2014-547 .41.11a TOWN OF QUEENSBURY
i
742 BayRoad,Queensbury,NY 12804-59 2 (518) 7 1-820
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140547 Date Issued: Thursday, November 06, 2014
This is to certify that work requested to be done as shown by Permit Number P20140547
has been completed.
Tax Map Number: 523400-266-001-0001-043-000-0000
Location: 88 FOX Rd
Owner: DAVID SEAMAN
Applicant: DAVID SEAMAN
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 C ��
property owner of the responsibility for compliance with Site Plan, �1� �
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
`�a 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140547 Application Number: A20140547
Tax Map No: 523400-266-001-0001-043-000-0000
Permission is hereby granted to: DAVID SEAMAN
For property located at: 88 FOX 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: DAVID SEAMAN Fireplace
MARYELLEN BISTLINE Total Value
88 FOX Rd
QUEENSBURY,NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-547
Fireplace (gas)
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 29,2015
(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 Tow of Qu sbu • // Ws, _`�, ctober 29,2014
SIGNED BY \ for the Town of Queensbury.
Director of Building& Code Enforcement
Office Use Only
FUEL BURNING APPLICANCE &
Received
CHIMNEY APPLICATION Tax Map ID
DATE I
'O J_QI I I I r`/ Permit No.
Permit Fee
TAX MAP ID
ZONING
OWNER: 1) ' , d J'g a Wt &P\ PHONE/E-MAIL e D ^ 3 U 3 (21
ADDRESS v % I_ O O. PC ,
INSTALLER/BUILDER.. Vl/D.y/ne "c-row The S¢61/ery PHONE/E-MAIL
ADDRESS: A r3 y('e
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: PHONE
BUILDING ADDRESS:
Fuel Burning Appliance Information Wood Coal Pellet Gas Oil NOTE: ROUGH-IN & FINAL
Stove v INSPECTIONS ARE REQUIRED.
Fireplace Insert
Fireplace, Factory built*
Fireplace, Masonry
Furnace(Garage Only)
*If Factory built provide manufacturer name: ; model#:
Listed by: Number:
Chimney Information
Masonry** (check one) Block Brick Stone
Flue Tie Steel ' Size in inches
Material 5( Double wall Triple wall Insulated Direct Vent Chimney Liner
**If Non-masonry provide manufacturer name: model #:
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and I 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. Se
I have read and agree to the above: Print Name: IAViC► a tivNa t/l Date:
Signature: , Date: d iq
5
Town of Queensbury Building&Codes Principal Structure Application July 2014
Town of Queensbury Fire Marshal
_—1 742 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 spe 'fications is allowed. /�
Permit# i*S Schedule Inspection ll f't/l(7 Time 05—S---
am pm anytime Inspector AC
Name /d < A/�1 Address 0 )-Z:V ee Rough In Final'
Appliance Manufacturer Model # `►� l� ��
Direct Vent Factory Built ChimneyVFlue Size NJ• Double Nall Triple Wall Insulated
Yes No N/A Comments
Floor Protection eo " ivi JI Sq )'k 76cz)Onv
Clearances to Combustibles (all sides) `/
Firestop(s) Vertical Chase
Wall Penetration
Vent Clearances to Combustibles
,/Y
Vent/Chimney Termination
Chimney height must be 3 feet above roof
penetration;2 feet above any combustible
construction within 10 feet
Gas Shut-Off Valve
Combustion Air )/
Hearth Extension (if any)
Mantel
Height above f/p opening
Witness Operation
Tank Placement(if LP)
CO Detection X
CSST Bonding
White—Building Dept. 1'dlm%—Customer Pink—Fire Marshal