2014-014 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140014-40588 Date Issued: Tuesday, January 23, 2018
This is to certify that work requested to be done as shown by Permit Number P20140014-40588
has been completed.
Tax Map Number: 296.50-1-4
Location: 8 GENTRY LN
Owner: Elizabeth Brown
Applicant: Elizabeth Brown
This structure may be occupied as a: Gas Fireplace Insert
1/19/2018: not verified by FM, but verbal confirmation from Paul Chambers By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( avi9 4
)4ct.
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
`lirN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140014 Application Number. A20140014
Tax Map No: 523400-296-050-0001-004-000-0000
Permission is hereby granted to: ELIZABETH &RUSSELL BROWN
For property located at: 8 GENTRY Ln
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: ELIZABETH & RUSSELL BROWN
8 GENTRY Ln Fireplace
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
FIREPLACE CO..INC.
PAUL CHAMBERS 518-668-9300 EXT 30
2951 LAKE SHORE Dr
LAKE GEORGE NY 12845-0000
Plans&Specifications
2014-014
Fireplace - gas insert into existing fireplace
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,January 15,2015
(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 ensbu, i Wei e,�ay,January 15,2014 •
SIGNED BY . for the Town of Queensbury.
Director of Building&Code En orcement
Office Use Only
Town of Queensbury Building & Codes Received: AciCa`S0"/ cf
Tax Map ID: ��f�t J t 2014
FUEL BURNING APPLIANCE & CHIMNEY APPLICATION Permit No.: t�(7 / --a I y
Permit Fee: $ 5,22)Pd
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 //////q'
Owner /If /?YC&1) Installer/Builder flrc f/Qc Co.
Address C—errlrt, ((F L..- Address .2y.r/ (at e;Acre
e 7Y
au_ee nsbavi IIS( l 'oq 1 G[Ce 6w 'U' /7.t,rc
Phone 4-dQ Phone 37g' G?6 S :306
Location of proposed construction and/or installation: -fit S/Cc.l(Q.f7Crt Ca/ccs-frreriace.TvtSer"/ /v?,e1 T n,5 re
Contact Person for Building&Codes Compliance: i)CLt J C \ U ja g /3o2) 3c,
Subdivision Name:
Fuel Burning Appliance Information Wood Coal Pellet Gas Oil
Stove
Fireplace Insert K.
Fireplace,factory built*
Fireplace,Masonry
Furnace,(Garage Only)
*If Factory Built,Please Provide: Manufacturer Name: / Model No. SVS -3;k 51e Z
Listed By: (AI, wit ..40. Number:
Chimney Information
Masonry** ✓check one _Block Brick _Stone
Flue ✓check one AZTile Steel _Size in Inches /
Material ,/check one Double Wall _Triple Wall _Insulated ✓Direct Vent Yhimney Liner
**If Non-Masonry,please provide: Manufacturer Name: Model No.
Signatures:
Print Name: CLI z/ibET/l A l3A06c.)00
Signature: f/Ze., -.a4(..--47(-) Date: �//t'/'
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.