2014-091 TOWN OF QUEENSBURY
FOTO742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140091 Date Issued: Friday, May 23, 2014
This is to certify that work requested to be done as shown by Permit Number P20140091
has been completed.
Location: 1172 STATE ROUTE 9
Tax Map Number: 523400-288-020-0001-020-000-0000
Owner: GREAT ESCAPE THEME PARK LP
Applicant: GREAT ESCAPE THEME PARK LP
This structure may be occupied as a:
Commercial Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property r�/n �J ‘ISt
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: P20140091 Application Number: A20140091
Tax Map No: 523400-288-020-0001-020-000-0000
Permission is hereby granted to: GREAT ESCAPE THEME PARK LP
For property located at: 1172 STATE ROU FE 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: GREAT ESCAPE THEME PARK LP Commercial Alteration $80,000.00
PO BOX 543185 Total Value
DALLAS TX 75354-3185 $80,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014-091 Lumber Jack Grill
Comm. Alteration 206 sq ft
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,April 08,2015
(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 Tow . Qu •nsbu Jsv/A T i .;',A' ' 08,2014
SIGNED BY �[� for the Town of Queensbury.
Director of Budding&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes
Received:
PRINCIPAL STRUCTURE APPLICATION Tax Map ID: /4 do-/ -ad
Permit No.: /9—0 9/
A permit must be obtained before beginning construction Permit Fee: $ .70
Please read: *TB resolution 86-2013(1-28-2013): $850 recreation fee for new dwelling *Rec Fee: $
units, including single-family dwellings, duplexes or two-family dwellings, multiple family Site Plan No.:
dwellings, apartments, condominiums, townhouses, and/or manufactured and modular Subdivision No.:
homes,but not including mobile homes. This is in addition to the permit fee./
Date `� S ho(4- Applicant G r«.4
Tax Map ID Z It 2 I - Z 0 Address 1r3 Z S`� t'</ p..4 `i
Zoning Q L Over,s 'h�ry ; 'V r-1%o9
// Phone/E-mail --41)-- 3 Soo
Property Owner K rec i «pt 7Ls-e Pe-IF L2 Contractor/Agent
Address l\ cie/c Po,{-e 9j Address
6.4«,5 ��. y Nr t')loy
Phone/E-mail Phone 1 E-mail
Contact Person for Building &CI ode Cocat,/ �S=Lf�e'f eC Day Phone: -I 6 Q- G 6/
/--
Building Street Address: LL (m�pliance:- ack 6 tX
Subdivision Name: Lot#: Historic Site: Yes ✓No
Estimated cost of construction: $ e.1*f>
Type of Construction:
Check all that apply Please indicate measurements as required below:
_ =
o G
d v d 1st Floor 2nd Floor Other Total Height
? a a
Single Family
Two-Family
Multi-Family(#of
units )
Townhouse
Business Office
Retail-Mercantile
Factory-Industrial
Attached Garages(# ) / /
Other ✓ /CS S x ) *5- t--• O (� cg
�/pab f!_
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
•
If commercial or industrial indicate name of business G r ro 41("Pe R / L P
Proposed use of building or addition 1-cs s t Rca
Source of heat(circle one) C 6 a ka I/ Gas Oil l Propane>Solar Other
Fireplace-complete a separate application for"Fuel Burning Appliances&Chimneys" Yes
Are there structures not shown on plot plan? /4 S
Are their easements on the property? TPS
Site Information
a. Dimensions or acreage of lot 2 3 '2.4
b. Is this a comer lot?
PS
c. Will the grade be changed as a result of construction: Yes _ZWo
ublic wat r Private well
te• e Private Septic System
Value of all work to be performed(labor and materials) $ W Oo o
Declaration: I acknowledge no construction activities shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval, I certify that the application, plans,and supporting materials are a true and complete statement/description of the.
work proposed,that all work will be performed in accordance with the NY State Building Codes, local building laws and ordinances, and
in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a
certificate of occupancy. 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: � 4� 5 c l.r cc-dsr
Signature: Date: lib/9O7y
FOR OFFICE USE ONLY:
Operating Permit Issued: _Yes _No
Occupancy Type:
Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
•
Checklist - Single family dwelling or Multiple dwelling / Commercial project
SINGLE FAMILY DWELLING PROJECT CHECKLIST
PROJECT NAME:
Please include two(2)sets of the following documentation: Yes No NIA
1. Building Permit Application Completed
2. Energy Code Inspector's Report from ResCheck
3. Septic application(if applicable)
4. Solid Fuel Buminq or Gas Appliance Form(if applicable)
5. Driveway Permit
6. Structural Drawings
Floor plan(s)
Foundation plan
Cross Sections
Elevations
Window and door schedule
Natural Light, Ventilation and Emergency Egress Requirements
Plans signed and sealed by registered architect or engineer
7. Plot Plans- Indicate proposed structure, showing setback dimensions from all surveyed property lines;
Show location of all existing structures on the property;
' Show location of water supply(well or water lines);
Show location and configuration of septic disposal system or sewer line
8. Electrical Inspection agency selected
MULTIPLE DWELLING OR COMMERCIAL PROJECT CHECKLIST
PROJECT NAME:
Please include two (2)sets of the following documentation: Yes No NIA
1. Building Permit Application Completed ✓
2. Energy Code ComCheck and Inspectors Report Form ✓
3. Septic application completely filled out(if applicable)
4. Solid Fuel Burning or Gas Appliance Form(if applicable)
5. Driveway Permit
6. Structural Drawings
Floor plan(s)
Foundation plan
Cross Sections
Elevations
Design loads including floor,snow load and wind load
Seismic design (required after January 2003)
Plans signed and sealed by registered architect or engineer
Window and door schedule
7. Plot plan: Indicate proposed structure,showing setback dimensions from all surveyed property lines
Show location of all existing structures on the property
Show location of water supply(well or water lines)
Show location and configuration of septic disposal system or sewer line
8. Electrical inspection agency selected ✓
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
of Queensbury Building &Code Enforcement
Office No. (518)761-8256
Commercial Final Inspection Report
Inspection request received:
Name: h (.cn r frefacic, (< &A I 1 Inspected on: _ —Z —
Location: Arrive: VAfrelltp.m.
Permit No.: / q-,9Q Inspector's Initials: ,=„41r, Air
/ COMMENTS
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"I Roof Complete
Exterior Finish I Grade Complete 6"in 10'or Equivalent
Interior I Exterior Guardrails 42 inch Platform/Decks
Interior!Exterior Balusters 4 inch Spacing Platform/Decks
Stair Handrail 34 inch—38 inch!Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq ft.
All Doors 36 inch w/lever Handles/Panic Hardware, if required
Exits At Grade Or Platform 36"(w)x 44"(I)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight I Other Floors Okay
Relief Valve, Heat Trap!Water Temperature 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site .
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room (2 hr.), 1 %doors > 10%> 1000 sq.ft.
%Hour Corridor Doors&Closers
Firewalls I Fire Separation,2 Hour, 3 Hour Complete!Fire Dampers!Fire Doors
Ceiling Fire Stopping,3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets!Mirrors
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters,34 inch, Checkout 36 inch
Handicapped Ramp/Handrails Continuous/12 inch Beyond[Both sides]
Active Listening System and Signage Assembly Space
Final Electrical I Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway 4"
Water Fountain or Cooler
Building Access All Sides by 20'/Drivable Surface 20'wide
Special Inspections/Engineer or Architect Approval DV- 1-0
Okay To Issue Temporary or Permanent C/O
Okay To Issue C/C
Commercial Final Inspection_11 27 12
Town of Queensbury Building&Code Enforcement C(U c-2STO
Office No. (518)761-8256 I
Commercial Final Inspection Report Thrt-
Inspection request received: CIS12L9h ire -T t'l
d
Name: (re.� ft SC ` VU
�/1C Inspected on: 5/ Z ( / t/
Location: t. R2 51-3st-e. otitel Arrive: 1/: a.m./p.m.
Permit No.: 1'- `—O c1 l Inspector's Initials: d1�`
Lib sity°14- C,--2; L
COMMENTS
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Extenor Finish/Grade Complete 6"in 10'or Equivalent
Interior/Exterior Guardrails 42 inch Platform/Decks
Interior/Exterior Balusters 4 inch Spacing Platform/Decks
Stair Handrail 34 inch—38 inch I Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq.ft.
All Doors 36 inch w/Lever Handles 1 Panic Hardware,if required
Exits At Grade Or Platform 36"(w)x 44"(I)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve,Heat Trap!Water Temperature 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr), 1 'A doors > 10%> 1000 sq.ft
%Hour Corridor Doors&Closers
Firewalls!Fire Separation,2 Hour,3 Hour Complete/Fire Dampers I Fire Doors
Ceiling Fire Stopping,3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan, if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets/Mirrors
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters,34 inch,Checkout 36 inch
Handicapped Ramp!Handrails Continuous/12 inch Beyond[Both sides]
Active Listening System and Signage Assembly Space
Final Electrical I Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification, if req
As-built Septic System Layout Required or On File Jedfr �fS
Building Number or Tenant Address on Building or Driveway 4" geed
�
Water Fountain or Cooler o f F it IF -4 Ijjjc
Building Access All Sides by 20'/Drivable Surface 20'wide G o
Special Inspections/Engineer or Architect Approval
Okay To Issue Temporary or Permanent CIO
Okay To Issue C/C
Commercial Final Inspection 11 2712
• Inspection Form !! �! 0 a°
Town of Queensbury Fire Marshal 0 Periodic Inspection Date:J r Time:
742 Bay Road,Queensbury NY 12804 0 Re-Inspection - ! [ °n/
518 761 8206/518 761 8205 CO Inspection Permit#: L� w�,
Fire Marshals Representative
MJ Palmer Business Name: ec,f\Lftt- EScype
Location: L..a wnp n.,.mct Co.l l /
GK Stillman Contact:
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: _a ,
Main Aisle Width FC 1024/1025&FC1029.11
Secondary Aisle Width EC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906 S•, -
EVAC Plan FC 404.2 (4\
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Intenor FC 1006.3&FC1029.8
Extenor 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 /
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 detectors FC 610
Clearance to Sprinkler/Ceiling FC 315 .2.1
18" / 24"
EVAC SIGNS IN Rooms FC 404.6(R1 &R2)
Fuel Pump Waming 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
DATE: OK NC
Insp 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 0711(�late
Sprinkler FDC Fife Marshal In Wdl1
Kitchen Suppression Semi Annual CO f Y_&t�approval
Fuel Island Suppression Semi Annual �"J
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506 MAY 0 2014
Operating Permit, if required will be issued after Fire
Completion of Inspection Town 01
•
Town of bu
\.
T.Qwn of Queensbury Building &Code Enforcement 1\00N\ a._y
Office No.(518)761-8256
Commercial Final Inspection Report
Inspection request received:
Name: q/t ' c_,Q9_ Inspected on: s– i–
Location: L Lin,"seiC ' F? (3-r-EI (P Arrive: Ae/ a.m./p.m.
Permit No.: / L/ " / Inspector's Initials: -�/
COMMENTS
Y �l NA
Chimney I"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish/Grade Complete 6"in 10'or Equivalent
Interior I Exterior Guardrails 42 inch Platform I Decks I n L
Intenor/Exterior Balusters 4 inch Spacing Platform/Decks — 1"'c ELF./ ey,M
Stair Handrail 34 inch—38 inch/Step Risers 7"/Treads 11" N�
Vestibules For Exit doors>3000 sq.ft
All Doors 36 inch w/Lever Handles/Panic Hardware,if required ��
Exits At Grade Or Platform 36"(w)x 44"(1)I Canopy or Equiv. t V7a11('AA
\
Gas Valve Shut-off Exposed&Regulator(18")Above Grade t
Floor Bathroom Watertight/Other Floors Okay D�
Relief Valve,Heat Trap I Water Temperature 110 Degrees Maximum —�\,J‘_.—fsa
Boiler!Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site s•—• a—/� -- if r >
Oil Furnace Shut Off at Entrance to Furnace Area ���
Stockroom/Storage/Receiving/Shipping Room(2 hr), 1 %]doors > 10%> 1000 sq.ft. 4\' t ,
%Hour Corridor Doors&Closers
Firewalls/Fire Separation,2 Hour, 3 Hour Complete I Fire Dampers I Fire Doors
Ceiling Fire Stopping,3,000 sq. ft.Wood Frame
Attic Access 30"x 20"x 30"(h), Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets/Mirrors
Handicapped Bath/Parking Lope Accessible
Public Toilet Room Handicapped Accessible 1(//
Handicapped Service Counters,34 inch,Checkout 36 inch
Handicapped Ramp!Handrails Continuous/12 inch Beyond[Both sides]
Active Listening System and Signage Assembly Space
Final Electncal/Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification, if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway 4"
Water Fountain or Cooler
Building Access All Sides by 20'/Drivable Surface 20'wide
Special Inspections/Engineer or Architect Approval
Okay To Issue Temporary or Permanent CIO
Okay To Issue C/C
Commercial Final Inspection 11 27 12
Cit
Town of Queensbury Building & Code Enforcement �t olatt�
Office No. (518) 761-8256
Framing I Firestopping Inspection Report
Inspection request received:
Name: th-ea,
� _�IJA Inspected on: -- . —
Location: yaCaeg Til Arrive:
Permit No.: <-/--O 9/ Inspector's Initials: -�
TYPE OF STRUCTURE: Ctm _fr. (27
-
Y N NIA COMMENTS:
Framing
Attic Access 22"x 30"minimum
Jack Studs/Headers
Truss Specification Provided
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft.8 in.
Stairwells 36 in.or more
Exterior Deck Bracing
Headroom 6 ft.8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 %(w) 16 gauge(8)16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft.or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2,3 hour
Fire wall 2,3,4 hour
Siatigpzgilfr
Penetration sealed
16 inch insulation in cavity min. I `6? \�� t/
Garage Fire Separation
House side%inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in.(W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off,if required
Framing/ Firestopping Inspection Report
Town of Queensbury Building & Code Enforcement —/ 1\uJ. /— 3
Office No. (518) 761-8256 a
Framing / Firestopping Inspection Report
Inspection request received:
Name: tfi a.n$ AC
-2. 2c9tfL _ Inspected on:
Location: Pt'}-9IArrive: A1$.m. p.m.
M I b !
Permit No.: q/ Inspector's Initials: 'ir
TYPE OF STRUCTURE: A ( Urne c SCK I I
y‘_// N NIA COMMENTS:
Framing
Attic Access 22"x 30"minimum
Jack Studs/Headers
Truss Specification Provided
Bracing/Bridging
Joist hangers
=Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft.8 in.
Stairwells 36 in.or more
Exterior Deck Bracing
Headroom 6 ft.8 in.
Notches/Holes I Bearing Walls
Metal Strapping for Notches Top Plate
1 Y:(w)16 gauge(8) 16D nails each side
Draft stopping 1,000 sq.ft.floor trusses
Anchor Bolts 6 ft.or less on center
Ice and water shield 24 inches from wall
Fire separation 1,2,3 hour
Fire wall 2,3,4 hour C �
Firestopping rJ � TO �\
Penetrationsealed ^ _ ..\
inch
t 1
16 ncchinsulation in cavity min. l.V
Garage Fire Separation Cy _ �ci 1 "QJ 6 U
House side%inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in.(H)
20 in.(W)
5.7 sf above/below grade
5.0 sf grade
Design Professional Sign-off,if required
Framing/ Firestopping Inspection Report
TOWN OF QUEENBURY
RANGE HOOD SUPPRESSION
WORKSHEET
LOCATION:
DATE:
INSPECTOR: vily 16 i
SYSTEM INFORMATION
MAKE: A r►S� :� °
MODEL: I u>
SIZE:
Y¢
SYSTEM DATA TESTING DATA
PASSX FAIL I PASS FAIL
All appliances properly covered Nozzle caps off r'u rJ� c
System monitored by fire alarm Fire alarm activation
Nozzle protection in plenum Central Station Monitored
Hood filters Gas valve off
X' Extinguisher Exhaust hood On
Fusible Links All appliances shutdown
Nozzle Caps
Manual Actaution 10720'
Range Hood Operational Grease Duct Test MC506.3.2.5
U L 300
Appliance layout vs. drawings Type 1 hood interlock MC 507.2.11
16" deep fryer/open flame t- Makeup air interlock MC 508.1 L
Pre-Engineered Restaurant Fire Suppression Systems Report
SERVICE COMPANY DATE OF SERVICE. ": TIME A.M. I P.M.
y� ANNUAL SEMI-ANNUAL RECHARGE INSTALLA74 N RENOVATION
NE l YO R K FIRE & Sr 0 u R I I'! LOCATION OF SYSTEM CYLINDERS UL 300
4 Glens Falls TechnicalPark /�;, OYES ❑NO
�t / i
Glens Falls} IV i 1 2801-3 JAL NUFACTURER M DE4NUMBER WET DRY CHEMICAL
(518) 798-9551
CYLINDER SIZE MASTER CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE
CUSTOMER FUSE LINKS 360°F. FUSE LINKS 450'F. FUSE LINKS 500°F. OTHER
fy
Name
- - FUEL SHUT-OFF ELECTRIC GAS SIZE
Address -
_ i
SERIAL NUMBER LAST HYDRO TEST DATE LAST AECHARGE DATE
City State ZIP
MANUFACTURER'S MANUALREFERENCE
Telephone Store No.
PAGE NUMBER: DRAWING NUMBER: DATE
Owner or Manager
COOKING APPLIANCE LOCATIONS: LEFT TO RIGHT
1. All appliances properly covered w/correct nozzles 20. Replaced fuse links
2. Duct and plenum covered w/correct nozzles 21. Check travel of cable nuts/S-hooks
3, Check positioning of all nozzles. 22. Piping&conduit securely bracketed
4. System installed in accordance w/MFG UL listing 23. Proper separation between fryers&flame
5. Hood/duct penetrations sealed w/weld or UL device 24. Proper clearance-flame to filters
6. Check if seals intact,evidence of tampering 25. Exhaust fan in operating order ;
7. If system has been discharged, report same 26. All filters in place
8. Pressure gauge in proper range(If gauged) 27. Fuel shut-off in on position
9. Check cartridge weight(If applicable) 28, Manual&remote set/seals in place
10. Hydrostatic test date 29. Replace systems covers
11. 6 year maintenance date 30. System operational&seals in place
12. Inspect cylinder and mount 31. Slave system operational
13. Operate system from terminal link 32. Clean cylinder&mount
14. Test for proper operation from remote 33. Fan warning sign on hood
15. Check operation of micro switch 34. Personnel instructed in manual operation of system
16. Check operation of gas valve 35. Proper hand portable extinguishers
17. Clean nozzles 36. Portable extinguishers properly serviced
18. Proper nozzle covers in place 37. Service&Certification tag on system
19. Check fuse links and clean NOTE DISCREPANICES OR DEFICIENCIES BELOW
COMMENTS:
On this date, this pre-engineered fire suppression system was inspected and operationally tested in accordance with the fire
suppression system requirements of NFPA17 or 17A, 96 and the manufacturer's manual with the results indicated above.
X
SERVICE TECHNICIAN PERMIT NO. DATE: TIME: AM PM CUSTOMER'S AUTHQRIZED AGENT
The above service technician certifies that the system was personally inspected and found conditi718 Ito as in,dicat 'd on this report.
AUTHORITY HAVINr, ,II1PIr,I(TIC)N
Glens Falls, Metal
Fatmicatcars
P.O. Box .516 I. Ft "Ward,NY
Date. 5/20/14
This letter is intended to certify that the, bood system and ductwork were installed
per NFPA 96 , New York State Mecbaaical code
A tight test was performed in our shop , per code.
Install included
Existing hoods
New Welded duct with. Firewrap,
Exhaust fan and lift TA fan.
Job - 6 Flags , Lake George,NY
LumberJack grill
Dutch Fume], cake
Matt ElJswoilh,
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Hone of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Great Escape, Lumberjack Grill
14- 091
t� 4/7/2014
The following comments are based on review of drawings:
• Verify function of exit and emergency li hting ;'
• Verify fan clearance =/< 18" to roof
• Verify hood and duct clearances
• Compliant locks/ latches required
• Perform function test of Ansul system, to include:
Ansul function /
Gas / Electric Trip on activation
Hood / make up air function on activation 011
Fan interlock function v-
Horn / Strobe function on activation
Inspection and testing report from contractor
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office • Phone: 518-761-8206 • Fax: 518-7454437
frremarslzal fteensbury.net • www.queensbunl.net
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