2024-0407 FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION Permit#: Z0 �( �bL it
1 �.,/
Permit Fee' �L �, [ter)
Town of ry CZcensbu D L U IF : \
742 Bay Road, Queensbury, NY 12804 I1 Inoice#.
P: 518-761-8256 www.queensbury.net
� AUG 0 6 2024 Ji
**ONE A PIA iAillOWRE=RT-P ,LIANCE**
BUILDING&CODES
lV1 'Project Location: i1 i9ar I' Place Tax Map ID#: yq( / f2-7i
Room of Install:��taneve Planned Install Date: g 13)Vi
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** Lopi eadita..i I- P/(G5
(**Manufacturer's name:1ft.\" 5 J 5� �5j Lopi
5 Model #: ine +'UN1 )
SOURCE OF HEAT:
Wood Coal Pellet )4 Gas
CHIMNEY INFORMATION:
Masonry (require plans to be submitted): 0.1\11,1
f l\vjUt1/496 "VM)
block brick stone
/' 4I01Tht A 1 y�e
4'S
Flue: (2�
tile steel size, in inches
Material*: -
double-wall triple-wall_insulated
Aecli
( Manufacturers name: OuraverAl" Model #:il100VA-0. L33
Fuel Burning Appliance&Chimney Application Revised December 2020
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: ,
Name(s): pure r� pro
Mailing Address, C/S/Z: /Z/ fLeIL Race /( '' ibbav
Cell Phone: (5i ' ) 612 -30117 Land Line: ( )
Email: 7I1dGAy1f7 6J cem
• Primary Owner(s)•
Name(s): 'retie (' i2
Mailing Address, C/S/Z: Ace ,4 C!5/Ar
Cell Phone:_( Sib ) -i2 - 1/7 Land Line: _(
Email: AC( eril &,1 L.COM
❑ Check if all work will be performed by property owner only
• Installer/Builder: Workers' Comp documentation must be submitted with this application
Contact Name(s): 64arn/45 Ohilinney
Contractor Trade: a/yytii Or/Ce5
Mailing Address, C/S/Z: 8y Ay-le 9 / Qv r151U;
Cell Phone:_( ) 307- 7370 Land Line: _(
Email: 2/► r1Ao. a''f�,/!, • C°711
Contact Person for any questions regarding this project: , 1//2"-- 7 .6(6110,
Cell Phone: ( ) Land Line: (S!r )3c7 737O
Email: caG k 4/5 i**Aei,ear
ADDITIONAL INFORMATION:
1. Two (2) 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.
5. Workers' Comp insurance information is required with this application. -
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: 3d 61 r
2
SIGNATURE:, ` DATE: -J 0
L'I.
Fuel Burning Appliance&Chimney Application Revised December 2020
��� FIRE MARSHAL'S OFFICE
_s1 Town of Queensbury
f 742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Maggie Cafaro
14 Dorset Place
2024 — 0407
Gas F/P Insert
• Verify Trac pipe or proper bonding
• Very liner attachment to stove
• Verify chimney termination
• Verify CO detection is present
• Verify if unit is NG or LP, proper orifice
• See hearth requirements page 12
• See mantel requirements page 11
• Verify gas shut off location
14,\N„e
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office • Phone: 518-761-8206 • F a x: 518-745-4437
firemarshal@queensbury.net • www.queensbury.net
54_,A,A5 5W eete
,i_ ,pir ge,i5 liVI-e-(51151"1
( HL
Ica 4
1` t c favo
1 II
AeLo b041
1
1
_1 1 „),
i , 11 L_
_-__I
t- I 41661/14
I t
[ iiIiiv E )\ 1
N_ IET0062.024 1 ' �
TOWN OF QUEENSDURY 1
BUILDING CODES 1
295.14-2-72 2024-407
Magdalena Cafaro
14 Dorset PI.
Fireplace Insert
• Proposal
CKplace Champs Chimney, Awning & Fireplace
I ' 845 us-9
Queensbury NY 12804
AWNING FIREPLACE j 518-307-7370
=wtnJtt.champschimney.corn,www.champsfireplace.com
rf ,'
AUG 0 6 2024 }
Proposal No. 659
Cafaro, Maggie TOVVN OF QUEENS BURY Proposal date 7/19/2024
14 Dorset Place BUILDING ti n� CODES
� , -- Salesperson Ken Brown
5 1 3-812-3047
Total $15,987.00
1)Rebuild the chimney above the roofline,This includes removal of chimney debris in the yard,demolition of the current chimney and removal of this
debris,rebuilding of the brick chimney to a height to meet the 3-2-10 rule,and pouring a new concrete crown with a drip edge.
2)Install a Lopi Radiant Plus medium gas insert.This includes the gas insert,intermittent pilot:assembly,remote control,fan,designer face,arched
backing plate,aluminum liner system with a cap to bring the flue to meet the minimum requirements,and gas line connection.
3)Install a stainless steel liner system to bring the furnace/hot water heater flue to meet the minimum requirements.This includes connecting to the
current furnace pipe and a cap.
=;h :s.}*«°=7.4sv^ --,c._ j.^.: �rs�?S^`•= � ,;,, ";"'i:"s•:,>N"""" '"'S" �.an � r d� fg>.:- 9 'iJ.+, `:f^.- d'i'�: �`:'w�;
� Ja .... ,e 4 -..._., J@ k .S' ((,, ., ,
q E' }'° , x r C '".�; � ',+,. , ? rc.',cr„ Y 4 &•;.: •c�£n �.,".:, Pk sy
a
Chimney Rebuild 1 5,500.00 5,500.00
Lopi Radiant Plus Gas Insert 1 6,987.00 6,987.00
•
Stainless Steel Chimney Liner 1 3,500.00 3,500.00
Subtotal $15,987.00
Sales tax t`;c 50.00
Total $15,987.00
Date
Signature
[' 7/19/2024 10:09 AMt'yi��R. u rC 00. Tice
Terms •
This proposal reflects current estimated costs and availability of materials and is subject to change beyond 30 days.A 50%deposit is due in order for us
to order materials,schedule the work,etc..Total balance is due at time of completion.
•
•
295.14-2-72 2024-407
Magdalena Cafaro
14 Dorset PI.
Fireplace Insert
���
_ 9
CHIMNEY ` °
i
IEMBII
AUG 0 6 2024
•
(1A• ,Ayj' �� Vl1jN T ,/(�`I( U ;:1 [ 1,l 4 .; ' t •
r<
'C /• s `,, .^• IOVmil' r�•4r� c
rk
rout of H ,�,LDlNG iz '`- },6I imney on Home Fireplace/Appliance
AWNING % FIREPLACE'. ��_�.Y—
845 Route 9
Queensbury, NY 12804
518-307-7370
CHIMNEY SERVICE &SHOWROOM
CUSTOMER: CHIMNEY SERVICE REPORT
Cafaro, Maggie Directions to home: Job No.: 11465
14 Dorset Place
518-812-3047 Mobile Service by: Ken Brown
Date: 7/18/2024 9:10 AM
Mcqby47@gmail.com
SYSTEM INFORMATION:
Fireplaces, number of: Level of inspection: Construction:
1 I Masonry
Fireplace opening size: Firebox type: Comment:
Heating Appliances, number of: Level of inspection: Type:
Comments:
Fuel: If other specify: Comment:
Chimney construction: Chimney height(feet): Liner:
I � -
Comments:
Flue sizes: :.!' 13"x 13" = Other
:4°': 8"x 8" 13"x 17" If other specify:
8"x 13" 6" round
8"x17" ,= 8" round
Last cleaned:
Page 2
...,.... .
Chimney ChaSO—4.- s.,::,'...:.';.. MI FACTORY BUILT
,..,::..,
•
'Clearance from FIREPLACE AND CHIMNEY
Cornbustibie!.; \
Ceng_..)„,[--- ,:::% -4,4
-...... ...,..'),i:
....:::,-•--,;..:.'.--, ,, ,::
;,,,,^.... . Linirig i.:-; .c, „e':`,.-,..
Combustible Wall----* -,,,- i \ii '-'-'''-- -`f ••••`'''''' . '! CHASE COVER
"<?:::!-';:;•-`-'1,---'
--,-..„4•-.1„4,,,•'..-` i,i,,,,,,,,,,,,,
i•4
,..:;•;;‘• 4`t,',.'•
k4 F1RESTOP
Smoke Chamber- -......„--- Smoke
Assembly BIers * i Ch'i rnber •'?i;I:- : •;•.:„. ,--/ •---, %,'.;,'''---'7,•:--'.<:-' CHIMNEY
14.4antol•—* - '''s•,•••'• ,,,,:,
-„:.:---, --,:;--r.,-•...--••
Damper 'e•-,.i••.:-....04.••-- :',./..;:.
* Smoke -::•_ '•---:-,-;:•'-
•-
• - ,P,:.•
Fireplaco ' '"I
Face * .z. Throat ,:i',,s;-•;:i..i 1:' -•., 17 ' !,, ,;,:.- ...., ;,,, ;
,-;,-,-: ,!: . iii i•',., ,. .,---,,„•,--',.: :
k,,
Lintel—).ii.....A lig..,,,,
:,/,/ ;,,,: ;
,;:-;'-7 - . ,`„7 :ii,',;,..!,,,- 1 -.-,--' • ; ;
Firebrick--* ,-,.. ,••••,1 . ,,,.\:(-,i', ,. j, ,..ir. '; Ft PLACE
Firebox -,,, . ..-,", i , !:„,.
!: , 1 ....1, ;,........,.,
Assembly Fifebox ..
.. .„,, ! !.'t ! 11 i.-..:--- a :' ; ,•,
Fire•box- '
Ash1,' i - i,, •' -- • ..,,,;.- •,- ,„
Opening ‘,.
Dump MA r:4 .r',..._ii)e: .,..), ,...
i k,N:.i'0, ;:iT:c.,..', • • , <1.--7.3.,z,......'/ • -,
oulof Hoorth Inner Hearth
....... 71,,,'"!,7, • — — :',IX; ' ^`[‘•'4'.Z.i[l :212,.„' •„,„/';;,,..,•' ,,,,,,• 1.1EARTHI
i .
._
in.:;t11,.<^:a76:.;.e:;i ',..ii , ,..•.,-- •.:-,:.,.
' :-...
') -..i.•;,,--,".-;','...t:,.".,- ',4,...:,-,
• 4 ASh ...,Z,.., .'%,;:::",''.:'
Assembly ,,q,.:)::: Dotrip :,,,,if
'',.',2,-=
7.!.. '-','.:C..•,17-',:.-"-:.7"..:'7,-;1.•1-, •7,-',11`,;-"•.,-, ,;-7::'''
:',::;,''.
„..,
."f
.,a,,,,• Clean Out .
Door 30-
' (Anatomy diagrams for general reference only)
. . .
Page 3
;TERMINAL
gt
1'XXII
1 1 STORM
,,..CLEARANCE 1 i ,coLLAR- _LF:q. ,,...„
., -,---.. ,
15"- '1-4,. 1-74•11 FLASHING '---.,, i 1---
,...„
-
---...,,....\-,,•,i•••"tr,F-.„, ROOF •,,.„ •-•-•.,_
•"'i 11 "1"--,--...(, - ., X
11 I WX:, •
,....._
2F1X•c115iN91,1,10 151,..._i ,‘ ..„, . . ---,- .,,,
1 --1••,•..,.
1'• --t,..„...„?.- - ---- , , - - - 1 - • . ._,...
CEILING Jtilai'
1 immii
1 i
COMBUSTIBLE i ,
CHIMNEY 1 comausTwill it" ' WOOD
,CEILING
SUPPORT ! 1 i 1 WALL 11 1 all
r ' ,...................1 Elligult
7 i = STOVES
'10 I la V
_...; ,•-.7 i , —I TUMBLE iii .,:. mil
i , l•
CHIMNEY -1''' i
I I • -11
CONNECTOR1 1 1 1 1 1 III
,1
1 _
...,
, ,....
, i r,.......:1
COMESTIBLE F-1 . ,
._ ..
FLOOR r f•'="WALL „AL-COMBUSTIBLE
PROTECTOR1
, WALL 1
1 111•111
CIX:111,1a:1131.117LF_LIT:3;1=a immaymmil,
C001 ilif WcFan 1 air
"' 44— iinply
- ,
(hut lir
tAlb-Act
----->
'iocP tla mpg!r
,-------- *
.-....,
—„,_,_ .. ;,,,. ...t.....i. ,,
•-...-4.
4.)„ itliirr' ki
,,,um I,* -----.1.-- •
... -IP- L supply
rmster
p'.7.-tnr 1 ' 1
.. .6,. ,,,--:: „e''' t....-- 4.--.5.uPPIY
mv;tat '11..; '°---"-, '- plenum
+ .
FURNACE
exchaiviru
ii .
. ,,,,,,,b,,,,i011
=s t ,-„,,,,,,.. \\., 0 Oiarrbei
hIst-c.Iff ,,1
I D • gas control
, 4.0
11 li 1111 INV
.t mott..„„"1 JAI,- ...4..., . ,el'Art...
hut ner atvot
011" 15 --•:( Ce4r....o' • ' rX0F "iv Now.511t15.0+,
******47444 'fp, ollm, ic-tatallit
- • rir ltot surfac'..t.'
. * '
, igniter
blower
Otrillti ,ik-ilAI b kwier chamber
ti,s 9 al
F T Sifte ' 4.7' rmtar
sit 00 s '
'
- -.,
/„.,"
titer .4 ,s,,,....,_, 7
-„,„....,..,./
(Anatomy diagrams for general reference only)
Page 4
COMMENTS:
Flue openings
7-1/4 x 7-1/4
10-1/2 x 11-1/2
Outside measurements
12-1/2 x 12-3/4
8-1/2 x 8-1/2
INVOICE 1 RECEIPT:
Description Qty Unit Price Amount
Subtotal 0.00
Sales tax 0.00
Total $0.00
Payment method Check#or CC#last 4 digits Payment amount BALANCE DUE
$0.00 $0.00
ANNUAL INSPECTION
® The National Fire Protection Association(NFPA)recommends that an
annual inspection of all Chimneys,Vents,&Fireplaces to be performed. Date
NFPA° Your next inspection is scheduled for:
CUSTOMER VERIFICATION
This report is the result of a visual inspection done at the time of Date
cleaning. It is intended as a convenience to our customer, not as
certification of fire worthiness or safety.Since conditions of use
and hidden construction defects are beyond our control,no
warranty is made for the safety of any appliance and none is to
be implied.
I have read this form and understand the apparent condition of
my fireplace,appliance,chimney, and/or vent system.
Furthermore, I understand the limitations of this report as given in
the paragraph above. Customer Signature
518-307-7370-www.champschirnnev.com
Page 5
IflfICIC RPflI r ,
cEu fiF9 ' ,>
: , , ,m„uNgl t
`''''Iv rm nliui :ifYN 1
„,,,,,,,.,,,,,,„..,
x, • -;` ?:fitplo ..,,,,,„,
,.,:„.,,,,,,,„,,,,
4' ' „..,:pro ;�`,, ,,,,,,
•
>'f:4; . . ,,.. p,m ';. :,1:, of
the ' t;,.u:".'
• y .ne.ed —_. iui 1 . ..
1.
f&'•IMba'rrC '. m.0*'°:"`
-r tM.i r
, ,s..../.......,..,„ ,.0. ,....,,..„...,„,:,,,..,,,
.,,,,,,,,::,;..,.. ,...,..„,,,.........,.....,......„.„.:,.........,,t
`yam'' __
,...„„ ,,
.....,,„,:...,„,..,..„:..„.,....,„=„3.„.
.,,,„...,„„,,,,..„,.,, ,.
2.
.m .. It t. \-'x _..®..,.. ._e
f `
i
.- ; t ..A ., g: it. 'h ;
s
S;T� , s
y lt,t .?ice'
f T
`- e rzaaH�
3.
Page 6
it
F 4jtit tip v, t
i .,, I ..-,..--, , . , , ... Z r'
r,,o, ..k.i.„ ,iii. .'
<3,.` I f • : iF,
* ,,.
k,.3.
r
1 - l S
' . 44.
4.
@4c
ti
1
1
5.
6.