2012-388 ow. TOWN OF QUEENSBURY
woo742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120388 Date Issued: Friday, August 17, 2012
This is to certify that work requested to be done as shown by Permit Number P20120388
has been completed.
Tax Map Number: 523400-301-015-0001-020-000-0000
Location: 6 FERRISS Dr
Owner: LEE S NESBITT
Applicant: JOHN BELLOW
This structure may be occupied as a:
Fireplace
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the °3 y
property owner of the responsibility for compliance with Site Plan, s''.. i!. d
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 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120388 Application Number: A20120388
Tax Map No: 523400-301-015-0001-020-000-0000
Permission is hereby granted to: JOHN BELLOW
For property located at. 6 FEMSS 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. Type of Construction Value
Owner Address: JOHN BELLOW
SHERRY BELLOW Fireplace
6 FERRISS Dr Total value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
THE STOVERY
RICH 518-638-8950
4245 STATE ROUTE 40
ARGYLE NY 12809-0000
Plans&Specifications
2012-388
Fireplace-natural gas
$50,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,August 09,2013
(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 of Queensbury; Thursday,August 09,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Fire Marshal
y ! 742 Bay Road
f^"1 Queensbury,NY 12804 0 7/i2—
--;1. 761-8205/761-8206
fax 745-4437
Factory Built Gas Fireplace/Stove Inspection Report
Notice: New York State requires that all UL Listed,factory built appliances be installed according to the instructions and
specifications contained in the Installation Manual accompanying the appliance.No deviation from the manufacturer's
instructions or specifications is allowed.
f
Permit# / 2 Schedule Inspection hi' Time/M:3 (S)
_ ' pm anytime Inspector V�S
Name O lg 4/AK-Address 4' g*'' 1515 ''' Rough In_Fina)X
Appliance Manufacturer 172 /-)6,7-- Model# 577-36
7i(
Direct Vent Factory Built Chimney `4, Flue Size�--' Double Wall Triple Wall Insulated
h.
Yes No N/A Comments
Floor Protection J/
Clearances to Combustibles (all sides) /
Firestop(s) Vertical Chase
Wall Penetration
Vent Clearances to Combustibles
Vent/Chimney Termination
Chimney height must be 3 feet above roof /
penetration;2 feet above any combustible �/
construction within 10 feet
Gas Shut-Off Valve4
Combustion Air V
Hearth Extension (if any) / .
Mantel , /
Height above f/p opening �/
Witness Operation
/
Tank Placement (if LP) l,
CO Detection 7.
b
CSST Bonding
___17-
White—Building Dept. Yellow—Cust)mer Pink—Fire Marshal
Revised 4/14/2010
APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS
Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the
New York State Fire Prevention & Building Code. 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 all inspectors to enter
premises to perform required inspections.
A01,3 0 9 2012
Important Note To Applicant: Rouqh-ln and Final Inspections Are Required:
Owner:: :75 -1n c/ _C-Ae r// Installer/Builder: T)i S Io t'e j
Address: (a re_(rt. Si .JD i'' . Address: i-+2cyi v,7c1ofU
Phone Nos.: r,S - -7 rS - c24/(. ., Phone Nos.: t k - 6,3 5-Ci
Location of Property: f-c;v't"i SSlei. - Subdivision Name:
Location of Proposed Construction and/or Installation: S %l rn -e
Contact Person for Building & Codes Compliance: ct''-e
Fuel Burning Applicance Wood Coal Pellet Gas Oil
Information
Stove
Fireplace Insert
Fireplace, factory built*
Fireplace, Masonry
Furnace, (Garage Only)
* If Factory Built, Please Provide: Manufacturer Name: Model No.
Listed By: Number:
Chimney Information BLOCK BRICK STONE
Masonry** Check Ones(
TILE STEEL SIZE IN
INCHES
Flue Check One ✓
DOUBLE WALL TRIPLE WALL INSULATED DIRECT CHMNEY
VENT LINER
Chimney Material Check One/ f�
** If Non-Masonry, please provide: Manufacturer Name: Model No.
ADDITIONAL NOTE: CONSTRUCTION / INSTALLATION MUST CONFORM TO NYS FIRE
PREVENTION & BUILDING CODE AND/OR MANUFACTURER REQUIREMENTS. CONSULT
AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED INSPECTIONS
Town of Queensbury * Community Development Office * 742 Bay Road, Queensbury NY 12804