2014-102 TOWN OF QUEENSBURY
wis 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140102 Date Issued: Tuesday, April 22, 2014
This is to certify that work requested to be done as shown by Permit Number P20140102
has been completed.
Location: 4 WESTERN Ave S
Tax Map Number: 523400-309-011-0002-036-000-0000
Owner: HAYES & HAYES LLC
Applicant: UNIQUE CIGS ELECTRONIC CIGARETTES
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 ' n /�
owner of the responsibility for compliance with Site Plan, Variance, or
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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
Fay 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140102 Application Number. A20140102
Tax Map No: 523400-309-011-0002-036-000-0000
Permission is hereby granted to: UNIOUE CIGS ELECTRONIC CIGARETTES
For property located at 4 WESTERN Ave S
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: HAYES & HAYES LLC
297 SARATOGA Rd Certificate of Occupancy(COM)
SOUTH GLENS FALLS NY 12803-0 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014- 102 Unique Cigs Electronic Cigarettes
C/O ONLY - Space "C" divided - Suite 4
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,April 14,2015
(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 Town . Que• sbu // J�r M�„ i a/ • i 1 14,2014
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SIGNED BY • .11/Eit` for the Town of Queensbury.
Director of Building&Code Enforcement
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::"...'f:?(!"):::::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,
andlor 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:.. 1191t/
.BUSINESS NAME, . £%'/th. 6 /e-5. 14/C • •
;;;;)BUSINESS ADDRESS: y S. k-rsko>r/ 4- t $_ ,e
BUSINESS PHONE 57 t— 7 13 — 6 7.3
CONTACT 1: HOME PHONE 5/ r3 sew `7..
;:;';..:ADDRESS: /096- Z7eC/`iv4..i /24' Nvd fog y r/s 'z'/ /2- r .,
,' CONTACT 2: M/c./e-d/n'n,i'c — HOME PHONE S7 fi 33 SV"61 . .. %:;;,: :
ADDRESS: 7/oq 4.2.E w' c 4 .2 ' �� �2 S g24: ' . :`; ':..:.;`
Town of Queensbury Fire Marshal-New Business Permit 518-7614206
cud XVI Z321IaSV7 dH HVG6:ZT 6T/07/60
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��(`� r cInspection Form
Town of Queensbury Fire Marshal 0 Periodic Inspection Date: Time: ll
742 Bay Road,Queensbury NY 12804 0 Re-Inspection
518 761 8206/518 761 8205 ®CO Inspection Permit it: I(-f—1 o2'
Fire Marshals Representative
)(MJ Palmer Business Name: 00tOs C,t6,S
Location: 1.4 S telt Ave -
_ GK Stillman Contact:
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 ,ri 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 Widthth 1024/1025&FC1029.11 I,J�
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Secondary Aisle Width FC 1025&FC1029.11
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FIRE EXTINGUISHER: Hung FC 906 ,
Inspection of extinguisher FC 906 / I_ I/�
EVAC Plan FC 404.2 l/-1!,`r„`„}`�CI
t7ID SIGNAGE FC 505.3 /
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8 J/ 7
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Exterior FC 1006.3
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1 J�
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 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 Imp 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 Fire Marshal lire on Complete
Kitchen Suppression Semi Annual OK to Issue CerUflca a of Occupancy
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506 APR 1 ^ 2014
Operating Permit, if required will be issued after
Completion of Inspection Fire Marshal
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