2012-592 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120592 Date Issued: Thursday, January 03, 2013
This is to certify that work requested to be done as shown by Permit Number P20120592
has been completed.
Location: 989 STATE ROUTE 9
Tax Map Number: 523400-296-013-0001-022-000-0000
Owner: 697 UPPER GLEN STREET
Applicant: LAKE GEORGE CROSSFIT
This structure may be occupied as a:
Certificate of Occupancy (COM) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property 1 r 4 //e)t—
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120592 Application Number: A20120592
Tax Map No: 523400-296-013-0001-022-000-0000
Permission is hereby granted to: LAKE GEORGE CROSSFIT
For property located at: 989 STATE ROUTE 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 Value
Owner Address: 697 UPPER GLEN STREET
989 STATE ROUTE 9 Certificate of Occupancy(COM)
QUEENSBURY NY 12804-0000 Total value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2012-592
CO Only LAKE GEORGE CROSSFIT
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(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 Queensbury; Thursday,December 27,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
;: ' ;',4: Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •92804
BEG:2_�, 2012
David Hatin, Director of Building& Codes _ . $, 91,9c'
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal
ESTABLISHMENT OF A NEW BUSINESS
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit.
TAX MAP # 079 (0. 1 3-/ 2 i BLDG. PERMIT FILE#
l "�a
f applicable
Name of Business: t AY0 oe fry) C•NSC A-
Address q Qc,�c�r, 1r P-54of Business: I Eci S`j,�,'�Q ��u�e y/�� QUESTIONS? CALL 761-8256 OR
` EMAIL codesRqueensburv.net
(23VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: t i C' INFORMATION
// www.queensbury.net
Business Phone Number: .5 LS r X44 — 4-01t,
Type of Business: ;-\-C\PS S V—a_C;Qt
Owner of Property: Sji ev Z J c\1-0 u"SY-1 Phone Number(s): ct 18 521
Home Cell
7
Owners Address: (O �`p�p C Q Q J 21 _1t(�Q f ( k 2-c 21)
Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature:
Date: (2-17.-14/2
Of person submitting this form
Notes / Comments:
3 P D. ---s(?
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: ra a Ea
BUSINESS NAME: t_A- G,004-te Cco S'Ef
BUSINESS ADDRESS: 10 Sir"'-e c2-O e I QuQe( 5okif1 t1 (2 09
BUSINESS PHONE:
CONTACT 1: 4 .00 'L HOME PHONE 6 '"-44 --01 I0
ADDRESS: ° SUSCA\ Q,./Lce , QlienS‘OJry 6" ‘'i 1240+-1
CONTACT 2: COQ HOME PHONES /6 - b5d - aa9I
n
ADDRESS: (P �t c�15 1c..,.� Qcl.oc��5 (iry kl 11-10-1
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.
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.
Inspection Form
Town of Queensbury Fire Marshal O Periodic Inspection Date: II i'3 ii 5
Time: Os
742 Bay Road,Queensbury NY 12804 o Re-Inspection � �
518 761 8206/518 761 8205 CO Inspection Permit#: 13 - 63')
/Fir Marshals Representative
MJ Palmer Business Name: 1-` C%lc -SS�,--1 -f-
Location:
-Location: coq. 0.51c. j.
GK Stillman Contact: -1 1%ii( Jia
•
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014& FC1029 NOTES
Exit Enclosure FC 1020& FC1029
Exit Discharge FC 1024&FC1029
Locks and latches FC1008& FC1029.2
Sign:Normal FC 1011 &FC1029
Sign:backup FC 1011.5.3&FC1029.7.5
AISLES:
Main Aisle Width FC 1024/1025& FC1029.1 I
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906 (4p
Inspection of extinguisher FC 906 /r.,,,IfV\ ..... - ,ThV
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3& FC1029.8 /�/��
Exterior FC 1006.3 I1T J�•
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1 _
Combustibles in Equipment Rooms FC315.2.3
F.D.Signage- FC 510
No Smoking Signs FC 310.3
Storage FC 315.2 �, C(...."0
Compressed Gas FC 3003
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803-804 & -.\-91.\"
Smoke Detectors FC 907
CO detectors FC 610
Clearance to Sprinkler/Ceiling FC 315.2.1
18" / 24"
EVAC SIGNS IN Rooms FC 404.6(R1 &R2)
Fuel Pump Warning Signs FC2205.6 /
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 ' INSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
21 DAYS
SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
~HVAC Shutdown
Sprinkler System Annual
Sprinkler FDC
Kitchen Suppression Semi Annual Fire h-�I``" ! I`i{,;; = ;
Fuel Island Suppression Semi Annual
OK to Iss,r-1:Arti,,. . e^:Ur,:::
Hood Cleaning 3-6 -Annual
Knox Box:installed/checked FC506 ti i
' ) r
Operating Permit, if required will be issued after _ W 31 I _ __
Completion of Inspection �t�JV��(R��41t «,_`:
1
Inspection Form
Town of Queensbury Fire Marshal O Periodic Inspection Date: i43 lin-- Time:0, 3P�
742 Bay Road,Queensbury NY 12804 Re-Inspection _ 5—��
518 761 8206/518 761 8205 o CO Inspection Permit#: I D
Fir Marshals Representative
MJ PalmerBusiness Name: Gy ?_, ._ _,1-1)_0 ('� S�j"1
Location: `i � - N-;,L
X GK Stillman Contact: ,f) ;- }e, 3 u vv-tsA
Type of Inspection N/A Yes No q- X71
EXITS: Exit Access FC 1014& FC1029NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024& FC1029
Locks and latches FC1008& FC1029.2 ,-----
Sign:
/Sign:Normal FC 1011 &FC1029
Sign:backup FC 1011.5.3& FC1029.7.5
AISLES:
Main Aisle Width FC 1024/1025& FC1029.11 ./'
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906 ---174f�� 4--AY v,s�,�iz
_ 4044-S—
Inspection
of extinguisher FC 906
1
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3 ./
EMERGENCY LIGHTING:
Interior FC 1006.3& FC1029.8 /�
Exterior FC 1006.3 .t,,1eZ L,6hf.T _(.J teei htle*--1-71:
Clearance to Electrical FC 605.3 f /�4 t1�,,, /
Electric Wiring Enclosed/Labeled FC 605.3.1 ,% ► 'a l- (L/ 6 �niC��— (..�AA1,-,5
Combustibles in Equipment Rooms FC315.2.3
F.D.Signage- FC 510 ,-----
No
/No Smoking Signs FC 310.3
Storage FC 315.2
Compressed Gas FC 3003
Vehicle Impact Protection FC 312.1 ..�
Interior Finishes FC 803-804 -.----"
Smoke Detectors FC 907 .-------
.----"---
CO
------CO detectors FC 610
Clearance to Sprinkler/Ceiling FC 315.2.1 f
18" / 24" �'"i. ./.$151)4/ ✓� Mor ,e,GZ.1._
EVAC SIGNS IN Rooms FC 404.6(R1 &R2) ,----' / c
Fuel Pump Warning Signs FC2205.6 t� t1 f � ^ t'7
Fuel Station Emer Procedures FC2204.3.5 ,l r
Exterior Storage FC 315.3 l REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
21 DAYS
SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual 4f.d•- f " DATE: OK NC
HVAC Shutdown
Sprinkler System Annual J//i
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
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