CO-000019-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000019-2017 Date Issued: Tuesday, April 25, 2017
This is to certify that work requested to be done as shown by Permit Number CO-000019-2017
has been completed.
Tax Map Number: 296.13-1-22.1
Location: 989 State Rte 9
Owner: 697 UPPER GLEN STREET,LLC
Applicant: Adirondack Rustic Rose
This structure may be occupied as a:Certificate of Occupancy ONLY
Adirondack Rustic Rose By Order of Town Board
Suite 200,Upstairs TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the pyj[f/x4
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CO-000019-2017
Tax Map No: 296.13-1-22.1
Permission is hereby granted to: Adirondack Rustic Rose
For property located at: 989 State Rte 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
Tyne of Construction
Owner Name: 697 UPPER GLEN STREET,LLC Certificate of occupancy $0.00
Owner Address: 989 State Route 9 Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Certificate of Occupancy ONLY
Adirondack Rustic Rose
Suite 200,Upstairs
$50.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Tuesday,March 20,2018
Of 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 expira
tion date.)
Dated at the Town of ueensbond M 017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury Fire Marshal 296.13-1-22.1 CO 19-2017
Adirondack Rustic Rose
ESTABLISHMENT OF A NEW BUSINESS 989 State Route 9, Suite 200, upstairs
CERTIFICATE OF OCCUPANCY PERMIT APPLICP Certificate of Occupancy ONLY
vermn ree:
'Note: This application is for occupancy only,with no work requiring a building permit.
Name of Business A D:r iz J n G(, �,r S E, eGS(z,
Address q 84 R- ,),k fC LL"o
Type of Business K'.4ck n W (..S.�e o,�,M LA;, ;, 1 S
Manager Fo_a rJ`� .SU YV EDe-2_ D
OR
Person in charge JAN 2 3 2017
Business Phone No. 516 - 30-7 `13 N 7
TOWN OF QUEENSBURY
Property Owner C q U PPe(L G COMMUNITY DEVELOPMENT
Address �,f y J T- &I 5
Phone Sir - 3)L. - )t4 I
✓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: f aAAAC SNYDrX,
Signature: �� f
Date: 1-23- 7
Notes/Comments:
cjS� 5kL�e -Ro�`�e � d�.cstNt°ss f�1�2�
5; �C Ivo 6 �-7
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 durinQ 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
Please print clearly
DATE:
BUSINESS NAME:
BUSINESS ADDRESS: qr� t� STg(E �Z+ °1 � " L '-S� U L AJ�
BUSINESS PHONE: Slij 3°� 53Y7
PHONE 1:
CONTACT PHONE 2:
TOWN/VILLAGE RESPONDING FROM: O u 15 .--
PHONE 1: ,SIPi J 6�� 7332
CONTACT 2: PHONE 2:
TOWN/VILLAGE RESPONDING FROM: (DwAal3 u r�
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.
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
Phone: 518-761-8206 • Fax: 518-745-4437
firenzarshal@queensburil.net • wzuza.queensbuntmet
Fire Marshal Michael J Palmer Deputy Fire Marshal Gary K Stillman
CLFIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
" Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Adirondack Rustic Rose
989 Route 9
CO-000019-2017
Plan review based on submittal:
• Verify location of exit and emergency lighting fixtures, and function
• Add compliant fire extinguishe
• Locks / Latches shall comply with Chapter 10 of the 2015 IFC. Thumb
turn and keyed locks are not allowed
• Carbon Monoxide detection is required
• All building life safety systems to be compliant
'N� —7 L
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fi r e M a r s h a I's Off i c e • P h o 1t e: 518-761-8206 • F a x: 518-745-4437
firemarslutl@queensbui7l.net • 7VIMqueensbury net
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Route 9 Suite 200, upstairs
989 State Rou p
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1 MARTIN KALIN TO MARTIN KALIN, �`RUSTEE F THE MARTIN
ACE -NOT
ST, FILED 'IN THE
O�, THE 466@
CN
WARRE,4 COUNTY CI ERK IN BOOK 3414 CU
T PAGE 76:
3414,A
salt 6bx�o
DATED .00TOBER 25, 2007. LL
AND STEVES LAND SURVE 'OR
USEN
Lo
FILED;IN THE'OFFICE, OF,THE .WARREN COUNTY,CLE K Cv
1) "MAP OF LANDS' OF KRISTENSEN" DATED mARCH/19, f498
MAP REFERENCE.
MAP CABINE7 A NUMBER 93.
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NOTES.
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BAREPARED FR JULY :2016 :FIELD, 30 E
2)" NORTH ORIENTA11ON IS" BASED,CN,DEED REFERENCE 1.
.3) SuBjtcl�:170 AN, EASEMENT S DESCRIBED IN DEED REFERItNEE7_17-------
4)',SUBJECT TO,rA:VT1UTY, EASEMENT, FILED, IN, THE OFFICE OF THE WARREN
"COUNTY,CLERK IN�BOOK: AT PAGE :63 IPF SCALE'
GRAPHIC
0
5)� SUBJECT TO A TREE�EASEMENT FILED IN THE OFFICE OF THE WA 0,
RREN 20
1 2 0 80
COUNTY CLERK�,IN BOOK 977 AT PAGE 14.
-EN
6) SUBJECT TO,�COVENANTS AND RESTRICTIONS,,F11 ED IN THE, OFFICE OF THE WARR
COUNTY CLERK IN BOOK 183 AT PAGE 135.
7) THISSURVEY WAS PREPARED WITHOUT THE BENEFIT OF AN ABSTRACT 'OF TLE AND 1 inch 20 �ft
ORL
--IS: THEREFORE SUBJECT TO ANY'EASEMENTS, COVENANTS RESTRICI!Okt OF REC �7'
ORD wed: 02113117" r�vise hbuse, dime7zsions
ANY STATEMENT-LOF: FACTS, SUCH DOCUMENT WOULD DISCLOSE. �,Rev
01119117 add _y
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8) SUBJECT TO APPLICABLE LAWS AND APPROVALS OFL THE TOWN, COUNTY, AND,STATE
REGARDING THE DEVELOPMENT OF LAND. SURVEY MADE
MAP,OF A FOR
SURVEYORS ,SEAL-IS A VIOLATION OF�SECTION 7209,r SUB-DIVISION 2,, OF THE BE &
A 9) UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP ,BEARINGLrA LICENSED LAND DA V
NEW YORK,STATE EDUCATION LAW.,
E10) ONLY COPIE FROM THE ORIGINAL OF THIS SURVEY MARKED W!TH, AN ORIGINAL OF; ATHRYNLL 'LIEB TRE' r
LANDr SURVEYORS SEAL SHALL:BE'CON SID ERED. TOL BE VALID TRUE COPIES. ,
TO b Stdte of New Yo
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TIES,: STRUCTURES AND, FACILITIES HAVE BEEN ,SHOWN FROM �wnl 0 ueens Co-zint of 'D�.arre n rk
:11) UNDERGROUND UTILI y
05
SURFACE LOCATIONS 5
,OBTAINED.FROM,A FIELD SURVEY. HojFAIW
THERE MAY BE OTHER UTILITIES WHICH THE EXISTENCE OF ARE;,NOT .KNOWr SIZE, USSELL , E.
TYPE AND LOCATION OF ALL.U_flLI-n ST UST BE VERIFIED 13Y
PROPER AUTHORITIES PRIOR TO ANY AND ALL CONSTRUCTION. CALL DIG SAFE PRIOR
TO ANY EXCAVATION. 342 jf r S tr e e Hdso Falls, New York 12839
-D #:.289.14-1-41
RE*v`J5E_D jANUARY IG, 2-CA7 TO DA-IOM BASto ON _Russell E. Howard� PLS .Y.S. Lic. No. 50540 ate: 07122116
Tax Ma
AN U: 18040A
"a.-te pabed im-h 20 foet
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