2014-075 , r TOWN OF QUEENSBURY
ra742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140075 Date Issued: Monday, July 14, 2014
This is to certify that work requested to be done as shown by Permit Number P20140075
has been completed.
Location: 9 HUNTERBROOK Ln
Tax Map Number: 523400-289-015-0001-003-000-0000
Owner: RCILETTI, LLC
Applicant: STATE FARM INSURANCE
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 (DJ 4J
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 8c Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
ea,
`� 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140075 Application Number: A20140075
Tax Map No: 523400-289-015-0001-003-000-0000
Permission is hereby granted to: STATE FARM INSURANCE
For property located at: 9 HUNTERBROOK Ln
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: RCILETTI, LLC
92 MASTERS COMMON NORTH Certificate of Occupancy(COM)
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-075 STATE FARM INSURANCE -Rita Hawkins
C/O Only
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, March 27, 2015
(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 of Qu nsb T rs j ' 'arch 27,2014
isti
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Fire Marshal
Received: 0,., 27 21114
ESTABLISHMENT OF A NEW BUSINESS Tax Map 16:11 89. /5---/-.3
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: j1/41•1075-
Permit Fee: Spell
*Note: This application is for occupancy only,with no work requiring a building permit.
Name of Business ' F rm ems_ r __, c 0 R , t.jk1,1 5
Address c 4icy/Pit h k L'ia w
Type of Business - Sed-'r/i!-
Manager l , / ( � i,,-*i4 5
OR
Person in charge
Business Phone No.
Property Owner R f A- -1-bwic ivt r (view bC. - ?2U term LC-C._
Address Q 4-t-oyttr ent tc_. -etpt ._
Phone 62UCQ,v1r1O r r Ny (2A-D(i sit -Virg 0 if
✓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: � ti A cz s tC-ty�
Signature:
Date: 7
Notes 1 Comments: I
&mi' 7-Le ! Pderd 6eIL,
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: 3124I2_014-
BUSINESS NAME: S ci..se ^^ I "f s 012-41,-4
Rt-1 *soca tc_LANIs Acs*&Uf
BUSINESS ADDRESS: 1-I Q t tem1c <- € clitay
BUSINESS PHONE: 51
S -19g`
CONTACT 1: R-'Haig 14143 HOME PHONE 518. 2-3 7-'4°t O
ADDRESS: -1 Z. m .5-trec u '""t^^en N3 - Cs�1«-•sia.v - NSI
J 12&0`f
CONTACT2: drea- M( b(`.HOMEPHONE 51 &' S79 3F.aC
ADDRESS: c `` 7 r , Ek-vdsrr Falit f NY 122-31
Town of Queensbury Fire Marshal-New Business Permit 518-761-8206
Inspection Form Qe:
*SI
Town of Queensbury Fire Marshal 0 Periodic Inspection Date: C7'
742 Bay Road,Queensbury NY 12804 e-Inspection
518 761 8206/518 761 8205 Inspection Permit#:
Fire Marshals Representative ✓�
Mi Palmer Business Na i'A' atie Lr/
1 / Location: ,r.. ',6..t Rene
/GIL Stillman Contact: frith'
1vK'/�S
«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
Sig n• 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
Inspection of extinguisher FC 906
EVACPlan FC 404.2
TRUSSUSS ID SIGNAGE FCC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8
Exterior FC 1006.3
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
IA
1a� /l,
No Smoking Signs FC 310.3 cif
Storage FC 315.2
Compressed Gas FC 3003
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803-804
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) /A
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior storage FC 315.3 REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
Emergency Disconnect FC 2203.2 21 DAYS
SYSTEMS: FC 901.6 InvOK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual lj DATE: OK NC
HVAC Shutdown
Sprinkler System Annual
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
Inspection Form
Town of Queensbury Fire Marshal 0 Periodic Inspection Date: ON Time://01011
, 742 Bay Road,Queensbury NY 12804 aRe-Inspection
518 761 8206/518 761 8205 eac'CO Inspection Permit#: ty- e) ,?5
Fire Marshals Representative .
_ M.1 Palmer Business Name: . - ' 1g __ft..aaJW. -/re--
Location: ? ifirlh je2 a - „sr"
KGB Stillman Contact: NP4 1-keePin_S-
.
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 „,....--""
Exit Enclosure FC 1020&Ed 029
/dd. NOTES
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&FC1029.11 .0"..
Secondary Aisle Width FC 1025&FC1029.11 ...0""
FIRE EXTINGUISHER: Hung FC 906 ...<.,„,
Inspection of extinguisher FC 906 ../
EVAC Plan FC 404.2 1............ ,....e
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3&Ed 029.8 ....
rd-KWIreMW-a.: 6,
Exterior FC 1006.3
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1 .../... 47,47/3n7 Cf. ,-- .04/
Combustibles in Equipment Rooms FC315.2.3 ,....../
F.D.Signage- FC 510 .../... h1- 4
4.
tvi s44.nee.9-., frle.acrki--ak54444CLA
No Smoking Signs FC 310.3 ,....../ z
Storage FC 315.2 ,....../
Compressed Gas FC 3003 ...,.../. .
Vehicle Impact Protection FC 312.1
Interior Finishes Finishes FC 803-804 r)‹....
...--!..
Smoke Detectors FC 907 •-• porch /\OItsin 14.14 115-
...---
CO detectors FC 610
Clearance to Sprinkler/Ceiling FC 315.2.1 ()ean fee-feri CC-
18" / 24" 'Z ale-5 4n.r.44 Ast-1402.
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 .....--"
REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311 ,---""
Emergency Disconnect FC 2203.2 ../.. 21 DAYS
-t- if-41974 225Zi X DATE: OK NC
SYSTEMS: FC 901.6 lnsp 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 0 101 -FS/ C19
t i
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
A
/0 A '1
Inspection Form (, L/
Town of Queensbury Fire Marshal 0 Periodic Inspection Dale: s ��io �
W'742 Bay Road,Queensbury NY 12804 o Re-Inspection
,%/
518 8h06/518epr se61 8205ao CO Inspection Permit
`�� /
Fire Marshals Representative
4. MJ Palmer Business Name:
Location: 97i /7,r /fid —
GK Stillman Contact: n
Type of Inspection N/A Yes No �1 r'" /��
EXITS. Exit Access FC 1014&FC1029 NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024&FC1029 - ��I ./� /,,,,
Locks and latches FC1008& FC1029.2
..4Z.
I ) 1yn2(�K_� / r /12f/LM -
Sign Normal FC 1011 &FC1029
� 1 f� � " _ ��� �I
Sign.backup FC 1011.5.3&FC1029.7.5 / cS7GfK 1 �5, /�S ��'1
AISLES: r 1- /17ovi aZ/ /fr "9 12
Main Aisle Width FC 1024/1025&FC1029.11 / A"
Secondary Aisle Width FC 1025&FC1029.11 — I
FIRE EXTINGUISHER: Hung FC 906 1_/64-A-5-
Inspection of extinguisher FC 906 / I— t2ee-4
EVAC Plan FC 404.2 / -7_-) gilt t - /.j/ J�e
TRUSS ID SIGNAGE FC 505.3 /
- 1
EMERGENCY LIGHTING: ,2-3/4., L."-4 _ fl - k
Interior FC 1006.3&FC1029.8 J � �'��
Exterior FC 1006.3 / w.�nT
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1n A'i --I Jt/
Combustibles in Equipment Rooms FC315.2.3 / ll
F.D.Signage- FC 510 / (((
No Smoking Signs FC 310.3 3 J i /
Storage FC 3 5.2 y' j -L,�/
Compressed Gas FC 3003 / /,c s!- .`
Vehicle Impact Protection FC 312.1 f/� L( ���,?,-
Interior Finishes FC 803-804
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 REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
Emergency Disconnect FC 2203.2 21 DAYS
SYSTEMS: FC 901.6 lnsp 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
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