2014-559 .�� TOWN OF QUEENSBURY
43, 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140559 Date Issued: Wednesday, November 19, 2014
This is to certify that work requested to be done as shown by Permit Number P20140559
has been completed.
Tax Map Number: 523400-302-013-0001-005-000-0000
Location: 226 DIXON Rd
Owner: THOMAS & JUNE BURKE
Applicant: THOMAS & JUNE BURKE
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 ,.----•. r
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals bythe
pp Director of Building&Code'k nfor ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
i4ora 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140559 Application Number: A20140559
Tax Map No: 523400-302-013-0001-005-000-0000
Permission is hereby granted to: THOMAS & JUNE BURKE
For property located at: 226 DIXON 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: THOMAS & JUNE BURKE
226 DIXON Rd Fireplace
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-559
Fireplace -pellet stove in garage addition
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 05,2015
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tow • •ueensbb.; : i sda , November 05,2014
i
SIGNED BY ,i- f .moi for the Town of Queensbury.
Director of Building&Code Enforcement
., Fire Marshal's Office
O,
Town of Queensbury• 742 Bay Road• Queensbury, Ned; lark •-12NOW 0 5 2
Michael J. Palmer. Fire Marshal•Gary Stillman, Deputy Fire Marshal •
APPLICATION FOR FUEL BURNING APPLIANCE & CHIMNEYS
Application is hereby made to the Building&Codes Office for the issuance of a Building & Use Permit
pursuant to the New York State Fire Prevention & Building Code. The applicant or owner agrees to comply
with all applicable laws, ordinances,regulations, and all conditions that are part of these requirements and
also will allow all inspectors to enter premises to perform required inspections.
IMPORTANT NOTE TO APPLICANT:� [ ROUGH-IN AND FINAL INSPECTIONS ARE REQUIRED. /,�
OWNER: �l�kO,VI4' ! ✓LCI, "- IC e" INSTALLER/BUILDER: /0/77 Icirl�P.
1� ADDRESS: Z26 D I W,V PJ . ADDRESS:
,(\ PHONE NOS. 578 _ 7r8 8 ,_t7, 440 PHONE NOS.
` II �J '/! A
v LOCATION OF PROPERTY: Ptee�sbaYi , lir T i SUBDIVISION NAME: �Y .ft
LOCATION OF PROPOSED CONSTRUCTION AND/OR INSTALLATION:6.'4'Mtge �McAVrl evil-
c,
C
c, CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: 7,71/7 ,I irke PHONE: ` ` / ' / D
✓ FUEL BURNING APPLIANCE WOOD COAL PELLET GAS OIL
INFORMATION
/ STOVE V
FIREPLACE INSERT
FIREPLACE,FACTORY BUILT*
FIREPLACE,MASONRY
FURNACE(GARAGE ONLY) D /1
*IF FACTORY BUILT,PLEASE PROVIDE: MANUFACTURER NAMEY I )7 T / �k-71i MODEL NO/11.56i6
LISTED BY: (��17-P 6)1C'.L I NUMBER:$! 9-447-4758 QUESTIONS ?
CALL 761-8205 or 761-8206
CHIMNEY INFORMATION BLOCK BRICK STONE OR EMAIL:
fremarshalaqueensbury.ne
MASONRY" CHECK ONE ✓ VISIT OUR WEBSITE
TILE STEEL SIZE IN FOR MORE INFORMATION
INCHES www.queensbury.net
✓ ,/ ��
FLUE CHECK ONE
DOUBLE CHIMNEY
TRIPLE WALL INSULATED DIRECT VENT
WALL., LINER
CHIMNEY MATERIAL CHECK ONE ✓ V •
**IF NON-MASONRY,PLEASE PROVIDE: MANUFACTURER NAME: nirat/e>'I T MODEL NO.AILiL/'///J
ADDITIONAL NOTE: CONSTRUCTION/INSTALLATION MUST CONFORM TO NYS FIRE PREVENTION &BUILDING CODE AND/OR
MANUFACTURERS REQUIREMENTS. CONSULT AVAILABLE TOWN OF QUEENSBURY HANDOUTS REGARDING REQUIRED
INSPECTIONS.
Town of Queensbury Fire Marshal
742 Bay Road
iI Queensbury,NY 12804
r.#0761-82051761-8206
fax 745-4437
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
/$ 31
instructions or specifications is allowed.
Permit# / Schedule Inspection (1)Y)l1 Time dam ' m) AS'
anytime Inspector
Name% ,d// 1(9949 Address ZZ J, 1fe,e7 Rough In Final
.---)
'/
Appliance Manufacturer de „bit .mr.ir Model#____ 11 3 PS
Masonry Chimney Factory Built Chimney Flue Size Double Wall Triple Wall_Insulated_
YesvNo N/A = p Comments
Floor Protection /� / (e /l1/ .i7 p if7,4
Clearances to Combustibles (all sides) Y _ft , _ b f S ge, 1 d 4-i ildes
SafetyStripInstallation(fireplaces only) 0 0r$ i
( P 7
Firestop(s) Vertical Chase
Wall Penetration )(1-
Chimney
Chimney Clearances to Combustibles X
Chimney Termination
3 feet above roof penetration;2 feet above
any combustible construction within 10 feet
Combustion Air / -e'''
-- A 711/2— I
Hearth Extension
Mantel (height above f/p opening)
Fireplace Doors/Screen (required) X
Carbon Monoxide Detection
.0SCfr
White—BuildIng Dept. Yellow—Customer Pink—Fire Marshal
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