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BOTH-000518-2016
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-000519-2016 Tax Map No: 308.14-1-52 Permission is hereby granted to: Timothy Burns For property located at: 183 PITCHER RD 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 tiled and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance Tvoe of Construction Owner Name: Timothy Burns Fuel Burning&Chimney $0.00 Owner Address: 6 Briwood CIR Total Value 50.00 Queensbury,NY 12804 Contractor or Builder's Name I Address Electrical Inspection Agency Plans&Specifications Pellet Stove S50,00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,July 31,2017 (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*1. 1722(016 ) Dated at the Town of eens rid SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement Fuel Burning Appliance & Chimney Application Office Use Only _ Received DATE: " ` 4(p Tax Map ID TAX MAP ID: Permit No. 51b -20Ika ZONE: Permit Fee '1 5, lnv. 11o6 'j 95 - J 7,2— OWNER Vit .r� PHONE/E-MAIL a0D TIS�ioo Gere ,c©r� ADDRESS INSTALLER/ PHONE/E-MAIL BUILDER CONTACT PERSON FOR BUILDING&.CODE COMPLIANCE: 5k OA C PHONE/E-MAIL BUILDING ADDRESS ROOM OF INSTALL: �-1 J kAJ G ce �-N PLANNED INSTALL DATE: FUEL BURNING APPLIANCE INFORMATION WOOD COAT, PELLET GAS OIL NOTE: ROUGH-IN& STOVE X FINAL INSPECTION ARE FIREPLACE INSERT REQUIRED. FIREPLACE,FACTORY BUILT* NOTE: MANUFACTURER'S FIREPLACE,MASONRY INSTALLATION MANUAL FURNACE(GARAGE ONLY) 4 <A �;� MUST BE AVAILABLE AT TIME OF INSPECTION *If factory built provide manufacturer name: Model #: Listed by: Number: CHIMNEY INFORMATION Masonry** (check one) BLOCK 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 wiIl allow inspector's to enter premises to perform required inspections. I HAVE READ AND AGREE TO THE ABOVE: PRINT NAME: yv,a ri_ , u S DATE: SIGNATURE: t - DATE: Town of Queensbury Building&Codes Principal Structure Application Revised September 2014