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2013-360 TOWN OF QUEENSBURY rorsy742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building& Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130360 Date Issued: Wednesday, September 02, 2015 This is to certify that work requested to be done as shown by Permit Number P20130360 has been completed. Tax Map Number: 523400-289-018-0001-017-000-0000 Location: 19 FITZGERALD Rd Owner: RAYMOND E ERB Applicant: RAYMOND E ERB 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 n �j property owner of the responsibility for compliance with Site Plan, �„ws�(/ �VJ Variance, or other issues and conditions as a result of approvals by the Director of Building& Cod Enforc ment Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY `oro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building Sc Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130360 Application Number: A20130360 Tax Map No: 523400-289-018-0001-017-000-0000 Permission is hereby granted to: RAYMOND E ERB For property located at: 19 FITZGERALD 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 filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Type of Construction Value Owner Address: RAYMOND E ERB JOAN M ERB Fireplace 19 FITZGERALD Rd 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 2013-360 Gas FIREPLACE(standalone) $0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 06,2014 (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 To of ensb JVf//J L - d, __ gust 06,2013 .01 SIGNED BY ` for the Town of Queensbury. Director of Building&Code Enforcement Town of Queensbury Fire Marshal 44- 742 Bay Road Queensbury,NY 12804 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#20...3----761:3 Schedule Inspection e131 ) Time 1``) /�/�- �'' am m anytime Inspector �/7�1� Name JOGrl Ej�i Address 1 q' F71-2cie7zci I Q Rough In Final, Appliance Manufacturer /V EPD Lam/ Model# OD s 2s p IJ Direct Vent Factory Built Chimney Flue Size Double Wall Triple Wa11_ Insulated Yes No N/A Comments Floor Protection Clearances to Combustibles(all sides) A Firestop(s) Vertical Chas Wall Penetration Vent Clearances to Combustibles �/ Vent/Chimney Termination /[ Chimney height must be 3 feet above roof \ J penetration;2 feet above any combustible construction within 10 feet Gas Shut-Off Valve • Y Combustion Air /` Hearth Extension (if any) Mantel �`, Height above f/p opening Witness Operation Tank Placement(if LP) CO Detection CSST Bonding White—Building Dept. Yellow—Cast Amer Pink—Fire Marshal LYI Office Use Only Town of Queensbury Building & Codes Received: TaxFUEL BURNING APPLIANCE & CHIMNEY APPLICATION Perm t NoM3 O 2�1%3g 3&0 -�� Permit Fee: $ 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: Rouqh-In and Final Inspections Are Required: Date /I ✓c_u ; T 7 �f Owner %r N 1-4ri 0•4 Eh/3 Installer/Builder Addressr1' )�{ PA n it Rd• Address t P vc arirq thy Jai loLt Phone (c/a) 7 l a -- 4t17 Phone Location of proposed construction and/or installation: Pt ten I e Hcpn r_ a 'f 4 dd its C C1 t-ti✓ Contact Person for Building&Codes Compliance: Subdivision Name: • Fuel Burning Appliance Information Wood Coal Pellet Gas Oil Ij Stove y� Fireplace Insert Fireplace,factory built' Fireplace,Masonry Furnace,(Garage Only) frit Pete ari *If Factory Built, Please Provide: Manufacturer Name: Gni ,,r_/4. Model No. 6 b Sa SN 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 1.../Direct Vent _Chimney Liner "If Non-Masonry,please provide: Manufacturer Name: Model No. Signatures: Print Name: (0n,✓ iii - ErA Signature: /4u u_ > Date: A u 5 dni.3 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. • a' leu 0 '5 2013 rn sk ' St ,'‘,::-:'1.S. ate-Ti } GP-e 3a iFi '+ R} r F •• - -ai \ rxk nt 'r _r, •4• 245 State Rt 40 • 4 w_,.ar k t tr -rw i '= Soutti4 4):i VY}12809 4 =,(518) 638 8950 • FAX (518) 638'6786 vx4 .421 SOLD BY • - www•thestovery corn *' �^ s, s� �_ '-1,� • NAME •m. }' v h ADDRESS - - ` / a v/L - AL_ :'$-: /a-.,!.:. .:':. :-3, .- - <.a_ . 9 CASH 0 CHARGE MERCHANDISE RETURNED 0 C.O.D. 9 PAID OUT PAID ON ACCOUNT QTY. DESCRIPTION © PRICE AMOUNT liallal ©A-1/nla 4-12-0a MI i _ 011irallala , 10� ��� = p2/O ® Gfe- /0o6 at o '— In ..k — NOTICE « _a moo -- ®Attention.The code enforcement official shall be _ notified b the .urchaser of an .urchase or 23 yo of any solid fuel or gas burning appliance, _ chimney,or flue. BEDEWED BY //ltf;r4-4C ,%i a wins TOTAL 18661 63r vE: :, ,t:. .� ..•,-, :! ;,;, -:',/, _. ^' 7WNK 'YOIJ L . .,plvf ,%-hn SIOYtri c� '+ -. --_ y _ - • 1111Nry ,it 63f-89so leo,: ' ' 5 �;� t -) a� t-:,: QUALITY • /is d 7— J I✓r/ Pa �e o.✓ AUG 0 5 1013 iti ty-542 ss-‘ Flaom,�f Tree d sf>tf D*;SMBau4 04o , "S' ffi.3 ' 'i-;; ;- -�s--� s 1' . ',\A >' ,. }, i Aye I� F ' _ //[� I I 41.:: - s � LY i �3 fl/JG �/Q al/ 't n10./ i t `E t.,..i """ II � f �`- s ' - � !, - i t I' ` 1 b T Ea✓ /ye. ireR Are* 1. ir' fi -f�, f;-.1,itN. 1� fl'is ii Walt _• -j cWC--- 'c.:� ' `r- ''" 'f. i ii: 1r = 4-_: `'`t rF � i. • s f R1,gs AIIcno d "�AnQM x le:1k f i,. , r 4, ; JS i-i. . Tested as a heater to ANSI Z21.88 and CSA 2.33. Unit includes:electronic ignition gas valve with battery back-up and on/c built-in adjustable flame heat control,stainless steel gas flex connector and shut off,night light with on/off switch,exclusiv< "PHAZERAMIC" burner,ember bed and logs,ceramic glass, secondary heat exchanger. Bathroom/bedroom, bedsitting rc approved. Suitable for mobile homes. Up to 24,500 BTUs. 50%flame/heat adjustment for maximum comfort and effiaenc•. Model Description GDS25N Painted Black Finish, NG Stave - Va✓T — FL0o4 /'h n — GDS25NN Porcelain ajolica Brown Finish, NG /4/4 // TA ea ,r, a s le-a -F GD525NM Summer M s, NG 3. coo 0 GDS25NW Winter Frost, G 7 Ao W175-0246 Conversion Kit G to LP 3a / o OPTIONS/ACCESSORIES . GDSLL-KT Leg Leveliig/Stove Securing Kit T.vi44_/./.,-.1/0:.0 Jru u/n�.✓z T,� 1 GS-331 S Stove Top Inst Soapstone - Lorena Slate Finish aro by.1 / -$4,-6-0 k11 -1 J GS-331F Stove TopInset Granite - Ubatuba Green Finish / V I GS-331 N Stove Top Inset Gram' e -Giallo Golden Brown Finish Note: See Direct Vent Stoves - Venting components for additional venting. Note: Terminal extension plate (W500-0103[see venting]) may be required. (Refer to instructions.) Some Items May Be Special Order 800-873-1330 • fax 518-828-5639 • www.bacsales.com