2013-538 TOWN OF QUEENSBURY
742 Bay Road, uccnsbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130538 Date Issued: Friday, November 29, 2013
This is to certify that work requested to be done as shown by Permit Number P20130538
has been completed.
Tax Map Number: 523400-301-014-0001-005-000-0000
Location: 11 PHEASANT Walk
Owner: JOHN & MEGAN HUNT
Applicant: JOHN & MEGAN HUNT
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, c i`
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.
0.h4 TOWN OF QUEENSBURY
..4 .
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Vtl°6 417
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130538 Application Number: A20130538
Tax Map No: 523400-301-014-0001-005-000-0000
Permission is hereby granted to: JOHN & MEGAN HUNT
For property located at: 11 PHEASANT Walk
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&MEGAN HUNT Fireplace
11 PHEASANT Walk Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-538
FIREPLACE -pellet stove
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 21,2014
(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 Tow eensbu T1 s,.y,November 21,2013
SIGNED BY a.4 / for the Town of Queensbury.
Director of Building& ode En'.rcement
Office Use Only
Town of Queensbury Building & Codes Received: 861,14.146-
61
Tax Map ID: ,I 1 ! 5
FUEL BURNING APPLIANCE & CHIMNEY APPLICATION Permit No.: j 3_53 a'
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: Rough-In and Final Inspections Are Required:
Date CNC,Y`i1`14Q:,C ZUkt 2L 13
Owner k' - I Installer/Builder
Address t\ 7i1eusiv1 Oat Address
Phone 6(8 - - 0Ldfi7 \ Phone
Location of proposed construction and/or installation: f'P, �i1\C . 1 COYmy- na.1/41 � (-spool
Contact Person for Building&Codes Compliance: T�a\1 fl I.• IA-04J
Subdivision Name:
Fuel Burning Appliance Information Wood Coal Pellet Gas Oil
•
Stove
Fireplace Insert
Fireplace,factory built* v';
Fireplace,Masonry
Furnace,(Garage Only)
*If Factory Built, Please Provide: Manufacturer Name:1 t eo.WCL\DY Model No. C R 50
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: -3—CA\V\ . g t3�
r /
Signature: Date: 11 LB
ADDITIONAL NOTE: CONSTRUCTION/INSTh LLATION MUST CONFORM TO NYS FIRE PREVENTION& BUILDING CODE
AND/OR MANUFACT RER REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING
REQUIRED INSPECTIONS.
Town of Queensbury Fire Marshal
1111104. 742 Bay Road
Teri" Queensbury,NY 12804
761-8205/761-8206
fax 745-4437
p
Factory Built Wood Burning 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.
zi
Permit# (u Sa3 Schedule Inspection l�' 115 Time an6m anytime Inspector MAI"
Name 'J J i Address I 1 Pilt..A Sat nov Vig IIS-- Rough In Final
Appliance Manufacturer 4-4141 w Oft6 , Model# v 1,l b J 2
1
Masonry Chimney Factory Built Chimney Flue Size g, Double Wall Triple Wall_Insulated 1 a{—
Yes No N/A Comments
Floor Protection
Clearances to Combustibles (all sides)
/11
Safety Strip Installation (fireplaces only) l� /
Firestop(s) Vertical Chase /
Wall Penetration ) Crie-17,0
Chimney Clearances to Combustibles
Chimney Termination
3 feet above roof penetration;2 feet above
any combustible construction within 10 feet
Combustion Air
Hearth Extension )1(
Mantel(height above f/p opening)
Fireplace Doors/Screen (required)
Carbon Monoxide Detection
White—Building Dept. Yelloss—Customer Pink—Fire Marshal