2009-580 ~� TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
E .TIFICATE ( F 0CCUP-A-N- ("..1Y
Permit Number. P20090580 Date Issued: Friday, November 27, 2009
This is to certify that work requested to be done as shown by Permit Number P20090580
has been completed.
Location: 1300 STATE ROUTE 9
Tax Map Number: 523400-288-020-0001-019-000-0000
Owner. DOUBLE S PARTNERS, LLC
Applicant: BLUE MOOSE TAVERN &RESTAURANT
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 ,
property owner of the responsibility for compliance with Site Plan, 4)
�t
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 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090580 Application Number. A20090580
Tax Map No: 523400-288-020-0001-019-000-0000
Permission is hereby granted to: BLUE MOOSE TAVERN &RESTAURANT
For property located at: 1300 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: DOUBLE S PARTNERS, LLC
14 LONE TREE LOOP Certificate of Occupancy(COM)
DIAMOND POINT,NY 12824-0000 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2009-580
BLUE MOOSE TAVERN&RESTAURANT- C/O ONLY
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,November 27, 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 zl �
b# y,November 27,2009
SIGNED EYIN for the Town of Queensbury.
Director of Building&Code Enforcement
.. .t
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----E----------f-----`
QCoinmuity Development Office
Town of Queensbuiay - 742 Bay Road - Queensbury, New York -12804
ta
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•David Hatht,Director of Building&Codes p!: :t i I
:+ ., § ,,. Ems=
Craig Btrnfln, Zoning Administrator•.'vtickael J. Palmer,Fire Marslufl .i !; r .`.�=f �, � ����
--------------
ESTABLISHMENT
. a�#
OF A NEW BLI�INVS� .==S�`��;....�. .�:�:...........
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
TAX MAP # BLDG. PERMIT FILE#
applicable
Name of Business: �I -f-01 r:ttk✓-,A •S eJ , L,c a e l v IM 0 oS-Q. row err-k
Address I _I
aw�,
of Business: 1 od &f QUESTIONS? CALL 761-8256 OR
EMAIL codes(ftueensburv.net
1 � VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: Cc �r a .'L INFORMATION
www.aueensbury.net
Business Phone Number:
Type of Business: R� - c�f (�•,, Q,,/`
Owner of Property: his J (� l�t,i P✓`�Phone Number(s): S�
Home Cell
O
Owners
Address: �L1 O J\.�� `' �o� Fes► 1`/ ii " M b ^;(—r(✓. 1�dS�
Please provide an tt l ky utt cant stow it�g�al/Drafts, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature: / Date: I a3
/Orp
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: ! 3 0
BUSINESS NAME: 9Jk 2 P. 10 f' fj �tnf�✓a- i -��� ( BA B l o e qc o S -
a� �2 es -aw.r nr
BUSINESS ADDRESS: 1 -o shc�� l�� { JC L C���yG_ IVY
la� `rs,
BUSINESS PHONE:
HOME
CONTACT 1: j • IV (S PHONE Ce�1
ADDRESS: �?13 I^dce A ,e
HOME
CONTACT 2: t,�, r e,� l� �_r PHONE sl -2
ADDRESS: IV / �a
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
P It o n e: 5.18-761-8206 Fax: 518-745-4437
firenzarshal@queensbuU net www.queensbury.net
Inspection for Permit to Occupy �^
Fire Marshal's Office Request Rec'd Permit No. J
Town of Queensbury
742 Bay Road �
Queensbury,NY 12804 Scheduled Inspection Date: Time: cJ }f
Phone: (518) 761-8206 Business Name.
Fax: (518) 745-4437 Location: 5M2 9
Type of Inspection N/A Yes No
EXITS:
Exit Access
Exit Enclosure COMMENTS
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal
Sign-battery
EVAC signs in rooms
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
FIRE ALARM SYSTEM
Fan Shutdown
Fire Sprinkler System FDC
Fire Suppression-kitchen
Fire Suppression-Gas Islan
Generator
Hood Installation
Elevator
Interior Finishes
Storage
Compressed Gas LAC
Clearance to Sprinklers X
Clearance to Electrical
Electric Wiring Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection
Knox Box
F.D.Si na e-Utility Rooms d/
No Smoking Signs Maximum Occupancy Sin !'!i
Emer enc vacuation Plan
Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
❑ Denied / call for Recheck
Inspected C
L:\FireMarshol\FM Forms Masters\permitto occupyform.doc