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2014-552 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20140552 Date Issued: Monday, November 10, 2014 This is to certify that work requested to be done as shown by Permit Number P20140552 has been completed. Location: 357 BAY Rd Tax Map Number: 523400-296-019-0001-029-000-0000 Owner: OLD SCHOOL HOUSE L.L.C. Applicant: INNOVA PHYSICAL THERAPY 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 P tY P other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement or Zoning Board of Appeals. ?ram TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140552 Application Number: A20140552 Tax Map No: 52340.0-296-019-0001-029-000-0000 Permission is hereby granted to: OLD SCHOOL HOUSE L.L.C. For property located at: 357 BAY Rd 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: OLD SCHOOLHOUSE L.L.C. Certificate ATTN: JOHN &DIANE MATTHEW: of Occupancy(COM) 2546 STATE ROUTE 9L Total Value QUEENSBURY,NY 12804-0000 Contractor or Builders Name/Address Electrical Inspection Agency Plans&Specifications 2014 - 552 Innova Physical Therapy,LLC C/O Only $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,November 04,2015 (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 4 Quee juq � u � ovember 04,2014 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only Town of Queensbury Fire Marshal Received: . ESTABLISHMENT OF A NEW BUSINESS Tax Map ID: CERTIFICATE OF OCCUPANCY PERMIT APPLICAT16N Permit No.: Permit Fee: *Note:.This application is for occupancy only,with no work requiring a building permit. i 'n � Name of Business � ' � e5d I �-� L L L C r Address Type of Business Manager OR Person in charge 2 OCT ' 2014 Business Phone No: j Property Ownern cJ c l C e/i 1 Ur ZLc— Address i Phone ✓Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters, and fixture layout on a i separate sheet of paper. Print Name: Signature: ff Date: Notes 1 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. I CONTACT NUMBERS: Director, Building and Codes-761-8253 Zoning Administrator-761-8218 Zoning-761-8238 Fire Marshal-761-8206 Planning-761-8220 t i Town of Queensbury Fire Marshal—New Business Permit 518-761-8206 EMERGENCY,C.®NTACT UPDATE OCT 31- 2014 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 i 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 beadvised 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, x PLEASE PRINT i J b DATE: L/ . BUSINESS NAME: BUSINESS ADDRESS: Lr S J ivt e S �� J BUSINESS PHONE: 36q /VV I CONTACT 1: V�GLY16�lC / HOME PHONE 7 �a "� }� ADDRESS: /y��s� 1� CONTACT 2: 1 Uw(,�`� LV r�;�d�- HOME PHONE ADDRESS: I Town of 4ueensbury Fire Marshal—New Business Permit 518-761-8206 EMERGENCY CONTACT UPDATE OCT 31 .'201.4 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 as'sist 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: _1 7 I l BUSINESS NAME 1 L l.0 BUSINESS ADDRESS S tlt BUSINESS PHONE � -- 727 CONTACT 1 -Y)n HOME PHONE 7 q � ADDRESS.: l(}.�� �`t -�. C�a"njC CONTACT 2 �'L /tA Gt Ci HOME PHONE �/ 5 ADDRESS: �- Town of QueensburyFire-Marshal—New Business Permit. 518-761-820.6 Inspection Form Town of Queensbury Fire Marshal o Periodic Inspection Date:l Time- 742 Bay Road,Queensbury NY 12804 oRe-inspection 518 761 8206/518 761 8205 CO Inspection Permit#: _6 4;i- Fire Marshals Representative �� �� AL MJ Palmer Business Name: Location: /�61( 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 Si 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 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.Si na e- 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(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 Emergency Disconnect FC 2203.2 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 Inspection Form Town of Queensbury Fire Marshal o Periodic Inspection Date: Time: 742 Bay Road,Queensbury NY 12804 O Rom-Inspection 518 761 8206/518 761 8205 CO Inspection Permit#: G� 5 Fire Marshals Representative MJ Palmer Business Name: ^� Location: XGK Stillman Contact:c7- iJ Type of Inspection N/A Yes No EXITS: Exit Access FC 1014&FC1029 NOTES Exit Enclosure FC 1020&FC1029 0/ 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 d � / FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 ff 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.Si na e- 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 404.6 111 &112) Fuel Pump Warning Signs FC2205.6 Fuel Station Emer Procedures FC2204.3.5 Exterior Storage FC 315.3 REINSPECTIONDUE APPROXIMATELY Vacant Buildings FC 311 Emergency Disconnect FC 2203.2 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 O z TREATMENT ROOM F9 WAITING ROOM OFFICE INNOVA PHYSICAL THERAPY 357 BAY ROAD,SUITE 4 QUEENSBURY, NY 12804 OCT 31 2014 iI CY:: i= ,'