2009-175 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090175 Application Number. A20090175
Tax Map No: 523400-288-012-0001-022-000-0000
Permission is hereby granted to: ADIRONDACK FACTORY OUTLET CENTER, IN
For property located at: 1444 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. Type of Construction Value
Owner Address: ADIRONDACK FACTORY OUTLE
1444 STATE ROUTE 9 Certificate of Occupancy(COM)
LAKE GEORGE,NY 12845 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-175
SAMMY D'S CAFE - C/O ONLY
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, May 15, 2010
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the T Quee � r' a ay 15, 2009
SIGNED BY for the Town of
Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20090175 Date Issued: Tuesday, May 26, 2009
This is to certify that work requested to be done as shown by Permit Number P20090175
has been completed.
Location: 1444 STATE ROUTE 9
Tax Map Number: 523400-288-012-0001-022-000-0000
Owner: ADIRONDACK FACTORY OUTLET CENTER, I
Applicant: SAMMY D'S CAFE
This structure may be occupied as a:
Certificate of Occupancy (COM) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the X y 1
property owner of the responsibility for compliance with Site Plan, �� ''G
Variance, or other issues and conditions as a result of approvals by the Director of Building&' de En cement
Planning Board or Zoning Board of Appeals.
Corrrmunity Development OfficeQ D
Town of Queenshurl/ - 742 Brno Road - Queensbury, New York -12804
•David Hatin,Director cf Building&Codes
Craig Brown,Zoning Administrator•Micltael J. Palmer, Fire Marshal TOWN OF QUEENSBURY;
--BllilLQlDi�B�-�QDES
ESTABLISHMENT OF A NEW BUSINESS
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
TAX MAP#,M- I�_l - BLDG. PERMIT FILE# Ort—
< If 6pplicable
Name of Business: -IN S C,.te.
Address
of Business: �y �} Q� QUESTIONS? CALL 761-82560R
Q L& ea�,z. tJY �02$`IS
EMAIL codesCfaueensburv.net
AVISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: L�w�;�� ,s,.� INFORMATION
i www.aueensbury.net
Business Phone Number:
Type of Business: o C G S,r �Ga�►v�e n I�
Owner of Property: Nov L Phone Number(s): 7q3, 6S77 : a 1 - 167.3
Home Cell
Owners
Address:
Please provide an accurate layout of your store showing all walls, xits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature: CG L cwt Date: S
Of person submitting this form
Notes/ Comments:
"Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: /0,q
BUSINESS NAME:
BUSINESS ADDRESS: n)Y 1 9 Iqs
BUSINESS PHONE: b
I - HOME
CONTACT 1: Vary �c l.��arC, PHONE Sl$- bq b - 9560
ADDRESS: �9 ����� } ��. �azvrn( 11
i HOME
CONTACT 2: C�r�s �r� I�� G-Tsrc PHONE SI 1- bob-12J
ADDRESS: 71 tJkh 14 Qtd _ 1 1\j1
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
{iremarshal@queensbur,.net www.queensburj.net
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No.�
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: Time:
r
Phone: (518)761-8206 Business Nam S
Fax: (518)745-4437 Location:
Type of In cfion N/A Yes Ho
EXITS:
Exit Access tl
Exit Enclosure <-- COMMENTS
Exit Discharge
AISLES:
Main Aisle Width
3econd6 Aisle Width
EXIT SIGNAGE
Sign—normal �-
Sign-batter t�
EVAC signs in rooms
TRUSS ID SIGNAGE ZIP
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun s
inspection of extinguisher
FIRE ALARM SYSTEM
Fan Shutdown
Fire Sprinkler System FDC
Fire Suppression—kitchen N
Fire Suppression—Gas islan
Generator
Hood Installation
Elevator ..... „
Interior Finishes ALL, rue Mary-A!In k
Stora e O (A tc fssue+^Arts to of
Compressed Gas A)IL- Sty
Clearance to Sprinklers in
Clearance to Electrical p 3
Electric Wiring d Enclosed/Labele QJ `
Combustible Waste
Vehicle Impact Protection
Knox Box Firef�;,f
F.D.Si na e—Utility Rooms M or e sku -
No Smoking Signs k
Maximum Occupancy Sin
Emegency Evacuation Plan
"pproved (If no other approvals apply,the B&C Office will is a Ce ificate of Occupancy)
❑ Denied I call for Recheck
Inspected By:
L:\FireMarshal\New Folder\permitto occupyform.doc
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