2013-206 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(zt Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130206 Date Issued: Friday, May 31, 2013
This is to certify that work requested to be done as shown by Permit Number P20130206
has been completed.
Location: 959 STATE ROUTE 9
Tax Map Number: 523400-296-013-0001-018-000-0000
Owner: RAYMOND HIPPELE
Applicant: PRIMERICA
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
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: P20130206 Application Number: A20130206
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: PRIMERICA
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
Certificate of Occupancy(COM)
50 ACORN Dr
DIAMOND POINT,NY 12824-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-206 PRIMERICA
Certificate of Occupancy
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,May 22,2014
(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 zr
,May 22,2013
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SIGNED BY for the Town of Queensbury.
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Director of Building&Code Enforcement
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Community Development Office
Town of Queensbury- 742 Bay Road- Queensbury, New York-12804
Date 0
01
David Hatin,Director of Building&Codes
Craig Brown,Zoning Administrator-Michael J.Palmer, Fire Marshafix! 16 2013 taMp
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# 3 BLDG. PERMIT FILE#
it applicaule
Name of Business: Primerica
Address 959 State Route 9 Suite E Queensbury,NY 12804 QUESTIONS? CALL 761-8256 OR
of Business: I I EMAIL codesCa-)queensbury.ne
Patricia A.Bowman VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager. INFORMATION
www.guueensbur
Business Phone Number (518)260-9157
Type of Business: Financial Services,insurance and Investments
Owner of Property.-... .Zim Realty Phone Number(s):-(518)796-2'394 (518)796-2394
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owners Address: 50 Acorn Drive,Diamond Point,NY 12824
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:-Earl J.Bowman,Jr. Date:
Of person subm'itting this form
Notes/Comments:
EMERGENCY CONTACT UPDATE
TO. WARREN COUNTY SHERIFFS'S DEP T FAX.- 743-250
PLEASE PRINT
DATE:
BUSINESS NAME: Primerica
BUSINESS ADDRESS: 959 State Route 9, Suite E, Queensbury,NY 12804
BUSINESS PHONE: (518) 260-9157
CONTACT 1: Patricia Bowman HOME PHONE (518) 260-9157
ADDRESS: 41 Hiland Springs Way, Apt. B Queensbuiy,NY 12804
CONTACT 2: Earl Bowman HOME PHONE (518)260-9159
ADDRESS: 41 Hiland Springs Way, Apt. B Queensbury,NY 12804
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 CD Period- Inspection Date: Time:
742 Bay Road,Queensbury NY 12804 o Re pection
518 761 8206/518 7618205 O Inspection Permit#:
Fire Marshals Representative
_ MJ almer Business Name: P294eJZ14P?-
Location:
K Stillman Contact: '-I-.
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&FC1029.11
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906
EVAC Plan FC 404.2
TRUSS ID SIGNAGE FC 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
No Smokinq 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(111 &R2)
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 REINSPECTIONDUE 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
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
Kitchen
Primerica
Office
Bathroom Desk
Bathroo
Stairway Hallway to
F11-Z L=5- other
EXIT—j offices
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