2014-463 ta TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140463 Date Issued: Wednesday, March 23, 2016
This is to certify that work requested to be done as shown by Permit Number P20140463
has been completed.
Tax Map Number: 523400-279-013-0001-014-000-0000
Location: 56 DREAM LAKE Rd
Owner: ALLAN & DEBORAH MUMFORD
Applicant: ALLAN & DEBORAH MUMFORD
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, / �d
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code nforcement
Planning Board or Zoning Board of Appeals.
11� TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140463 Application Number: A20140463
Tax Map No: 523400-279-013-0001-014-000-0000
Permission is hereby granted to: ALLAN &DEBORAH MUMFORD
For property located at: 56 DREAM LAKE 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: ALLAN & DEBORAH MUMFORD
7 SUGAR HILL Rd Fireplace
NORTH SALEM NY 10560-0000 Total varve
Contractor or Builder's Name/Address Electrical Inspection Agency
WAYNE CRAWFORD
172 GILCHRIST HILL Rd
HARTFORD NY 12838-0000
Plans&Specifications
2014-463
Fireplace (gas -propane)
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 26,2015
(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 o Queen ury; Jrid• ,, ,.;y' ,: ber 26,2014
SIGNED BY 1/4 for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
FUEL BURNING APPLICANCE &
-Received
CHIMNEY APPLICATION E C 11:aiMap'IDE nl L /-
DATE 61-2-6-4 (1 I'PennitNo. III Mme. aI ,3
SEP �rmiU 14i`�� " "�
11111 Y
TAX MAP ID TOWN OF QUEENSBURY 1
BUILDING&CODES I
ZONING r
OWNER: ( 1 tL�t✓I "W� Glint 6c,(0c,C a�` ' " c.rn /?PHONE/E-MAIL
ADDRESS �� -Arcane, /mow 2cQ. tat__ lir , Nd. t2 A4 C
INSTALLER/BUILDER: )�-Jetc_C 44.a ac /��� I '� 'PHONE_/E-MAIL
ADDRESS: 17 j enleit+'iv kh'U Rd . k/r8i~cC � �j - ILfr?
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE PHONE
BUILDING ADDRESS'.
Fuel Burning Appliance Information Wood Coal Pellet Gas Oil NOTE: ROUGH-IN & FINAL
V Stove -@Dem ✓ INSPECTIONS ARE REQUIRED.
Fireplace Insert
Fireplace,Factory built
Fireplace, Masonry
Furnace(Garage Only)
if Factory built provide manufacturer name: ; model if:
Listed by: Number.
Chimney Information
Masonry"(check one) Block Brick Stone
Flue Tie Steel Size in inches
Material T-Double wall Triple wall Insulated 4. Direct Vent _Chimney Liner
"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 will allow inspector's to enter premises to perform required
inspections. ,�
I have read and agree to the above: Print Name:e 4c- d-Zt4..,!1'l4isa Fr//��„0c. Date:
Signature: er /ileo Date:
/l/ 5
Town of Queensbury Building&Codes Principal Structure Application July 2014
-1
��
7.0 IF 4 3
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1 TOWN OF QUEENSBURY FIRE MARSHAL
742 Bay Road, Queensbury, NY. 12804-5902
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.
Permit#: .zoi N 43 Name: 4i'/ �h /7 #
Inspection Date: ,7/ //b Address: SA rra r/ ./-are'
Time: 04Gt)- 1.A1p 6® fir jS
/j
Inspector. °Xi
Rough-in/Final: Ai-yogi-
Appliance
Appliance Manufacturer. M, /7 Model#: 1..15/47_
f'
Direct Vent _Factory Built Chimne Flue Size Double Wall _Triple Wall _Insulated
0.4447
��. // Yes No N/A Comments Fk ta7 �
Floor Protection � 4f' //11
Clearances to Combustibles(ffll �e a', /'ROM Ctm&e2 el/�'/ - 710`73' L-
Firestop(s) Vertical Chase r" `
Wall Penetration//uW
Vent Clearance to Combustibles*/_
Vent/Chimney Termination Combustibles*
Chimney height must be 3 feet above roof \/
penetration;2 feet above any combustible (�C�
construction within 10 feet 97147
Gas Shut-off Valve 944$ X
Combustion Air q r�L lX,
Hearth Extension(if any)
Mantel-height above f/p opening
Witness Operation /�-„ V
Tank Placement(if LP) 7��� xN.
/�
CO Detection '/+ ✓` 344/`b
CSST Bonding i V 7 IT�G�
White-Building Department Yellow-Customer Pink-Fire Marshal 4I
Town of Queensbury Fire Marshal
ftp 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. /4
Permit i( 0"Y /` 3 yy�yScheddule,,Inspection 1126( f/t/ Time 2 • �o ammn anytime Inspector V rS
Name R/(w/AA,Ath /'wm&CAddress� .PY�.1 �K 1Cd4/V ) Rough In Final-eV'
Appliance Manufacturern1 (4) Model# H 3s —1RL
Direct Vent Factory Built Chimney ' Flue Size V Double Wall_ Triple Wall Insulatedsok
Yes No N/A Comments
Floor Protection
Clearances to Combustibles (all sides) X 2"t AM cen/left_ Fcyy/rzel- aQn'tl-13"
Firestop(s) Vertical Chase ,
Wall Penetratio /fir/
Vent Clearances to Combustibles r
Vent/Chimney Termination �C
Chimney height must be 3 feet above roof ` /
penetration;2 feet above any combustible Lu`
construction within 10 feet
Gas Shut-Off Valve
Combustion Air
Hearth Extension (if any)
Mantel
Height above Up opening X
�.
Witness Operation
Tank Placement(if LP)
CO Detection
x k4oilia, 6,4, iMose"
CSST Bonding X fileSa2,-,
White—Building Dept. Yellen—Customer Pink—Fire Marshal