BOTH-000724-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000724-2016 Date Issued: Thursday, October 27, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000724-2016
has been completed.
Tax Map Number: 302.14-3-45
Location: 15 PARK VIEW AVE
Owner: Jason Carusone
Applicant: Jason Carusone
This structure may be occupied as a: Gas fireplace insert
By Order of Town Board
TOWN OF QUEENNSSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the P \ a (/ 4 A—
property owner of the responsibility for compliance with Site Plan, ���ff///(LLA11+++"'Illkkk
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
QAW 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000724-2016
Tax Map No: 302.14-345
Permission is hereby granted to: Jason Carusone
For property located at: 15 PARK VIEW AVE
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
Tvce of Construction
Owner Name: Jason Camsone Fuel Burning&Chimney $0.00
Owner Address: 15 Park View Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Gas fireplace insert
$50.00 PERMIT FEE PAID-TBIS PERMIT EXPIRES: Thursday,October 19,2017
(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 of 'ry; n AWed a! r 19,2016
SIGNED BY: (.��(f// /a/ for the Town of Queensbury.
Director of Building&Code Enforcement
Fuel Burning Appliance & Chimney Application., office Use only
Received
DATE: l 1 ) b ��� 18 ZUIo Tax Map ID
TAX MAP ID: . 2 . f - ,�j ' j� Permit No. 0 - 0 -
Permit Fee 6
ZONE:
OWNERC 2U PHONE/E-MAIL $2]Z S
ADDRESS 15 .,q
INSTALLER/ PHONE/E-MAIL
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BUILDER jo S 0 !/
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: A OtV
CCrLV
PHONE/E-MAIL O 3Z - L' 7 7js BUILDING ADDRESS l S PA,-Z 41L<
ROOM OF INSTALL: L!„4(ZC2q&0Qr" PLANNED INSTALL DATE: Tj 114
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
FURNACE(GARAGE ONLY) MUST BE AVAILABLE AT
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 perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE: /
PRINT NAME: 45 DIU/0 2V504A=5 DATE:
SIGNATURE: DATE: 42 A5776
Town of Queensbury Building&Codes Revised September 2014