CC-000710-2016 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: CC-000710-2016 Date Issued: Monday, December 5, 2016
This is to certify that work requested to be done as shown by Permit Number CC-000710-2016
has been completed.
Tax Map Number: 296.19-1-32
Location: 375 BAY RD
Owner: 375 Bay Rd.,LLC
Applicant: 375 Bay Road LLC
This structure may be occupied as a: Commercial Interior Alterations
2,000 sq.ft. By Order of Town Board
Parson's Child& Family TOWN OF QUEENSSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the _ (/ �J 44t
property owner of the responsibility for compliance with Site Plan, GGG V
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
QL 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CC-000710-2016
Tax Map No: 296.19-1-32
Permission is hereby granted to: Jersen Construction Group
For property located at: 375 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
Tvce of Construction
Owner Name: 375 Bay Rd.,LLC Business Office-Alteration $90,000.00
Owner Address: 6Industry DR Total Value $90,000.00
Waterford,NY 12188
Contractor or Builder's Name/Address Electrical Inspection Agency
Jersen Construction Group
6Industry DR
Waterford NY 12188
Pians&Specifications
Commercial Interior Alterations
2,000 sq.R.
Parson's Child&Family
$400.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 19,2017
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Qu=nsbury before the exp[ /tWe
te.)
Dated at the Town of eensbu r� dn ¢lober 19,2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE Received Lo 13 I
Tax Map ID I q-/ -
TAXMAPID D_q(,P. (9'{32 UCf 1 ' 1.015 Permit No. GC-71 U -aol(0
Permit Fee fr 114-
ZONING _.. Rec Fee
Site Plan#
HISTORIC SITE Yes No Subdivision#
SUBDIVISION NAME 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 JE 154 codsfitoalbo glloOQ OWNER 315 BAY A0, Lt_G
ADDRESS 6 /A)P05-ro 1,luVcr ADDRESS /A1_6o ye4 pe.
W4rft,Fc2pf Aly /Zl�j tJArC&F'00 , Afy /L/88
PHONE/E-MAIL(51i] Z33-0600 ,FR(C��£�SEn1.Cv``C PHONE/E-MAIL(5)8)235 • 06eo
CONTRACTOR Si4,y L 45 Affljc4 N7 COST OF CONSTRUCTION(ESTIMATED): $ pOT4>d
ADDRESS: BUILDING ADDRESS: 375 IN:( eA
PHONE/E-MAIL
CONTACT PERSON FOR BUILDING& CODES
/COMPLIANCE: 21og'J 'P' Fc PHONE(54)3 3. `13tw
TYPE OF CONSTRUCTION
y
Check all that apply Please indicate measurements as required below
New Addition Alteration 1st floor sq. ft. 2ntl floor sq. ft. Total sq. ft. Height
Single Family
Two-Family
Multi-Family
(# of units
Townhouse
Business Office too&
Retail - Mercantile
Factory- Industrial
Attached Garage
(#of 1
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business et4+a t
Proposed use of building or addition PACE
Source of heat (circle one) Gas Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys N A
Are there structures not shown on plot plan? N A
Are there easements on the property? N A
Site Information /V A
a. Dimensions or acreage of lot
b. Is this a corner lot?
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed (labor or materials) $ 9�1oa0.0 0
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. 1 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. 1 acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. 1 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: AnlAkl T" DATE /o• iI ze,I
SIGNATURE: DATE 10 , l1-9011
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
CLFIRE MARSHAL'S OFFICE
TOZOn of Queensbunj
742 Bay Road, Queensbury, NY 12804
" Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Parson's Child and Family
375 Bay Road
2000sf
CO-000710 -2016
Plan review based on submittals:
• Add (2) combo paks as shown
• Verify FE location and inspection
• Verify aisles / Storage requirements
• Carbon monoxide detection required
• Verify compliant locks / latches—
• Key required for Knox Box
• An NFPA 13 letter of compliance required for any sprinkler system
modifications
• NFPA 72 compliance letter required for any fire alarm system
modifications
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal's Office • Phone: 518-761-8206 • F a a: 518-74511437
firenmrsl al ftueensbun/.net • w:uw.queensbunt.net
C-C-CiDo-11 -'
MIDDLE DEPARTMENT INSPECTION AGENCY, INC. y��
'Fo�iy�:.• that the electrical wiring to the electrical equipment listed below has been examined and is approved as ya
being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date �4
noted below and is issued subject to the following conditions.
Owner: Date: 11/222016 rS
Parsons ya,
Occupant: Location: ry��
2Nd FI & Rear 375 Bay Road Y�aS
Occupancy: Queensbury,Warren Co. NYy,h
melon-Residential � S
Applicant:
Crannell Elect, Design &Const
PO Box 4074
Queensbury, NY 12604
Joseph A.Holmes
No. 141554205404EL y
Equipment: r
100 -Amp. Sub Panel; 7 - Switches; 26 - Receptacles; 7 - Fixtures; 1 - Emergency Light; 2 - Exit Lights; 2 -
Exit/Emergency Combos �S
I
i
I
I
I
This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use.occupancy and
above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership
inspection. No warranty is expressed or implied as to the mechanical safely.effi. of the property indicated above,this certificate shall be immediately null and void.
ciency or Poness of the equipment for any particular purpose. This certilicete sha11 In the event that this certificate becomes invalid based upon the above conditions.
De valid for a period of one year Irom the above noted date. Should the electrical this certificate may De revalidatetl upon reinspection by Middle Department
system to which this certificate applies be altered in any way.irtClutling but not emaInspection Agency. Inc. An application for inspection must be submiaetl Io Mitltlle
etl lo.the introduction of atlditional electrical equipment antl/or the replacement o! Department Inspection Agency. Inc. to initiate the inspection and revalidation
linty of the components installed as of the above nosed tlate,this certdicate stroll be process. A lee will ba chargetl for this service. �