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CO-000104-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building&Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: CO-000104-2016 Date Issued: Tuesday, March 15, 2016 This is to certify that work requested to be done as shown by Permit Number CO-000104-2016 has been completed. Tax Map Number: 288.16-1-1 Location: 1424 State Rte 9 Owner: Northway Outlet LLC Applicant: G.H.Bass This structure may be occupied as a:C/O only GH Bass,space 6 By Order of Town Board TOWN OF QUEENNSSBU/RfY Issuance of this Certificate of Occupancy 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 Or QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: CO-000104-2016 Tax Map No: 288.16-1-1 Permission is hereby granted to: G.H.Bass For property located at: 1424 State Rte 9 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: Northway Outlet LLC Certificate of occupancy $0.00 Owner Address: 2700 Westchester AVE Total Value $0.00 Purchase,NY 10577 Contractor or Builder's Name 1 Address Electrical Inspection Agency Plans&Specifications CIO only GH Bass,space 6 $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: (Ifa longer period is required,an application ror an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town ofensbu trida. , e ,2016 SIGNED BY: 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.: CD - 104 .20 i � Permit Fee: f9b%, Y51 *Note: This application is for occupancy only,with no work requiring a building permit. Name of Business Address 14.21x-! Cl , '�t2O-ce Type of Business Pe_AV_;t S+C)re �n Manager �esS'��- LI OR Person in charge Business Phone No. �►� - �`��- ����' TOWN OP QUEENSBURY BUIL©lNG& CODESProperty©caner Address -)`ivD Ave., Su"-4e Phone 'PPVeC_40Se, NY 10 _0 �-- ✓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: IA Signature: Date: Notes/Comments: 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 Q DATE: � �I Ftp TOWN LD N&CODES EENSBU Y BUSINESS NAME: BUSINESS ADDRESS: 1/"P`t SA+.e Fou+e 9 srace 4 - C ee,,_ �w� , N r od BUSINESS PHONE: CONTACT 1: Te-,G' �1�'- HOME PHONE ADDRESS: CONTACT 2: 1 col-e Ati+koi✓,e HOME PHONE _7b;�—>-- DLit-- 6 bO ADDRESS: Town of Queensbury Fire Marshal—New Business Permit 518-761-8206 ' 71 --..z ... _ I L a — , jj 1 it t ! 3! ``✓ i p ' - V .. I � ham_ _ a-- IS'�i i I - i �— Town of Queensbury-Building and Codes-Fire Marshal 742 Bay Road-(518)761-8256 Building(518)761-8206 Fire Marshal Case Number: CO-000104-2016 Case Module: Permit Inspection Date: 03/14/2016 Inspection Status: Passed Inspector: Gary Stillman Inspection Type: OCC-Inspections Job Address: 1424 State Rte 9 Parcel Number: 288.16-1-1 Lake George,NY 12845 Contact Type Company Name Name Tenant Eldridge,Jessica Applicant [G.H.Bass] Granted Permission [G.H.Bass] Primary Owner [Northway Outlet LLC] Checklist Item Passed Comments Truss ID Signage FC505.3-TRUSS ID SIGNAGE FC505.3 YES Sprinkler System Annual-Sprinkler System Annual YES Clearance to Electrical FC 605.3-Clearance to Electrical FC 605.3 YES Fire Marshal-Fire Marshal YES 3/14/2016 ok for CO CO Detectors FC610-CO Detectors FC610 YES Knox Box:installed/checked FC506-Knox Box:installed/checked YES Provide key for Knox FC506 3/14/2016 key provided Occupancy Cycle-Occupancy Cycle YES B Exit Access FC1014&FC1029-Exit Access FC1014&FC1029 YES Main Aisle Width FC1024/1025&FC1029.11 -Main Aisle Width YES FC1024/1025&FC1029.11 Interior Finishes FC803-804-Interior Finishes FC803-804 YES Combustibles in Equipment Rooms FC 315.2.3-Combustibles in YES Equipment Rooms FC 315.2.3 Secondary Aisle Width FC1025&FC1029.11 -Secondary Aisle WidthYES FC1025&FC1029.11 Emergency Lighting Exterior FC1006.3-Emergency Lighting Exterior YES FC1006.3 Sign:Normal FC1011 &FC1029-Sign:Normal FC1011 &FC1029 YES Electrical Wiring Enclosed/Labeled FC605.3.1 -Electrical Wiring YES Enclosed/Labeled FC605.3.1 Emergency Lighting Interior FC1006.3&FC1029.8-Emergency YES Lighting Interior FC1006.3&FC1029.8 Exit Enclosure FC1020&FC1029-Exit Enclosure FC1020&FC1029 YES Inspection of Extinguisher FC906-Inspection of Extinguisher FC906 YES Mar 14,2016 Page(5) Tr x a Checklist Item Passed Comments Clearance to Sprinkler/Ceiling FC315.2.1 18"/24"-Clearance to YES Maintain 18"clearance to ceiling Sprinkler/Ceiling FC315.2.1 18"/24" 3/14/2016 corrected Storage FC315.2-Storage FC315.2 YES Locks and Latches FC1008&FC1029.2-Locks and Latches FC1008 YES &FC1029.2 Fire Extinguisher Hung FC906-Fire Extinguisher Hung FC906 YES Sign:Backup FC1011.5.3&FC1029.7.5-Sign:backup FC1011.5.3& YES FC1029.7.5 Exit Discharge FC1024&FC1029-Exit Discharge FC1024&FC1029YES 'I J Eldridge Stillman,Gary(Inspector) Mar 14,2016 Page(6) v .v _ .tea^,� � �.2d_i'�€"i�i _ r,.. �-w`•.a _ fig < .... A :- Please input agency related information you want to display on the generated reports Cellphone:XXX-XXX-XXXX.Address:XXX XXXXX BLVD XXXX Case Number: CO-000104-2016 Case Module: Permit Inspection Date: 02/29/2016 Inspection Status: Failed Inspector: Gary Stillman Inspection Type: General(Fire Marshal) Job Address: 1424 State Rte 9 Parcel Number: 288.16-1-1 Lake George,NY 12845 Contact Type Company Name Name Granted Permission [G.H.Bass] Primary Owner [Northway Outlet LLC] Applicant [G.H.Bass] Checklist Item Passed Comments Exit Discharge-Exit Discharge YES Truss ID Signage-TRUSS ID SIGNAGE YES No Smoking Signs-No Smoking Signs YES Exit Access-Exit Access YES Main Aisle Width-Main Aisle Width YES Exterior Storage-Exterior Storage YES EVAC Plan-EVAC Plan YES Secondary Aisle Width-Secondary Isle Width Secondary Aisle Width YES Exit Enclosure-Exit Enclosure YES CO Detectors-CO Detectors YES Plugin with Battery backup Energency Lighting Interior-Energency Lighting Interior YES Fire Extinguisher Hung-Fire Extinguisher Hung YES Sprinkler System-Sprinkler System YES Inspected by plaza owner Locks and Latches-Locks and Latches YES Interior Finishes-Interior Finishes YES Sign:backup-Sign:backup YES Storage-Storage YES Combustibles in Equipment Rooms-Combustibles in Equipment YES Rooms Clearance to Sprinkler/Ceiling FC 18"/24"-Clearance to NO Maintain 18"clearance to ceiling throughout Sprinkler/Ceiling FC 18"/24" Clearance to Electrical-Clearance to Electrical YES Sign:Normal-Sign:Normal YES Inspection of Extinguisher-Inspection of Extinguisher YES Feb 29,2016 Page(4) ti �� LION 001206 � Checklist Item Passed Comments FD Signage-FD Signage YES Knox Box:Installed/checked-Knox Box:Installed/checked NO Provide key for KnoxBox Electric Wiring Enclosed-Electric Wiring Enclosed YES Energency Lighting Exterior-Energency Lighting Exterior YES J Eldridge Stillman,Gary(Inspector) Feb 29,2016 Page(5) Inspection Form Town of Queensbury Fire Marshal CD Periodic Inspection Date:A.-_# { i=r_ Time:' "j} 742 Bay Road, e u--A . . NY 12804 • inspection —* 518 761 8206 ' 8 761 8205 CO Inspection Permit#: Fire Marshals Represen a e � —M Palmer Business Name: L F' / ' C 6 Location: l ci_-�_t# — * i?fie q 6' t GK Stillman Contact: Pe.Ctse,441 ;�,�.,,., Type of Inspection N/A Yes No EXITS: Exit Access FC 1014&FC1029 I,/ NOTES Exit Enclosure FC 1020&FC1029 V,/ Exit Discharge FC 1024&FC1029 V . Locks and latches FC1008& FC1029.2 L.,1 . Sign:Normal FC 1011 &FC1029 tom' Sign:backup FC 1011.5.3&FC1029.7.5 (,/ AISLES: ., Main Aisle Width FC 1024/1025&FC1029.11 V Secondary Aisle Width FC 1025&FC1029.11 L/ FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 ( / 1I 't ' t 4441 � '� f .-, ,� 4 � r EVAC Plan FC 404.2 L TRUSS ID SIGNAGE FC 505.3 V �� f EMERGENCY LIGHTING: / Ceil-, /i? 41\120'540/irInterior FC 1006.3&FC1029.8 V ( t Exterior FC 1006.3 // _J • Clearance to Electrical FC 605.3 ✓ j / Electric Wiring Enclosed/Labeled FC 605.3.1 V{ C S t"k `I .Cli (05-* ) Combustibles in Equipment Rooms FC315.2.3 F.D.Signage- FC 510 ‘,./` No Smoking Signs FC 310.3 Le" / Storage FC 315.2 / ✓ . Compressed Gas FC 3003 t� Vehicle Impact Protection FC 312.1 �'''� Interior Finishes FC 803-804 ` ���� Smoke Detectors FC 907 V AC:++�--�" CO detectors FC 610 �/ Clearance to Sprinkler/Ceiling FC 315.2.1 18" / 24" L. EVAC SIGNS IN Rooms FC 404.6(R1 &R2) Fuel Pump Warning Signs FC2205.6 Fuel Station Emer Procedures FC2204.3.5 t✓ Mb,„( Exterior Stora e FC 315.3 �� g REINSPECTIONDUE APPROXIMATELY i Vacant Buildings FC 311 Emergency Disconnect FC 2203.2 21 DAYS Insp OK NC DATE: OK NC SYSTEMS: FC 901.6 Date Generator Annual DATE: OK NC Hood Installation Elevator Semi Annual FIRE ALARM Annual _ DATE: OK NC HVAC Shutdown Sprinkler System Annual Ci:#'� Sprinkler FDC ----------- --- Kitchen Suppression Semi Annual Fuel Island Suppression Semi Annual Hood Cleaning 3-6 -Annual Knox Box:installed/checked FC506 Operating Permit, if required will be issued after Completion of Inspection