applications Office Use Only
ADDITION/ ` et. rmit#: 2ei U3 '
- AP' N_ .� , rmit Fee: $ lC L
Town of Qiccnsbury MAY 29 2019
742 Bay Road,Queensbury, NY 12804 In Dice#: 1510
P: 518 761 8256 www.queensbury.net .TOWN OF QUEENSBUR
ri , �J G : CODES
Project Location: L-(oU(lef "
•
Tax Map ID #: 3 Cv, (f - 1 - Subdivision Name: A
CONTACT INFORMATION:
• Applicant: r
Name(s): _ [1OGLOI6(NS�1 W ec, L(, (-
Mailing Address, C/S/Z: 4f (o Dv4( QA, S4v.ee-(
Cell Phone: ( --re Land Line: ( 5 f 8 ) - c() - ( 4 c
Email:
• Primary Owner(s):
Name(s): —jaws e5 6. -a p /,p
Mailing Address, C/S/Z: I oZ�o (AN' ► - o / Qveeil\ l6,)J\y
Cell Phone: ( ) 3G. I - S." Land Line: (
Email:
El Check if all work will be performed by homeowner only
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): CDf J
Contractor Trade: (7.OJ LJ cp v L f
Mailing Address, C/S/Z:
Cell Phone: ( ) Yp. r - 88 O ¶ Land Line: (
Email: QcIp (-( VlOao,f c- S(c- ,Iron _ Loon
**List all additional contractors on the back of this form
• Architect(s)/Engineer(s):
Business Name: TSe10A0A-4-e
Contact Name(s): 'n
Mailing Address, C/S/Z: V t 3 0.-to)'{ V ( (k-Fk✓t 0.t/k-
Cell Phone: (t 1? ) 3 4- 1 - loop Land Line: (
Email: tGkeJQ ]Delwko4e-b, i1d,cJ cowl
Contact Person for Building & Code Compliance: K�t�. r�� 11EAsIjo.J�lL t
Cell Phone: ( ) Land Line: (5-1 )35(47 - I tf (la- If
Email: k.,/i S v\ lK ctod6\f 4-1 JO c)
Addition/Alteration Application Revised February 2019
• Contractor(s): Workers'�� pp Comp documentation must be submitted with this application
Contact Name(s): 1�1t.OA 66-00(, Q - A I vIckivl Y f_q C_
Contractor Trade:
Mailing Address, C/S/Z: (,f 2'cc7 'mac4 .ei 0-ecket , A (tq,tM.QYvk Y 1 2 00/
Cell Phone: ( rr 113 ) `(-t Land Line: (
Email: NJ_ a 16,6J1 \/ et/L..4110dtSeS * c pvv"
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): f .Ai G1 Lours Flox- (j I�vi bfi •
Contractor Trade: V IcoJtVVi.N ''
Mailing Address, C/S/Z: 2(,7 AUr OM(f CF., ScI+'ev _ Y y , UY 1 'D-307-
Cell Phone: ( ) Land Line: (37 ) - 0-2`13
Email:
rk
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): be €b SdtJ Ut. ' 2 1bU�d�l ICC
Contractor Trade: Ie(A-4 C- 1 l
Mailing Address, C/S/Z: D-(0S ,bo,r(At ULG'l•/ Lt}L'o(uv1kit-Ile LA l la-Ds < ( " ( � 7'
Cell Phone: ( ) Land Line: (.97 , )/r5? - 3q 7 L
Email: /] toi6aA .1.& i tr. ,).00O y Gt, o .
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): j . Lvk.e L w'i c 'c,c4L-7. ,-C . LLc-
Contractor Trade: _Ex A v& i`d'^
Mailing Address, C/S/Z: ' 11(p �v/t om((. cWe cc_tivz✓ti ect t IAJti' LQ_3'
Cell Phone: ( ) Land Line: ( Set ) 3sto '/cf c"
Email:
• Contractor(s): Workers' �C`omp documentation must be submitted with this application
Contact Name(s): /AtI [n\ .dSU
. M 4 I e �AC .) 4/LLC`f
Contractor Trade: rt it-C .! vas A -4 (/ - 1
Mailing Address, C/S/Z:(f O (,k U,-}-�1u /A> ., 411Ocvv\y
Cell Phone: ( ) Land Line: ( 5( ) k$ 7--e7' 8
ei
Email:
• Contractor(s): Workers' Compdocumentation must be submitted with this application
Contact Name(s): eF 6,0.4�- -fvc-Cr. LLC--
Contractor Trade: TjpVALVl.C�
Mailing Address, C/S/Z: �J is e S #2-41,O Aiki S cvJ J4 (/UY l ',
Cell Phone: ( Pt, ) -1A48 Land Line: ( )
Email: 4 cf kta ved o V\ . VA.e--
Addition/Alteration Application Revised February 2019
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s): stioPPAALOkirA - S4-'CC-a Ik
Contractor Trade: ;>[01.,lf1
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (vIS ) 02g0 18 C, I
Email: I p\,( �,c)vicp)___040 I • C' \
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
• Contractor(s): Workers' Comp documentation must be submitted with this application
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: ( ) Land Line: (
Email:
Addition/Alteration Application Revised February 2019
PROJECT INFORMATION:
TYPE: Commercial Residential
WORK CLASS:
Single-Family Two-Family Multi-Family (#of units
Townhouse Business Office Retail
Industrial/Warehouse Garage (#of cars ) Other (describe
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1,2 C TZ— 1st floor:
2nd floor: &2 2nd floor:
3rd floor: 3rd floor:
Basement (habitable space): qa S f^ Basement (habitable space):
Total square feet: /( 3,2 It- Total square feet:
ADDITIONAL PROJECT INFORMATION: cel n OJ
1. Estimated Cost of Construction: $ ago v vc/
2. If Commercial project, what is the proposed use:
3. Source of Heat (circle one) Gas. Oil Propane Solar Other
Fireplaces need a separate Fuel Burning App lances & Chimney Application
4. Are there any structures not shown on the plot plan? YES &Explain:
5. Are there any easements on the property? YES NO
6. SITE INFORMATION:a. What is the dimensions or acreage of the •arcel? 10 .L 4/ .A-
Jec
b. Is this a corner lot? YES NO
c. Will the grade be changed as a result oft e construction? YES NO
d. What is the water source? PUBLIC CPRIVATE WELL)
e. Is the parcel on SEWER or a PRIVATE SEPTIC system? 5e.b.5Pi'
Addition/Alteration Application Revised February 2019
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to
fees and department approval.
3. I certify that the application, plans and supporting materials are a true and complete statement and/or
description of the work proposed, that all work will be performed in accordance with the NYS Building
Codes, local building laws and ordinances, and in conformance with local zoning regulations.
4. I acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate
of occupancy.
5. I also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all
newly constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: bicAlktk 149043•111A)C7Lt
SIGNATURE: DATE: 428///
Addition/Alteration Application Revised February 2019
i y Office Use Only
s' FUEL BURNING APPLIANCE & Permit#: Q - z-ztl
CHIMNEY APPLICATION Permit Fee:$ I�
Invoice#: I bc-i
f gm:eosi n)
742 Bay Road, Queensbury, NY 12804 P:
518-761-8256 www.quenshu:v net
Project Location: '�
j (v (('f Tax Map ID:
Room of Install: tti Q € JV' Planned Install Date: U P6/161
**ONE APPLICATION PER APPLIANCE'`*
CONTACT INFORMATION:
• Applicant:
Name(s): loC1o4O v Sk , j whe S / LL L
Mailing Address, C/S/Z: qq(o 15UJLteGt- St , Sc �e vINC F y /P (‘--) (.4 •
Cell Ph.: _( ) Land Line: (S-1 ) 3 ±j, - /t(3 5
Email:
• Primary Owner(s):
Name(s): \l' z.‘, 011) ✓l-e •
Mailing Address, C/S/Z: ? Cv LA irk/ IlLoet-A / (eve e-41c. In ✓y
Cell Ph.: _( ) Land Line: _(CIO ) 36, (-41
Email:
• Installer/Builder:
Name(s): J e - 6deo tieI VCk,0
Mailing Address, C/S/Z: 1l6 0 C,e-vt A-tie tit t..)e / d41 Id ck,v17 c
Cell Ph.: _( ) Land Line: (cl3 ) 5(0l - ?( 00 C 4
Email:
'/
Contact Person for Building & Code Compliance: F-J L.✓1t\OA931-0)A..).44—'
Cell Ph.: ( ) Land Line: ( (2‘, ) V G, -At -cc .'xt • 13c/
Email: VWiSA-ccvga ,A4 ( (win
•
Tom.....-< CI..11.Ji....0
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
Stove Fireplace Insert Fireplace
__Fuel Fired Equipment(Garage Only,B"clearance per IMC304.3)
Fireplace, factory built** 4
**Manufacturer's Name:-\ect-t Model#: f'''t CO CL�
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION: la
_Masonry:
block brick stone
Flue:
tie steel size,in inches
Material*:
double-wall triple-wa II_insulated
(*Manufacturer's ry-1 : Model #:
ADDITIONAL INFORMATION:
1. Two inspections are required. A rough-in inspection,prbr to installation and a final inspection,after
installation.
2 Manufacturer's installation manual must be available at the time of inspection.
3 Masonry fireplaces & chimneys require plans to be submitted.
4 Twenty-four (24) hour notification 's required for inspections.
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 ofthese requirements and also will allow the inspector to enter the premises to perform the
required inspections. ,
I have read and agree to the above:
PRINT NAME: {-6\1/1 V. -Iro
SIGNATURE : / !DATE:U �� r
Fuel Burning Appliance&Chimney Application
,
Specifications 8000CLX
Please consult the manufacturer's
HEATc'GLO. installation manual for all details and 8000CLX
No one buildsabattarfln requirements before making a final Direct Vent Gas Fireplace
design layout decision.
MODEL , FRONT WIDTH BACK WIDTH HEIGHT DEPTH GLASS SIZE
Actual Framing Actual Framing Actual Framing Actual Framing 39 x 23-5/8
8000CLX 48 49 35-1/2 49 41-7/8 42-1/8 21-1/2 22
35-1/2
17-3/4 [901)
'--[451j—o•
maillimmeeminnitok
ei 21-1/2
(5461
B-1/2 11-11/16
[2161Alga ■ [297) 11■->1 i
TOP VIEW
I I .-- I i
36-5/8
I [930]
42-7/8 35-1/2
[1089) [901j
1
1.25] 31110 p( }
L
0 DIA I ,") V r
A 43-1/8
[1096] 1
48
[1219]
FRONT VIEW
• _[�I[-_.JII[!I _1JI\ __.__-I1.,
0 0 1 [152j
I C
i GAS LINE ,
ACCESS 41-7/8
O [10641
28-7/8
[7341
2-7/8 2-3/8
[60]
4 [73) I C
'0 II:D so t -.e O� I
r
r8-1/2 t r9-15/16_
[216) [2521
LEFT SIDE RIGHT SIDE
Additional information can be found online at www.heatngio.com
Specifications 8000CLX
MINIMUM FIREPLACE CLEARANCES FRAMING DIMENSIONS
AREA TO COMBUSTIBLES l2
(in Inches) �-
/i
CLEARANCE TO CEILING 25 •
NON-COMBUSTIBLE FLOOR O
COMBUSTIBLE FLOORING O
•
BEHIND APPLIANCE 1/2
-~N_l•' 2•118
W.
SIDES OF APPLIANCE 1/2 10701
APPLIANCE LOCATION 55911
'
f_49'112451
NOTE:THE REAR STANDOFF
A.. _ MAY NEED TO BE REMOVED Adiust framing dimensions for Interior sheathing(such as aMNrock)
+. •G f'O' WHEN VENTING AT 45' •'Add 12 inches for rear venting with one 90•elbow.
J CLEARANCES TO COMBUSTIBLES
A I ., uc f _.,r,n
�, u Lit 25
ve
13... '• 1 r n A IB-" ❑ f> I
i Ali ii O. F 1 1
'
A B C E F G _._.•!
D H 0' . 1
'
in. 55-7/8 49 79 61-1/2 See Section D. 22 19.314 10 .1 1 ` 1IIIIIIIIIIIIIIC f) r•1/l
Mantel Protections •...—._.."�
rim 1419 1245 2007 1562 P''oi 559 507 254
MANTEL LEG/WALL PROJECTIONS MANTEL PROJECTIONS
ONote: to-r..sr!:
/ Measurement is ra)
taken from top t
-TI
of the opening, 11
NOT the top of >) m
A n Q the fireplace 1"1 �'`
J .'�114 I
/j _ •Il 17
/ ___.1 r.
.4nlrllr.•i N(\�.Lt K(>,p.rn.Y- —•T� 11
I n
If A minimum is_.then()maximum is_. � I I III
iJ:2
in. 2.7/I6 3-7/16 4.7/16 5-7/16 6-7/16 7.7116 fri
A min 62 87 113 138 164 189
in. 1 2 3 4 5
• B mrn 25 51 76 102 127 w Mir ex.s,y IMFn c I p,
Product information provided is
PRODUCT LISTING CODES not complete and is subject to
US ANSI Z21.88b-2008 change without notice.Product
installationonmust adhere strictly
to instructions accompanying
CAN CSA 2.33a-2008 product to avoid risk of fire and
serarf[a UL3078 Potential injury.
Additional information can be found online at www.heatnglo.com
HEAT4GLO, Lakeville.MN Weir heatnglo.com
Phone:088.427.3973 952.985.6000 1101$01110
Ne eM MAW a Mttuere
GS/NNG/9000CLX 0315
'r.,� Office Use Only
) FUEL BURNING APPLIANCE & Permit#: • -1 - 2-0 1
CHIMNEY APPLICATION - Permit Fee: $ 2.
Invoice#: 1 kfJ b
1 Queenshi,
742 Bay Road, Queensbul; N'r 12804 P.
518-761-8256 ; et
Project Location: (IV le c Tax Map ID:
Room of Install: Aktc) " Planned Install Date: gibbet
**ONE APPLICATION PER APPLIANCE**
CONTACT INFORMATION:
• Applicant: 11��
Name(s): (��i�t fV1�1�5 L L L
Mailing Address, C/S/Z: (Q ) /(tec 54,/eefi
Cell Ph.: _( ) Land Line: _(-S( ) AG - IL(Z>
Email:
• Primary Owner(s):
Name(s): �"n,�e5 A.itkopu'1 C.
Mailing Address, C/S/Z: i)-C u(Ae i�C� '�1 rveev1\ J 7
Cell Ph.: _( ) Land Line: (�( ) �P^' 7 LOTS
Email:
• Installer/Builder: •/ 1`
Name(s): l25� :Tore, `DfeC („.ad1i '\
Mailing Address, C/S/Z: ( }( p Cev, eLk AU2 - ) thG1,'1A y k 22.3—
Cell Ph.: ( ) Land Line: _(5(8 ) 8I 1 .-em O D e x d. -.j
Email:
Contact Person for Building & Code Compliance: t 4.006r-d),sc-A._
Cell Ph.: _( ) Land Line: _(c(r, ) T - kX4 • Icy
Email: V-4 Vlmct.i0 (,) .4 14 19- r O✓✓1
Town of Oueensbury nforcement
•
FUEL BURNING APPLIANCE INFORMATION:
TYPE OF DEVICE:
Stove Fireplace Insert Fireplace
Fuel Fired Equipment(Garage Only,B"clearance per IMC 304.3)
Fireplace, factory built** /
4 ( l
** Manufacturer's Name: �%� Model#: ��—
•
SOURCE OF HEAT:
Wood Coal Pellet Gas
CHIMNEY INFORMATION: ,1 /;(.
Masonry:
block brick stone
Flue:
tie steel size,in inches
Material"":
double-wall triple-wa II_insulated
("Manufacturer's r i a r-r-m _ - Model #:
ADDITIONAL INFORMATION:
1 Two inspections are required. A rough-in inspection,prbr to installation and a final inspection,after
installation.
2 Manufacturer's installation manual must be available at the time of inspection.
3 Masonry fireplaces & chimneys require plans to be submitted.
4 Twenty-four (24) hour notification 's required for nspections.
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 bws,ordinances,regulations and all
conditions that are part ofthese requirements and also will allow the inspector to enter the premises to perform the
required inspections.
I have read and agree to the above:
PRINT NAME: &,-m..
SIGNATURE : DATE: &114/t-r
Fuel Burning Appliance&Chimney Application
Specifications SL-5/5X
Please consult the manufacturer's
HEAT&GLO, installation manual for all details and SL-5/5X
No one builds a better fire requirements before making a final Direct Vent Gas Fireplace
design layout decision.
Actual Framing Actual Framing Actual Framing Actual Framing 27-3/16 x 18 1/16
SL-5/5X 36 37 25-3/4 37 34-3/8 34-3/4 16-5/16 16-1/4
253/4 1/2
654
(3ire
1 16-5116
(403]03] 8-13/18 (414]
i __ 1.=(224] ,,
iii06-518 t
[188]
HEAT-ZONE®ACCESS
0 5 •1 I!
lh_—IIII IIII.I�ii _ (io3J
14 i,lm` ,. 38-7H6
Q ]356] Q [926]
•
r 34-1/16 O 34318
fi 30-1/16 [885] [873]
[764]
{I
2-3116 18-1/16
[4I 59]
W
3-9/16
M ( /6 54Qi *rlaililligi. — _....
€ 6 l i�[7"i )1 I t t
[152] 91
--► �76 <--ELECTRICAL
GAS LINE ACCESS (914] [25] ACCESS
I
_ _.� ♦�.:�%i1•:�;.'2�:a.�x�; t— _ —.. _ _ _-. .DTI 1
I � 25•I 16
' 27.1/6 30-13116 �
t 16661 ffi,�4 pe31 29 3/8 25-7/16
. 17301 n461 16461
c1._ ...*ter
�■ T K/16
i 3117671 II15/6 32-1/18(814) I 3042/16(766(
l671 (411 32.3/4 18321 12% 3-1/2
(601
I!
Flrescreen Front Arcadia,Chateau,Halston, Clean Face Front
and Chateau Forge Fronts
i
a
I?
Additional Information can be found online at www.heatnglo.com
i
Specifications SL-5/5X
i
MINIMUM FIREPLACE CLEARANCES FRAMING DIMENSIONS
AREA- •
TO COMBUSTIBLES
(in Inches) ����
CLEARANCE TO CEILING 32
COMBUSTIBLE/NON-COMBUSTIBLE FLOOR 0
"I tie.
BEHIND APPLIANCE 1/2 ..----
I
SIDES OF APPLIANCE 1/2 - 1. I I' Iri
FRONT OF APPLIANCE 36
•
APPLIANCE LOCATION A C
Rough Opening n Rough Opening 0
rail (Width) Rough Opening (Depth) Rough Opening
• (Height) (Width)
---s-A-- DVP pipe SLP pipe- ()VP pipe SLP pipe
'� in 10 8-S/8 34-3/4 16-1/4 16-1/4 37
Se.lns..s ( mm 254 219 882 413 413 940
!or Akwe
Bon S.D
I
', TM section
�V\/ u 1 CLEARANCES TO COMBUSTIBLES
I /'i - Measure from lop of unit
ope%ning or horn of hood•
1)
I Mk r / O .. (6 t3,
- , I
r
Model ABC E F G I
In 42 37 59-1/2 1 1/2 ::in
s_-5/Sx
mm 106/ 940 'S8 23 13 Ili) 04
H I J K L M 0-
In 62-1/4 16-1/4 48-1/2 68-3/4 15-1/'6 /-1/2 35-(915j
Sl.-5/5X WY 1131
min 1381 413 1232 1/3/ 383 191
WALL PENETRATION MANTEL PROJECTIONS
cum
•
a,:,..;11,1 .
It*
I�� 9 r n
la nr911 co• 1' 8' o -t 1 +■J ` 15 n. p 0.b ` I . i tt"
I t 1
t l +r i- • 1 i ■ f I i
3i�\\ k.�� l� '
I9ror 7. • ,w.e.i..,
',I>,
24- . ...ey c.«.,d�., ronor l.000
Mn.MarMrelMlwa<«a.i
MANTEL LEG/WALL PROJECTIONS
Product Information provided is
O \ PRODUCT LISTING CODES not complete and Is subject to
!�/1 change without notice.Product
eI -I .--
US ANSI Z21.88a-2007 installation must adhere strictly
Vi
ew w eew�.. Tnn'4avr m..,, to instructions accompanying
I •rw- I I t CAN CSA 2.33a-M2007 product to avoid risk of fire and
^ mm.un .jr:r=un u,llnat.e � potential Injury.
lI ri.o... UL3O7B
-
` Additional information can be found online at www.hoatnglo.com
Mantel Leg Projection Wall Projeclion
(acceptable on both sides of opening) (aoeeplable on OR,side of operkig)
HEAT(GLO. Lakeville,MN Web:heatrtglo,com Odium
c
Phone:888.427-3973 O
Pie one builds.better h.
G5/tINGr&5'SX_01016