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BOTH-000442-2016
TOWN OF QUEENSBURY `4 - '` - 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF COMPLIANCE Permit Number: BOTH-000442-2016 Date Issued: Thursday, July 21, 2016 This is to certify that work requested to be done as shown by Permit Number BOTH-000442-2016 has been completed. Tax Map Number: 301.8-1-53 Location: 9 MIDNIGHT DR SOUTH Owner: Robert Benway Applicant: Robert Benway This structure may be occupied as a: Gas fireplace insert By Order of Town Board TOWN OF QUEENSBURY 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 Community Development- Building & Codes (518) 761-8256 BUILDING PERMIT Permit Number: BOTH-000442-2016 Tax Map No: 301.8-1-53 Permission is hereby granted to: Robert Benway For property located at: 9 MIDNIGHT DR SOUTH 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: Robert Benway Fuel Burning&Chimney $0.00 Owner Address: 9 Midnight DR 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 -THIS PERMIT EXPIRES: Thursday,July 6,2017 (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 xpiratiokii7for Dated at the Town o weey; p02016 SIGNED BY: - ) /� the Town of Queensbury. Director of Building&Code Enforcement Fuel Burning Appliance & Chimney Application office Use only Received DATE: , 1'8-1 Tax Map ID TAX MAP ID: l 8`-1 —53 J O S ' T Permit No. i� C ' 1 2 i' Permit Fee Sb, U© ZONE: s OWNER `ReAg PHONE/E-MAIL ADDRESS I M) N INSTALLER/ SA f44c-7f1 PHONE/E-MAIL BUILDER 580 -72-7 CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: P 0 ,P_ PHONE/E-MAIL BUILDING ADDRESS ROOM OF INSTALL: L'I ry Res 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: MANUFACTURER'S FIREPLACE,MASONRY INSTALLATION MANUAL FURNACE(GARAGE ONLY) MUST BE AVAILABLE AT TIME OF INSPECTION *If factory built provide manufacturer name: /17ery dv 4,4 ; Model#: FV 33 1 Listed by: Number: CHIMNEY INFORMATION Masonry** (check one) f 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: �r`�— I �"N rvYR DATE: SIGNATURE: DATE: �� !l, �o h/3 Torun of Queensbury Building&Codes Revised September 2014