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2014-112 TOWN OF QUEENSBURY Foca742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20140112 Date Issued: Friday, May 02, 2014 This is to certify that work requested to be done as shown by Permit Number P20140112 as been completed. - - - - - - - - - - --- Location: 959 STATE ROUTE 9 Tax Map Number: 523400-296-013-0001-018-000-0000 Owner: RAYMOND HIPPELE Applicant: ADIRONDACK TOBACCO COMPANY This structure may be occupied as a: Certificate of Occupancy (COM) By Order of Town Board \TOWNnOF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property / f/ /� owner of the responsibility for compliance with Site Plan,Variance, or +RvvssYY /d i�ort 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 FT* 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 • BUILDING PERMIT Permit Number: P20140112 Application Number: A20140112 Tax Map No: 523400-296-013-0001-018-000-0000 Permission is hereby granted to: ADIRONDACK TOBACCO COMPANY For property located at: 959 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: RAYMOND HIPPELE 50 ACORN Dr Certificate of Occupancy(COM) DIAMOND POINT, NY 12824-0000 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency • Plans&Specifications 2014 - 112 Adirondack Tobacco Company C/O ONLY Store I $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, April 15,2015 (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 of Q sb 4 T •.d Xs 4 1115,2014 SIGNED BY ' for the Town of Queensbury. Director of Building&Code Enforcement rel { IE U ' E Office Use Only Town of Queens rfi7s al D ,�pp Received: ESTABLISHMENT 0 EW 3'881 a Tax Map ID: €9(#,13 " 1 -1 S CERTIFICATE OF OCCUPANCY &RMRA•P' Permit No.: N151).,0 19 TOW' F c.r EC,.. BUI DING & CODES Permit Fee: / y / `Note: This application is for occupancyonly.withiequringlding permit. Name of Business tcob-clack Tbbo_Cco Co Address q s 9 Rf `T rz?t Pc 0• • — SSoce rt Qveenspv ry i<rt Type of Business (1044- YO\Cca s . tsD /FEW/ Manager /(ccs L1c ua&-t OR Person in charge Business Phone No. ; Property Owner L l nn WCJ 4y + bteociorer-4 L6 nova Address 9(9 £4. ftl# ReyoAPla-7k (avrLc7, MY &ksM Phone 798 -6tlWb '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: J4cci oS&s J Sc.l,(CLur h; �'T Signature: 7kria-ye c-Q,;,,,.c-ti ///j lit 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 DATE: 59/40`1 y BUSINESS NAME: `}c(scan do°lc T6c)ccco Coga-rah y BUSINESS ADDRESS: % ? Qt 9 1111 Royytit Pk Fa. Store 1 BUSINESS PHONE: 618, S M. ' 7 9 'i g CONTACT 1: / cL 7 et,rc.uc(' HOME PHONE 793 -30 96— ADDRESS: SADDRESS: 61, H&Ske. // /-7tre Cyevrs cAIS �/i' JZcSOI CONTACT 2: Bcecac(4 Sck, ie.* u, HOME PHONE 136 `849.99 6 `l6d«P4°`:� ADDRESS: b6 1-1csSkeMet), (c_d(S) tv Y 124151 • • Town of Queensbury Fire Marshal—New Business Permit 518-761-8206 Inspection Form r Town of Queensbury Fire Marshal 0 Periodic Inspection Datar1I1I 1 `L/ rTime: Y 742 Bay Road,Queensbury NY 12804 °Re-Inspection f . 518 761 8206/518 761 8205 SL CO Inspection Permit#: rt xFMarshals Representative MJ Palmer Business Name: I,Qi[ 106eav Location: �r65c7 Q-r 4 — SS9rZ GK Stillman Contact: Li--14,-,-- Type of Inspection N/A Yes No EXITS: Exit Access FC 1014&FC1029 Exit Enclosure FC 1020& FC1029 ' 4- NOTES Exit Discharge FC 1024&FC1029 / Locks and latches FC1008& FC1029.2 Sign.NormalckuFC 1011 5 FC1029 /1..- Sign. ILS v In 1?Y Sign.backup FC 1011.5.3&FC1029.7.5 I AISLES: Main Aisle Width FC 1024/1025&FC1029.117. Secondary Aisle Width FC 1025&FC1029.11 X� e E. 5 A 3115 FIRE EXTINGUISHER: Hung FC 906 _ J Inspection of extinguisher FC 906 V. EVAC Plan FC 404.2 TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTING: Interior FC 1006.3&FC1029.8 / Exterior FCis 1l FC 3 /1 l Clearance to Electrical FC 605.3 / p5v (C(/,�1 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 _ CompressedGas FC 3003 // FC Vehicle Impact Protection FC 312.1 Interior Finishes FC 803 -804 �' Smoke Detectors FC 907 V,' 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 FC2205.6I 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 I Generator Annual DATE: OK NC Hood Installation Elevator Semi Annual FIRE ALARM Annual WaftDATE: OK NC HVAC Shutdown Sprinkler System Annual Sprinkler FDC r . - . Kitchen Suppression Semi Annual Fire'Marshal Ini @ Fuel Island Suppression Semi Annual I; OI€,to/Issue '(,erti 9gt PTJI panty Hood Cleaning 3-6-Annual 1 Knox Box:installed/checked FC506 NAY (� k'il''IF d C 2Q Operating Permit, if required will be issued after i�I, Completion of Inspection Fire Marshal Town r a .,z ,bD act roitSc-c-h--- +rbc cco � � (HI va (G % i CD P&n y ppR111" hIseD lc iIN & G ''' Y A5 Noy or CN 0\b+ Ya., ` \y\ 1/41\ '? ge}ocQ1e 4 &ems 1" r4 F1rc Dept I-tA _ oun4tr 5.cce S Cort cc Epp,Ce m t cici io be 2A -- V.�� 1760c \ pun Dow" d, Fite A\en^ hbb< Doc.< 'b awe flick 5"y, Mount Royal Plaza — stairway to 2nd floor "Suites" is shown 959 State Route 9 on layout between Store Q and Store M Tax Map No. 296.13-1-18 Layout shows "Stores" 1st floor or ground level rK h/ f U T, Mount Royal Plaza — stairway to 2nd floor "Suites" is shown 959 State Route 9 on layout between Store Q and Store M Tax Map No. 296.13-1-18 Layout shows "Stores" 1st floor or ground level rK h/ f