2014-582 -411111A TOWN OF QUEENSBURY
"Awl742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20140582 Date Issued: Monday, August 08, 2016
This is to certify that work requested to be done as shown by Permit Number P20140582
has been completed.
Location: 1130 STATE ROUTE 9
Tax Map Number: 523400-295-008-0001-009-000-0000
Owner: WAKITA PROPERTIES, LLC
Applicant: CELLCO PARTNERSHIP/ D/B/A VERIZON WIRELESS
This structure may be occupied as a:
Commercial / Industrial Unheated By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property
4'W39 4
owner of the responsibility for compliance with Site Plan, Variance, or I
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code nforce ent
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NW 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140582 Application Number: A20140582
Tax Map No: 523400-295-008-0001-009-000-0000
Permission is hereby granted to: CELLCO PARTNERSHIP/D/B/A VERIZON WIREL
For property located at: 1130 STATE ROU 1'E 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: WAKITA PROPERTIES, LLC Commercial/Industrial Unheatet $17,000.00
1130 STATE ROUTE 9 Total Value
LAKE GEORGE,NY 12845-0000 $17,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
CELLCO PARTNERSHIP/D/B/A VERIZO
MICHAEL ORCHARD-TECTONIC
914-439-7505
175 CALKINS Rd
ROCHESTER NY 14623-0000
Plans&Specifications
2014-582
Comm. Unheated - small-cell facility
$100.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, November 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 trt l u- sbury ,j Fri. :y, ovember 14 2014
SIGHTED BY a -au. for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE I I ) I Received v
1 3 �A
iii Tax Map ICt'4U o,
TAX MAP ID l r _C\ Permit No. I y . 431
1 Permit Fee /ID 064
ZONING Co ( 1 GvI Rec Fee 777
Site Plan#
HISTORIC SITE Yes X No Subdivision #
SUBDIVISION NAME k_)\
Lot#
TOWN BD.RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS,INCLUDING SINGLE FAMILY DWELLINGS,DUPLEXES
OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR MANUFACTURED &
MODULAR HOMES,BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE.
APPLICANT��IC3�� )(5�1�� V�(��,1 W�rile S OWNER WCI,"1A 6� " eS L i_C
J
ADDRESS (L1\\ v\cc ?vow)" ADDRESS ) Jo
VOCr'12,5c--C1 3
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��0� 4c-oPHO ( r ov . 1t� I��TrnJ-(U HONE/E-MAIL JCI { Ml)9 U �a4 \ f
CONTRACTOR 000
'-)A3Vi
CO
COSTOF CONSTRUCTION(ESTIMATED $ ,
ADDRESS: BUILD/NG ADDRESS: \ `Jo
DcO (
PHONE/E-MAIL 1�� !Y. 5C
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: $C)(•\l0 .1 u( ^ C IC PHONE j\\
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New Addition Alteration 1St floor sq.ft. 2nd floor sq. ft. Total sq.ft. Height
Single Family
Two-Family
Multi-Family
(# of units )
Townhouse
Business Office
Retail - Mercantile
Factory- Industrial
Attached Garage
(# of )
Other
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of businessCO .11.\\)1 h SJ 1
Proposed use of building or addition11
L.G1).4)
Source of heat (circle one) Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances & 1 `�
Chimneys tJ
Are there structures not shown on plot plan? P(A
Are there easements on the property? (/�
Site Information �"ti
a. Dimensions or acreage of lot
b. Is this a corner lot? le-s-
c. Will the grade be changed as a result of construction Yes XC. No
d. Public water or Private well v ► \
j�
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $7 0,ouo O
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed,subject to fees and department
approval.
3. 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.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of occupancy.
5. 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: 1, 11 DATE 'i. \ I
SIGNATURE: &I / i DATE 1 y
FOR OFFICE USE ONLY
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
Town of Queensbury Building&Code Enforcement
Office No. (518)761-8256
} Commercial Final Inspection Report
Inspection request received: l`� \�
Name: CP-A\ Inspected on: •
Location: 1\b0 � � ti-c_ `� Arrive: 1 ' Ali a.m. p�
Permit No.: " c;11 Inspector's Initials: OP
COMMENTS
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"!Roof Complete
Exterior Finish I Grade Complete 6"in 10'or Equivalent
Interior/Exterior Guardrails 42 inch Platform/Decks
Interior/Exterior Balusters 4 inch Spacing Platform I 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/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 '/z doors > 10%> 1000 sq.ft.
Y4 Hour Corridor Doors&Closers
Firewalls I Fire Separation,2 Hour,3 Hour Complete 1 Fire Dampers 1 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 I Sinks!Toilets/Mirrors
Handicapped Bath I 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 I 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 I Engineer or Architect Approval
Okay To Issue Temporary or Permanent CIO
Okay To Issue C/C r�
Commercial Final Inspection_11 2712