CO-000636-2017 TOWN OF QUEENSBURY
742 Bay Road;Queensbury,NY 12804-5904 (518)_761-8201 .
�A Community Development-Building&.Codes (518)76-14256
BUILDING.PERMIT.
Permit Number: CO-000636-2017
Tax Map No: 296.17-1-51
Permission is hereby granted to: ADK Crossfit
For property located at: 870 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 incompliance with the'NYS Uniform
•Building,Codes and the Queensbury Zoning Ordinance
-Type of Construction
Owner Name: Israel Delforo Certificate of occupancy $0.00
Owner Address' 437 State Route 149, - Total Value $0.00
Lake George,NY.12845.
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Certificate of Occupancy Only
Tenant:ADK Crossfit
$50.00 PERMIT.FEE PAID-THIS PERMIT EXPIRES: Thursday,October 11,2018.
Of a longer.period is required,an application for an extension must be made to the.code Enforcement.Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of ueensb Wed e d October 11,2017
SIGNED BY: for the Town of Queensbury:
Director of Building&Code Enforcement
• CEIRTIFI ATE OF OCCUPANCY ONLY officeuseonly
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to
APPLICAVON
Permit Fee:
742`Bay Road„QueensbuV%NY 12804 .
Invoice ti: l''
-.P:8MB 76,1-8206 or 518=761=820 vvw;v.aueensliurv.net
`"This applircationi is iF0 oeeupo n-cy.only➢-with.-no work rei i'it, ga buiidinlg permit"
CONTACT INFORMATION:-'
4plicenta
Name(s):- 6119,4 4_ D13�.LVOVI
maiif-g Address, C/S/Z:. q -SA" MU yEe 1 Y� C4 C o2i0 X/ %2 S S
Cell Phone:. ) �12 .� OZ`1 Land Line:
Email. Cohn-
o Business Owner(s):
Contact Name(s):
Mailing Address; C/S
Cell Phone:_( ) Land Line: .
Email: �
Manager., .. . .00:T--0 6 �2017
.Contact.Name(s):. A
Mailing Address-, C/S/Z:
Cell,Phone:_(. '' Land Line:
Email'•
Property Ownee(s):
Business-Name: ,�1:nc ���o� � �{f��.�r, h : �1"6D�d�l�5 � LC-.
Contact Name(s):
Mailing Address,,C/S/Z: —7 5ouk6 5"re- 7rtve , 6cukh
;Celt Phone:_( ) C qt 71 _v(p -Land Lino: ,_( )
Emaii:_bj,C t1 t wi f7iCV 2<)$_.� ,CCU
Revised June'2017
Certificate of Occupancy Only.
-742 Bay Road,.QueehsburV,MY.12804
P:518-7614206 or;5Y8=761-820ci -W%iviiv.- e msbdry.d6Ej
-BUSINESS.INFORMATION'
Name of business: A w_,
Address (including suite, ';pace; etc.)':
(Z t-lco
Type.of business (i.e retai.l, car repair, etc:):.
Please provide an accurate layout of your store showing.all walls; exits ,stockrooms, rest,
.rooms,--counters and fixtures on a.separate sheet of paper.
INiPORANT: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 a,n outside contractor and the corresponding documentation
must be provided to,theTown of,Queensbury Fire Marshals office. 'Fire extinguishing systems
found`in kitchens a,nd gas stations require.semi=annual inspections. {Any violations noted:
-during an inspection.reguire'immediate corrective action and a re=inspection.
Applicant name: 159,ACL- 'Z)SLTo i2Q,
App.iicant signature:
.D.ate:. . . O l l.) . 17 . . . . .
Certificate of occupancy Only Revised June 2027
742 Bay Road,QueensbuiV,MY 12804
P:518-Z61-8206 or 5l8=7.61-8205 _vww.nueenshur)/.nEt
EMERGENC CONTACT INFORf AT.107 .
4#111IS FORM IS'USED:TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED.1 O:YO.UR
BUSINESS AFTER HOURS. PLEASE BE SURE THE,:CONTACTS LISTED,BELOW;ARE WILLING AND.
AVAILABLE TQ REPSOND DURING O.FF-HQURS,TQ ASSISTPOLICE AND/OR FIRE'PERSONNEL IN
GAINING ENTRYTOYOUR;BUILDING'*
'PLEASE BE-ADVISED.lHAY FAILURE TO', SSIST EMERGENCY SERVICE PERSORIWEL MAY RESULT IN
DAMAGE TO YOUR BUILDING-BY POLICE AND/OR.FIRE_PERSONNEL:
Date:. � 1 l7 1I...
Business Name: . CC
q
Business Location(including suite;spece,:etc.): Q17t�9' 'e l
Business Phone 02 y
1. +Contact.name: K)t3,re_Pr\ 6Cp -
,Main Phone: -�(0`'1Z ;Secondary Phone:_( )
:Coming from what town/village? LcaVj, ub
2. Contact name:. 1&fN A Cr
Main:Phone:_( I ) ) gZC.o.~-`779t� Secondary Phone:_(: ).
g
Cominfrom what to wn/village?:
TOWN OF'QUEENSBURY FIRE MARSHAL'S OFFICE.
P: 518 7.6.1-8206. F: 518.745 4437
FIR FNIARSHAL@QUFENSbURY.h1ET"
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL;GARY STILLMAN
Revised June 2017
Certificate of occupancy Only
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FIRE MARSHAL'S OFFICE
Toum of Queensbunj
742 Bay Road, Queensbury, NY 12804
"Horne of Natural Beauty... A Good Place to Live "
PLAN REVIEW
ADK Crossfit
State Route 9
CO-000636-2017
10/11/2017
The following comments are based on review of drawings;
• Verify fire extinguisher location and inspection
9 CO detection required
• Verify operation of exit/Emergency lighting..
• Lock/ latches shall comply with Chapter 10 of 2015.IBC.
• Verify paths of egress
•" Verify storage.
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire- Marshal 's Office Ph.one: 518-.761-8206 F a x: 518-745-4437
firemarshal@gueensbunt.net 7MMqueensbunt.net