2009-537
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: A20090537-36363Date Issued:
This is to certify that work requested to be done as shown by Permit Number
A20090537-36363
has been completed.
302.7-1-12
Tax Map Number:
118 QUAKER RD
Location:
Mike Singleton
Owner:
Mike Singleton
Applicant:
This structure may be occupied as a:
COMMERCIAL ALTERATION
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,
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.
................................................ ..
... . ............................... .
O
6Z ` 7-1lz-
T�' MAP — E USE ONLY NO. t� 5 ;
PERMIT NO. V OCT ; ,� 2009
FEES: PERMIT RECREATION ENGINEERING '
(If applicable) fOWNOF QUEENSBURY;
:........................................................ . - BUILDING & GQpE
PRINCIPAL STRUCTURE:
APPLICATION FOR ZONING APPROVAL & BUILDING PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO
REVIEW BEFORE ISSUANCE OF A VALID PERMIT FOR CONSTRUCTION.
h
L
APPLICANT/BUILDER: �.4 w, OWNER: /1II/et
ADDRESS: /lam 13 rt, fLf• ADDRESS: //,r-
PHONE NOS. 7ya- aYl PHONE NOS. 7-f,2 - ff-C
CONTACT PERSON FOR BUILDING &CODES COMPLIANCE: /1�4e PHONE:
LOCATION OF PROPERTY:
HAS THERE BEEN A SITE PLAN REVIEW; VARIANCE OR SUBDIVISION APPROVAL? ❑ YES NO
IF SO, INDICATE APPLICATION NO. AND DATE OF APPROVAL: ftr/L�
lI PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
ICHECK ALL THAT Z
APPLY TO YOUR z Q � 0 a a � ~'-
PROJECT w 1 O o r `� 0 i w
� =
(D
z'� o Q �- a Z a � r o � ° LL1
N O U- lL Z
r c� cn h- d = 06
iSINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO. of UNITS )
TOWNHOUSE
BUSINESS OFFICE f
I
RETAIL-
MERCANTILE
4
FACTORY OR
INDUSTRIAL
IATTACHED
GARAGE(1,2,3)
r
OTHER j
IF COMMERCIAL OR INDUSTRIAL— NAME OF BUSINESS:
ESTIMATED CONSTRUCTION COST: 5'-4�1 `=� FUEL TYPE: �O
HEAT TYPE: ` *HOW MANY FIREPLACE(S): AND/ OR WOODSTOVES(S):
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? o
IS THIS A HISTORIC SITE? !c&
PROPOSED USE OF BUILDING OR ADDITION: lZj jf� h eE c'° G
`Please complete a separate Application for"Fuel Burning Appliances&Chimneys" available in our office
Tozo11 of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 3-LGL 11-05
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN?
ARE THERE EASEMENTS ON PROPERTY?
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I 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. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I 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 abo e
Signed
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction
codes or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
/ I
Permission is hereby granted to the above ; This application / proposed action described ;
Applicant to erect or alter the building herein is found to be in accordance with the
described herein in accordance with said zoning Laws of the Town of Queensbury.
Application:
I r I I
/ I /
I I I
I I I I
r I /
BUILDING & COD OVAL ZONING APPROVAL
/
I r / I
/
/ I
DATE DATE
I r ,
QUESTIONS 7 CALL 761-8256 OR EMAIL
codes(@gueensbury.net
Office Use Only VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
Operating Permit Issued: Yes ��No
Occupancy Type: Construction Classification: 2,;
Assembly Occupancy Limit. Special Conditions:
Town.. of Qt.teenshit.ry • Colnnu,mity Developinent Office • 742 Bay Road, Queensbury, NY 12804
07 5-3
CD
Cr m o6 Z)
m v o
v
v C�
0
a -a
,-I-
CDs
CO
Display
3 �
y:
L
01
i;6*
CO
goo v
tetdsrQ 3
Work Ranch
i9WN OF QUEENSSURY BUILDING DEPARTMENT
fted on our limited examination,
eompfiance with our comments shall
not be construed as indicating the
plans and specifications are in full
compliance with the Building Codes of
New York State.
c
/U 36 .�
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No.
Town of Queensbury
Bay Road Qu !�
Queensbury,NY 12804 Scheduled Inspection Date: � � 3 '/ Time:
Phone: (518)761-8206 Business Name: `ri2, Cow 0-U�MP-TtTr-5
Fax: (518) 745-4437 Location: A 11,6z -F 2 0
Type of cKon N/A US No
EXITS:
Exit Access
Exit Enclosure COMMENTS
Exit Discharge
AISLES:
Main Aisle Width
Sec nclary Aisle Width
EXIT SIGNAGE n
Sign-normal X
Sign-batter
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 ,,,,+r "■""i"'wr`"'r'
Hood Installation
Elevator �� I 1 0
Interior Finishes
Storage `
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical
Electric Wiring Enclosed/Labeled M
Combustible Waste T c UrJ pL r
Vehicle Impact Protection
Knox Box
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
A Approved (If no other approvals apply,the B&C Office will is ue the ificat of Occupancy)
o Denied / call for Recheck
Inspecfed By:
L:\FireMarshal\New Folder\permitto occupyform.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. ' e�
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: /� � Time:
Phone: (518) 761-8206 Business Name: <Z0N -, -f
Fax: (518) 745-4437 Location: //9 12 2�,
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 /`rl G A, Liq i
Hood Installation
Elevator
Interior FinishesUI�v.I
Stora a
Compressed Gas
Clearance to Sprinklers
Electrical
Clearance to Electrical
Electric Wiring Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection
Knox Box
F.D.Si na e-Utility Rooms ,^
No Smoking Signs
Maximum Occupancy Sin J
Emergency Evacuation Plan
o Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
'4�enied / call for Recheck
Inspecte0y:
L:\FireMarshal\FM Forms Masters\permitto occupyform.doc