BOTH-000386-2015 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: BOTH-000386-2015 Date Issued: Friday, December 4, 2015
This is to certify that work requested to be done as shown by Permit Number BOTH-000386-2015
has been completed.
Tax Map Number: 296.9-1-66
Location: 11 MAPLEWOOD DR
Owner: SHERRI BELLOW,John Bellow
Applicant: John Bellow
This structure may be occupied as a: Fireplace,gas insert
By Order of Town Board
TOWN OF QUEENSSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (/ J
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000386-2015
Tax Map No: 296.9-1-66 REVISED
Permission is hereby granted to: SHERRI BELLOW
For property located at: 11 MAPLEWOOD DR
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
Tvce of Construction
Owner Name: SHERRI BELLOW Fuel Burning&Chimney $0.00
Owner Address: I I Maplewood DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
The Slavery
Plans&Specifications
Fireplace,gas insert
PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,September 8,2016
(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 sbury; Monda ,September 14,2015
SIGNED BY: for the Town of Queensbury.
Director of Building&Code nforce%,t
Fuel Burning Appliance & Chimney Application [Office Use Only
Received
DATE: q /o �5
t E C E 0 W E ' Tax Map ID
TAX MAP ID: Permit No. oZO l5--4,1g'
SEP 1_. 0 2015 Permit Fee 450 -
ZONE:
TOWN OF QUEENSBURY
BUILDING&CODE
OWNER
51e-ftZc( d/O /E-MAIL
ADDRESS ) / n/9€ pbe 1,0 0 a' J)12-- 2-t't S hu r/6 7 / °t 14
INSTALLER/ PHONE/E-MAIL
BUILDER -711 C S�U✓e fe-t/ - A2g y l AA/
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAIL BUILDING ADDRESS
ROOM OF INSTALL: Fa/m; �m , PLANNED INSTALL DATE:
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT
REQUIRED.
FIREPLACE,FACTORY BUILT* NOTE:
MANUFACTURER'S
FIREPLACE,MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY)
MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: ; Model #:
Listed by: Number:
CHIMNEY INFORMATION
Masonry** (check one) BLOCK v BRICK STONE
Flue TIE STEEL Size in inches
Material DOUBLE WALL TRIPLE WALL INSULATED
** If non-masonry provide manufacturer name: ; Model #:
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 inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAME: S h-e_ 13 lO DATE:
SIGNATURE: / R v ji DATE: lJ ,_S
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
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39DPBsho,in v ith lo.,rrofile faceplate in black and rustic brown brick panels.
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390E6 shown with 4-sided low profile faceplate in black and enamel panels. L390EB shown with low profile faceplate in sunset bronze and reflective panels. L390PB shown with arched full screen doors. it
Specifications(NG) ) L540EB L540PB I L390EB I ,1.390P "° Standard Features Optional Features
Input(BTU) 38,000 38,000 31,000 ( 31,000 • Natural gas • Low profile faceplates in two sizes
I
Turn down to(BTU) 25,000 25,000 22,000 I 22,000 • Flush front with ceramic safety glass • Customizable backing plate(3 or 4 sided)
EnerGuide Rating* 73.72% 73.72% 71.9% I71.9% • Ceramic log set molded from real wood • Full screen doors(different designs and finishes)
Efficiency(steady state) 84% 84% _ 84% ( 84% • Ceramic burner with built-in glowing ember bed • Removable mesh glass guard '
Min.Fireplace Opening' L540EB L540PB L390EB i L390PB • Electronic ignition with SureFire''switch(L390EB, • Brick panels
Width(front) 34" ** 30" ** r� L540EB)or standing pilot system(L390PB&L540PB) • Enamel reflective panels
I • Proflame GTMF Remote Controls(L390EB&L540EB) • Programmable wall thermostat
Width(rear) 25" ** 22" ** • Variable speed blower • Proflame GT,GTM,GTMF(L390PB&L540PB)
Height 24" ** 20" '** , • Heat exchanger for maximized efficiencies • Regency flex venting
Depth 16-3/4" ** 15-1/2" _-**'' • 30°angled flue(for versatile installations) • Propane conversion kit
View area I 540 sq.in. ** 390 sq.in.__**„ • Easy access controls • Hearth trims in 2"or 4"(black,low profile
'for Canada only • Direct vent faceplate only)
**ForPB min.fireplace opening measurements see page 18.
for detailed specifications please see pages 18-19.