CO-000355-2015 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: CO-000355-2015 Date Issued: Wednesday, November 18, 2015
This is to certify that work requested to be done as shown by Permit Number CO-000355-2015
has been completed.
Tax Map Number: 266.3-1-81
Location: 1019 State Rte 149
Owner: Harrisena Diner(Kerrie mae's)
Applicant: Curtis Madison
This structure may be occupied as a:
C/O Only By Order of Town Board
TOWN OF QUEENSBU�JRY
Issuance of this Certificate of Compliance DOES NOT relieve the J /J 4t
property owner of the responsibility for compliance with Site Plan,
V {V�y
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
OL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CO-000355-2015 Yz�lf 2t9 t5 � )
Tax Map No: 266.3-1-81
REVISED
Permission is hereby granted to: Curtis Madison
For property located at: 1019 State Rte 149
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: KEVIN QUINN Certificate of occupancy $0.00
Owner Address: PO Box 4133 Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
C/O only
Harisena Diner
PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,lune 8,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Quee before th �ionkDated at the To of Qee e 8,2015
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
*Sy
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150187 Application Number: A20150187
Tax Map No: 523400-266-003-0001-081-000-0000
Permission is hereby granted to: KEVIN OUINN
For property located at: 1019 STATE ROUTE 149
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: KEVIN QUINN
Certificate of Occupancy(COM)
NAOMI POLITO
PO BOX 4133 TotalValue
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-187
C/O only Harrisena Diner
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,June 08, 2016
(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 To' s = eensb ,V ► ,n,', ne 08,2015
SIGNED BY IPA` for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Fire Marshal
Received:
ESTABLISHMENT OF A NEW BUSINESS Tax Map ID:
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: 2D1�'le;(1'
Permit Fee: 4S-6 0 u
*Note: This application is for occupancy only,with no work requiring a building permit.
Name of Business HR k /sS t'/V/? 1)/AV L k "
Address /0/5 ,S% kr /C/ 166"`C�-I
Type of Business p/ N ERL
mD [ (s; I. 1 \5 f
Manager C v'4.T"/S /"//46/SOS/
OR ill MAY 2 2 2015
Person in charge
Business Phone No. 7 r7 j' - v i / TOWN
OF QUE
NG & ENSBURY
CODES
Property Owner I<L V/N G�v a N
Address PC) .60)C 9/31 0 c'L LAl5eaR
Phone 79 / — 4/0 yS7
✓Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters, and fixture layout on a
separate sheet of paper.
Print Name: Gokr is PIA!O/SON
Signature:
Date: 5--2-
Notes I Comments:
7}64 t/Se 140/‘ /OcS i'VE&
IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire
extinguishers, fire sprinkler systems, and fire alarm systems require annual inspections by an outside contractor and the corresponding
documentation must be provided to the Fire Marshal's office. Fire extinguishing systems found in kitchens and gas stations require
semi-annual inspections. Any violations noted during an inspection, require immediate corrective action.
CONTACT NUMBERS:
Director, Building and Codes-761-8253 Zoning Administrator-761-8218 Zoning-761-8238
Fire Marshal-761-8206 Planning-761-8220
Town of Queensbury Fire Marshal—New Business Permit 518-761-8206
EMERGENCY CONTACT UPDATE
TO: Warren County Sheriff's Department
1. This form is used to assist Emergency Service personnel who may be called to your business after hours. Please
be sure that the persons listed on this form will be willing and available to respond during off-hours to assist Police
and/or Fire personnel in gaining entry to your building.
2. Please be advised that failure to respond to assist emergency service personnel may result in damage to your
building to facilitate entry by police and/or fire personnel.
PLEASE PRINT
DATE: ` d /
BUSINESS NAME: '71/-7ke/SL`A/ D/NE/a.
BUSINESS ADDRESS: / 0/9 S7 AT, /V9
BUSINESS PHONE: c 3 - y)-
CONTACT 1: C-(42—ri S CIAO/SON HOME PHONE -v: ! y
ADDRESS: 3 YY /I/52V/L 4-iv RJ) QS co, / N.V
CONTACT 2: /cE //N Qv/N/V HOME PHONE )IY
ADDRESS: / e1�') `// 3 0:9„.-:b N SRr°A p N• `�
Town of Queensbury Fire Marshal—New Business Permit 518-761-8206
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