2024-0361 •
FUEL BURNING APPLIANCE & Office Use Only
CHIMNEY APPLICATION
•�`' Permit#: 20 7.4- 1).5
Permit Fee/
Town uiQuccnsbury
742 Bay Road, Queensbury, NY 12804 Invoice:# )
P:518-761-8256 www.queensbury.net
Project Location: 24I �( �- J(I v
+� Tax Map ID#: .196 . - l- Zb(-e2tkS r� y
Room of Install: ki LLv\c e)Orr Planned Install Date: LSL - S f� 1p2Y
. **ONE APPLICATION PER APPLIA CE,
JUL 19 2024
CONTACT INFORMATION: :.
• Applicant: . Imo- II BUILDING&CODES
Name(s): u(A� � o rn I -ter
Mailing Address, C/S/Z: o2y Bay_6(t are_--')r.
Cell Phone: (51$ ) (o1o1— O Land Line: ( -- )
eIC /ylTh C e giJi00 mom
• PrimarOwner(s):
Name(s): d('1 r\ +- o5e4tY1 a r ' -�-
Mailing Address, C/S/Z: - •a- IP.e_ r. , r
6
Cell Phone:_(6 I( 8 ) 6 •q- �fp(�p Land Line: _( � ) `
Email: t-e-ln P-X)(4__.
• Installer/Builder:
Business Name: CADLivr- S `",,,,�
Contact Name(s): 1= W
Mailing Address, C/S/Z: kSI)E
Cell Phone:_( )
Land Line: _( Sl ) 30'7- (73'70
Email:
Contact Person for Building & Code Compliance:
Cell Phone: _( ) Land Line: ( )
Email:
Em a; I „ha I l mo sha I I Lteensba� . net
•
Fuel Burning Appliance&Chimney Application Revised March 2017
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
Stove 4eplace
Insert — Fireplace
Fuel Fired Equipment (Garage Only, 18" clearance per IMC 304.3)
_Fireplace,factory built**
,� .
(**Manufacturer's name:1 1 S -R C1/w-'M 1 e -;�/�
odel#: ff � j"1-
SOURCE.OF HEAT:
Wood Coal Pellet
Gas
CHIMNEY INFORMATION:
Masonry(require plans to be submitted):
block /3rick stone
Flue:
-� _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:
RINT NAME: J 0 1 (\ ) 0te_r
SIGNATURE: �U v,... ,Ikit-, 1�
DATE: l f)i('Z-`(
Fuel Burning Appliance&C It/
irrfney Application
Revised March 2017
Proposal
Champs Chimney, Awning &
clit!tti
hAPS Fireplace
845 U5-9
Queensbury NY 12804
AWNING V R REPLACE 518-307-7370
www.champschimney.com,
www.champsfireplace.com
Rajter, John Proposal No. 541
24 Baybridge Dr Proposal date 5/13/2024
Queensbury NY 12804 Salesperson Ken Brown
518-669-7060 - - -
Install a medium Lopi Radiant Plus gas insert system with a remote.This includes full installation of
the stove, aluminum liner system,gas line, and electrical.The customer has a choice of face panels.
Description Qty Unit Price Amount'
Gas Insert 1
Subtotal $
Sign & accept
Terms
This proposal reflects current estimated costs and availability of materials and is subject to change
beyond 30 days.A 500/o deposit is due in order for us to order materials, schedule the work, etc..
Total balance is due at time of completion.
https://app.servicepal.com/pro/client/proposal/E03ACFDF-6D45-4A31-A3CB-5D05A79454CA?t=2024-05-13T19:25:25.9816778Z 7/19/24,1:58 PM
Page 1 of 2
RADIANT PL,USTM INSERT 7
1 ,650 Square Foot Heater N�A' �\vim
The Radiant PlusTm Large is an excellent choice for heating larger living spaces. This is
our most powerful Radiant PlusTM Insert. This model showcases a huge viewing area,
the highest heat output, and a realistic, wood burning fire display. The Radiant PIusTM
Large insert is a serious heater and makes a beautiful focal point in any room.
SPECIFICATIONS
Heating Capacity*: Up to 1,650 Square Feet
Maximum BTU/HR Input: 33,000 (NG) 31,000 (LP)
Minimum BTU/HR Input: 17,000 (NG) 15,500 (LP)
Steady State Efficiency (High): MV Model Up to: 87.81% (NG), 87.94% (LP)
G S B Model Up to: 87.81% (NG), 89.94% (LP)
P4 Canadian Efficiency: MV Model Up to: 74.43% (NG), 75.47% (LP)
GSB Model Up to: 75.17% (NG), 76.26% (LP)
AFUE Efficiency: MV Model Up to: 79.4% (NG), 81.1% (LP)
G S B Model Up to: 79.4% (NG), 81.1% (LP)
Glass Area: 27-3/4" W x 16-1/4" H (452 Sq. In.)
MINIMUM FIREPLACE REQUIREMENTS
My Fireplace
Dimensions
A - Height (Front) 23-3/4" (603mm)
B - Width (Front) 31 " (787mm)
Width (Back) 21-1/4" (540mm)
C - Depth 15" (381 mm)
D - Hearth Not Required A B
E - The gas line should be installed prior
to installing the heater.
CLEARANCES TO COMBUSTIBLES
& HEARTH PROTECTION
F - Sidewall to Insert 5" (127mm)
G - Side Facing to Insert 5" (127mm) F I
H - Top Facing to Insert 38" (966mm)
I - Mantel, 0"-12" Depth 36 1/2" (928mm)
J - Hearth Extension Not Required H
*Heating Capacity can be affected by negative pressure in
the home and by prevailing atmospheric conditions. Contact
local building or fire officials about restrictions and installation 0 requirements in your area.
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