2007-062 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. P20070062 Date Issued: Friday, March 02, 2007
This is to certify that work requested to be done as shown by Permit Number
has been completed. P20070062
Tax Map Number. 523400-296-017-0001-034-000-0000
Location: 863 STATE ROUTE 9
Owner HERBERT G SHEINBERG
Applicant: PIZZA HUT OF SOUTHEAST KANSAS
This structure may be occupied as a:
Certificate of Occupancy(COM)
By Oder of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve they
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the
Planning Board or Zoning Board of Appeals. Director of Building&Code Enforcement
TOWN OF QUE E NSB URY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
(2t Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070062 Application Number. A20070062
Tax Map No: 523400-296-017-0001-034-000-0000
Permission is hereby granted to: PIZZA HUT OF SOUTHEAST KANSAS
For property located at: 863 STATE ROUTE 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.
Owner Address: HERBERT G SHEINBERG Tempe of Construction Value
CIO SAVAGE< SAVAGE &BROW Certificate of Occupancy(COM)
PO BOX 22845 Total value
OKLAHOMA CITY, OK 73123-
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2007-062
PIZZA HUT OF SOUTHEAST KANSAS
CERTIFICATE OF OCCUPANCY
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Sunday, March 02, 2008
(If a longerperiod is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To4o-i Qu sbu s Fnf a
,4' hVuch 02, 2007
SIGNED BY
for the Town of Queensbury.
Director of Building&Code Enforcement
EMERGENCY CONTACT UPDAT
E
TO: WARREN COUNTY SHERIFF'S DEPT.
FAX: 7�-2.�oz
PLEASE PRINT
DATE: Z Is g
BUSINESS NAME: ?-r 2 2.
BUSINESS ADDRESS;
BUSINESS PHONE_
CONTACT 1: (�,r HOME
oy 8 S
ADDRESS:_ -Toc�M4' Ltf t_' C J� }� 12$
CONTACT 2: HOME
PHONEE ` - S 9 3 -3 o62
ADDRESS: l S L o 0 0 LIE IZg QC- �jy 1,z S a o
This form is used to assist Emergency service perwnnel who may be called to
your bvslness after hours. Please be sure that the persons fisted on this form will
be willing and available tO respond eluding off-hours to Msist Police and/or Fire
personnel in gaining entry to your building.
KgAse BE ADVISED THAT FAILURE.TO RESPOND TO ASSIST EMERGENCY SERVICE
PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING TO FAC141TATE ENTRY BY
POLICE AND,/OR FIRE PERSONNEL,
7`0 W1V OF Q LLEENSB hIXt 7 FZRF MARS' HAV S OFFICE
-P h v n O7 528-761-+9206 - F a ac; 518-745-4437
rrmarshal�? r,�ea�,sh�.��t zc�vw. c��nsbtt At
Community DevelopmMt office
?awn of Queensberry- .742 May!toad • QueFnabelry, New York s12804 ; ,� I� ,
Marilyn Ryba,F 'd0f4HVd Dir=f*r-DaVid Halm,Dlrcclor of aµilding&Carp i ��� �b��e-
Cra ig sftw r,2onzn 1S$ . dminiafttor•Micheal J.1yalilRer,Fin Mrn-5lfn7
i
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NEwRus.[NESS cERIYFICAn- OF occupANc'YpFRmjT
APPLTC.A7701V
TAX MAP# BLDG. PERMIT FILE#
I/ap�rtanis
Namw nf Allniness.- r
Address.
of Business: u 28ay QUEMVNS? CALL 701-82M OIL
r0p ,r� •EMAILSgdes pgvj nab net
Person In Charge or Managgr; L lJ z L L s n VISIT OUR WEBW-E PoR WORE
INFORMATION
WWW.ggflAR&WY RQI,
sualness Phone NumbeC.
Type of Susineas. V.ir—K r,3
Owner of Property: E AE NM-R G Phones Numbsgay:a39-399 -Z30tef
Home
Ownom
Addra..ss:
r/sasm provide sn stocurate layout of your store showing all wells, wdb, stookrooma, scat rooms,
counters and fixture layout on a.separate sheet of spar_
Signature.-
Date: 2 8 d
Notes/Comments;
���uL3?'se�SG l� P�TRnn�r i��i: �-I—o P� G►•1�k-�GG �
rA-" cA-vs ow lv�?L5►v x p *N
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71/I
Note:Th/s Oppl/Ce3tlOR i6 for aocU
Pancy only, wr7h no wonle
requiring,�h»ilrli»0 flap►ll, 1Vn fwa rAqulra9d for thin/h4rmit
Plrta Hut 863 RT 9,Cueensbury,NY 128W
274
Freezer /
coorar Shed
Delivery Ma Wotan
EntranoeVAt loa Heeler
Work
�k
Tabre Storage
Cooler aeon store
Beverag seer rape. a Ladle's Menus
e Cooler Room Room
Fridge
Wattress Station Cash StiOn-1
EnMrm 82
Entrance
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Dblivery Hot water
Entrance/EAt at:::j
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Sty Table Stomp
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.a
f'
Cooler e � O
Beverage Besr Taps E Ladie's Men
Cooler IL Room Room
Fridge
Waitress Station Cash Station
Entrance
JAI 62
Tafiles
eaoth eooa,i Booth
Booth
Booth Booth. Baoth
Booth Booth 0 � a
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Town of Queensbury Fire Marshal
742 Bay Road
Queensbury NY 12804
518 7618206 phone 518 745 4437 fax
firemarshal(q-
)queensbury.net
COMMERCIAL INSPECTION REPORT
NAME: — LOCATION: 3 � .
7
DATE: t o 7 TIME: 1 0(c> pm INSPECTOR:
Fire Alarm L) '—Sprinkler Elevator FDC
Generator Range Hood Fuel Island
Fire Pump 209U Other
Enter date of inspection
Receipt of Inspection: a ;;
CODE SECTION DESCRIPTION OF VIOLATION
a.` ,°
VIOLATIONS MUST BE CORRECTED IMMEDIATELY. A RE-
INSPECTION WILL BE CONDUCTED IN A TWELY MANNER
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. 0/ -662—
Town of Queensbury
742 Bay Road I
Queensbury,NY 12804 Scheduled Inspection Date:__ Time: �` 3
Phone: (518) 761-8206 Business Na e: Z
Fax: (518) 745-4437 Location:
T e of Ins ection N/A Yes No
EXITS:
Exit Access
Exit Enclosure COMMENTS
Exit Dischar e
Ar-
EVAC Plan _
AISLES:
Main Aisle Width "
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal
Sl n-batter
EVAC si ns in rooms
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extin uisher
Hydro extinguisher
FIRE ALARM SYSTEM
Fan Shutdown
Fire Sprinkler S stem
Fire Suppression-kitchen
Fire Suppression-Gas Island
Hood Installation
Interior Finishes
Stora e
Compressed Gas
Clearance to Sprinklers #
Clearance to Electrical
Electric Wiring Enclosed
Combustible Waste
Vehicle Impact Protection
Fire Lane .-
F.D.Si na e-Utility Rooms
No m Smoking Signs }
Maximum Occu nc Sin t- �j[�//�S� �j�,r�GL U! �'
Emer enc cuation Plan
Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
❑ Denied
❑ Call for Recheck
Inspected
L:\FireMarshal\insptopermitto occupyform.doc