BOTH-000202-2016 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: BOTH-000202-2016 Date Issued: Friday, April 15, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000202-2016
has been completed.
Tax Map Number: 296.20-1-50.2
Location: 255 QUAKER RD
Owner: TLC Central LLC
Applicant: TLC Central LLC
This structure may be occupied as a: Replace Suppression Hood
Imperial Charbroiler with smoke boxes,upgrade fire suppression and install By Order of Town Board
spark arrestor filters TOWN OF QUEEENSB/UfRY
Issuance of this Certificate of Compliance DOES NOT relieve the
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
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000202-2016
Tax Map No: 296.20-1-50.2
Permission is hereby granted to: Applebee's
For property located at: 255 QUAKER 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
Owner Name: TLC Central LLC Other Accessory Structure(s) $0.00
Owner Address: 180 Lawrence Bell DR Total Value $0.00
Williamsville,NY 14221
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Replace Suppression Hood
Imperial Charbroiler with smoke boxes,upgrade fire suppression and install spark arrestor filters
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 7,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensb ore YW
ate.)
Dated at the Town of ueensb ril 12,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Fuel Burning Appliance & Chimney cationy office Use only
D �p ived
DATE: ap ID
TAx MAP ID: a('R 12 No. bon+• +ox •zot.Q
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OWNER 7v— \ e.. C r.,Or, IL kk., 5�3 3\`�
ADDRESS QW t E! `� ` v� t b\-�\\ C-• \At c,r\rn0 C LbYA
INSTALLER/ —SLCS.�n� —�CCer. c.\ l_!_Q_ PHONE/E-MAIL
BUILDER
1kr'0'
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE:
PHONE/E-MAILBUILDING ADDRESS aSS &G-_
ROOM OF INSTALL: �c4,t1 PLANNED INSTALL DATE:
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
FIREPLACE,FACTORY BUILT* NOTE:
FIREPLACE,MASONRY MANUFACTURER'S
INSTALLATION MANUAL
MUST BE AVAILABLE AT
*vc%eXe- to0x.e_S Qca(r„d'-t et
5-??te5tnorn v tv�.� �\ 3 (tL grrC ` �� yS TIME OF INSPECTION
*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 _DOUBLE WALL _TRIPLE WALL _INSULATED
** 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 perfonn required inspections.
I HAVE READ AND AGREE TO THE ABOVE: \\
PRINTNAME: �eQe�ggr . \ DATE: ka- ;ltll\
SIGNATURE: _ DATE:
Town of Queensbury Building&Codes Revised September 2014