2008-520 VOID TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE C-)"VE7 OCCUPANCY
Permit Number. P20080520 Date Issued: Tuesday, November 16, 2010
This is to certify that work requested to be done as shown by Permit Number P20080520
has been completed.
Location: 973 STATE ROUTE 9
Tax Map Number. 523400-296-013-0001-019-000-0000
Owner. PILGRIM LAND HOLDING CORP
Applicant: PILGRIM LAND HOLDING CORP
This structure may be ocRA;Wfj§jTJRY TIRE, LLC
Certificate of Occupancy(COM) By Order of Town Board
TOWN O QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the 01
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080520 Application Number. A20080520
Tax Map No: 523400-296-013-0001-019-000-0000
Permission is hereby granted to: QUEENSBURY TIRE, LLC
PILGRIM LAND HOLDING CORP
For property located at: 973 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: PILGRIM LAND HOLDING CORP
CIO QUEENSBURY TIRE Certificate of Occupancy(COM)
973 ROUTE 9 Total value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2008-520
Queensbury Tire, LLC CIO only
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,October 01,2009
(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 Quee u? nesday, October 01, 2008
SIGNED BY for the Town of Queensbury.
Director of BuiZKA Enforcement
Y t
e01"n 1111ihj Development OfficeQ f
Town orQueensbury • 742 Bait Road • Queensbury, New York •12804
` art Sttimp ;
•David Hatin,Director of Building&Codes ;.
Craig Brown, Zoning Administrator•Michael J. Palmer;Fire Marshal ;
ESTABLISHMENT OF A NEW B'U5W-ESS:� -
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
TAX MAP# BLDG. PERMIT FILE#
It appliCaDle
Name of Business:L,, A =(:n7s"r kr�-i Tice , L L(2-
Address QUESTIONS? CALL 761-8256 OR
of Business:
EMAIL codesCa�aueensburv.net
VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: / 1 � ���� INFORMATION
www.aueensburv.net
Business Phone Number: —5)P _-40,
Type of Business:l"
Owner of Property: Phone Number(s):
Home Cell
Owners _
Address: �� � .� Y���1��71I I1JY 12� M
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature: . r l T — Date: ���
Of person submiuinj 6�rm
Notes/ Comments:
*Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit
r
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE:
BUSINESS NAME: l 1l a�_�, �11 Jl 1�i I IE LLC
BUSINESS ADDRESS:`'IT 3 �Za p_`'I , Meq_�-)N_ q `2B04
BUSINESS PHONE: 5 8,__�jq3 _ �qq lG
�I HOME�-
CONTACT 1: nab,
� PHON0Vt-`r 4 1 '-�2�
ADDRESS.4 ('1 (T�-) Cl F; p h/F)m �uq 12-1 � Q
HOMEr,
CONTACT 2:ffim�d SK Mee PHONPC8"44CC 9105
ADDRESS:
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 QUEENSBLIRY FIRE MARSHAL'S OFFICE
P h o n e: 518-761-8206 • F a x. 518-745-4437
.firenmrshal@queensburj net www.queensbu!ij.net
ee-
inspection for Permit/to Occupy
Fire Marshal's Office Request Rec'd_ Pemut No. �
Town of Queensbury
742 Bay Road �.
Queensbury,NY 12804 Scheduled Inspeclon Date: rne:
Phone. (518)761-8" Business Name:
Fax: (518)745-4437 Location:
rme of Ins N A Yes No
EXITS:
EW Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES: l
Main Aisle Width
Secondary Me Width
EXIT SIGNAGE
Sign-normal
Sign-bait J
EVAC skins in rooms
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hung
kLspection of e
HRE ALARM SYSTEM `, ���l D
fan Shutdown C
Fire S em FDC
Fire Suppression-kitchen
Fire Suppress"-Gas Islan
Generator
Hood Installation
Elevator
Interior Finishes
Storage
Com essed Gas 1
Clearance to Sorinklem
Clearance to Eiectncal
Electric Wong Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection
Knox Box
F.D.Skinage-Utility Rooms
No Smoldng Signs
Madmum occ6p—aicy Sign
Emergency Evacuation Plan
a Approved (if no other approvals apply,the B&C office wil asue the Cerfifiicate of Occupancy)
a Denied /caq for Recheck
inspected By:
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Inspection for Permit to Occupy
Fire Mardid'S OIrICO Request Rec'd Permit NoA ✓�
Town of Queensbury
742 Bay Road r
Queensbwy,NY 12804 Scheduled Inspection Date: - Time: ;Fo ,
Phone: (518)761-8206 Business Name: G��
Fax: (518)745-4437 Location:
Type of A To$ No
EXITS:
Exit Access
Exit Enclosure COMMENTS
E)dt Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
i normal
-S
I -battery
/
EVAC signs in rooms
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
G
FIRE EXFINGUiSHER: -
Hun
Inspection of extinguisher
FIRE ALARM SYSTEM
Fan Shutdown ✓ � !
Fire Sprinkler System
fire Suppression-kitchen
Fire Suppression-Gas Islan
Generator
Hood Installation
Elevator
Interior Finishes
-Story e
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical e/
Electric Wiring Enclosed Labeled ✓
Combustible Waste
Vehicle Irnpact Protection
Knox Box
F.D.Si na e-Utility Rooms
No Smokin Si
Maximum Occupancy Sign
Erneruency Evacuation Plan
a Approved (if no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
Denied /coil for Recheck ,
I
Inspected y:
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