2013-329 TOWN OF QUEENSBURY
FON 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130329 Date Issued: Thursday, August 07, 2014
This is to certify that work requested to be done as shown by Permit Number P20130329
has been completed.
Tax Map Number: 523400-289-012-0001-030-000-0000
Location: 15 FARMINGTON P1
Owner: ERNESTO PEREZ
Applicant: ERNESTO PEREZ
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
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
FON 742 Bay Road,Queensbury,NY 12804-5902 (5]S)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20130329 Application Number: A20130329
Tax Map No: 523400-289-012-0001-030-000-0000
Permission is hereby granted to: ERNESTO PEREZ
For property located at: 15 FARMINGTON PI
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: ERNESTO PEREZ Fireplace
15 FARMINGTON P1 Total Value
QUEENSBURY NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
DAVE WILLIAMS
OUEENSBURY NY 12804-0000
Plans&Specifications
2013-329
FIREPLACE replacing existing gas unit with a pellet stove
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,July 22,2014
(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 own o uee uitlp¢ 4i.f,'. y,July 22,2013
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only -
Town of Queensbury Building & Codes Received: juI 22 2013
Tax Map ID: A R 4,!?-1,3 z>
rti3Z>
FUEL BURNING APPLIANCE & CHIMNEY APPLICATION Permit No.: /3 3
Permit Fee: $ SD°V
Application is hereby made to the Building & Codes Office for the issuance of a Building & Use Permit pursuant to the NYS 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.
Important Note To Applicant: Rough-In and Final Inspections Are Required:
Date as 02021 02013
• Dave �` 11
Owner �� • Pt' Installer/Builder 1 I 6 M
Address 1 5 1 W • Address
' Lr • ''ter
Phone k�'fii�lrl Phone Q �11V yr
Location of proposed construction and/or installation: 1 6 TQ d rn I �5�n V ( i e ,, Av y
Contact Person for Building&Codes Compliance: t1-01-7t1-01-70 -�re.z — 413 _5i /13.1,
Subdivision Name:
Fuel Burning Appliance Information Wood Coal Pellet Gas Oil
Stove
Fireplace Insert X
Fireplace,factory built*
Fireplace, Masonry
Furnace,(Garage Only) alai
�
If Factory Built,Please Provide: Manufacturer Name: al b(c Model No.
Listed By: Number:
Chimney Information
Masonry" ✓check one _Block _Brick _Stone
Flue /check one Tile Steel Size in Inches
Material /check one _Double Wall _Triple Wall _Insulated _Direct Vent _Chimney Liner
"'If Non-Masonry,please provide: Manufacturer Name: Model No.
Signatures:
Print Name: fil l-n 1 'e r2 Z aft
�4
Signature: Date: UtIaa) 2 13
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.