert _Fireplace
_ Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
Fireplace,factory built**
**Manufacturer's name: Model #:
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION:
I' Masonry:
block brick stone
Flue:
tie >C steel size, in inches
Material*:
double-wall ) triple-wall insulated
2522Z 5
(*Manufacturer's name: eAchP, c Model #: )
z Z-zZ 3 2
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: ereitl
SIGNATURE: DATE: '2- 11
Fuel Burning Appliance&Chimney Application Revised March 2017