2005-430 TOWN OF QUEENSBURY
n NY 12804-5902 (518) 761-8201
��� 742 Bay Road,Quee sbury,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20050430 Date Issued: Tuesday, September 06, 2005
This is to certify that work requested to be done as shown by Permit Number P20050430
has been completed.
Tax Map Number: 523400-296-019-0001-032-000-0000
Location: 375 BAY Rd
Owner: PROVIDENT BAY ROAD, LLC
Applicant: CHIROPRACTIC OFFICE
This structure may be occupied as a:
Commercial Alteration By Order of Town Board
TOWN OF QUEENSBURY4tst,„,
Issuance of this Certificate of Occupancy DOES NOT relieve ther'D j 4
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
F 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050430 Application Number: A20050430
Tax Map No: 523400-296-019-0001-032-000-0000
Permission is hereby granted to: CHIROPRACTIC OFFICE
For property located at: 375 BAY Rd
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: PROVIDENT BAY ROAD, LLC
3 TALLOW WOOD Dr Commercial Alteration $18,000.00
Total Value $18,000.00
CLIFTON PARK, NY 12065-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-430 CHIROPRACTIC OFFICE
928 SQ FT COMMERCIAL INTERIOR ALTERATION
$111.36 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, July 27, 2006
(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 own of uee ry,� ;� es•ay, July 27, 2005
SIGNED BY 1/4 for the Town of Queensbury.
Director of Building&Code Enforcement
d Building 'Permit Application am ,
Town of Queensbury-Dept of Community Development,742 Bay Road,Queensbury,NY
(518)761.8256
A permit must be obtained before beginning construction. Permit File No, c)-WO5 -I 3 U
No inspection will bo made until applicant has received a Fee Paid $
valid building permit. All applicants' spaces on this Roc.Fee Paid $
application must be completed and must appear on the
application form, •
Reviewed By:
Applicant: , .1$" 4fAi cii-t ( 1 e. . Owner: r 4f '.. r;0F 0 A I--, ,G
Address: I 7))4 9 V LVA-vs re wat `?j - Address: 00 ‘ •
ittQ; oKn n / 'N-v i 6 S" . 1 6.c
Phone#(!k � 1 .- Zed a Phone#(S,LB ) 3
Property Location: Lot Number: "A / House Number 3-7 5 / •
Subdivision Name: NA- Tax Map Number: -2 3 ant" -2-16- al --
O New Building: residence /commercial Estimated Market Value of Construction: $` /r--, >' 7-:
❑ Addition: residence/ commercial If an Addition,what will use of new addition be?
Q' Alteration: residence/ commercial .1--•ev e, - :1 , u,p - e.,,1,,,,,v . .-04,4 7 ,,
)3' No change to exterior size: residence/co '1 }
O Other work(describe T0, M 14."1 6 4,4
j
Check Occupancylnformation lam`Floor 2'a Floor Other floor Total
Below sq.ft. sq.ft. sq.ft. Square Feet
❑ Single fain ly dwelling
o Two family dwelling
a Townhouse
O Multifamily dwelling
#of units
Office irr„ / 2 e sF- RECEIVED
❑ Mercantile 2t�05
a Manufacturing .)i N I.
a 1 oar detached garage � QUEENSBURY
a 2 oar detachedlarage TOM n
❑ • 3 car detached garage �U piNG AND CODS
O 1 oar attached garage
O 2 oar attached garage ```,
03 car attached garage ,
a Storage building-
commercial
❑ Storage building-
residential •
❑ Other
What is the proposed height of the structure U 4r. feet inches
Will any second-hand or ungraded lumber be used? If so, for what? Me,
Type of Heating System: electric/ oil / as7/wood /forcet`air/ baseboard/other:
Number of Fireplaces to be installed R'- Number of Woodstoves to be installed 04
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address- Phone Number
Builder ". 1.1 i 1,'y,".,-r,,,.4, C..0,4,,,v,*,I ` .A.r.fr '7
Plumber w,i.e,. ,`.° ,✓?r , two-4 km' :4 "r tf-2,i - 7 5`fi
Mason N/k -
Electrician Wiz,, r., ,,,,e..a ; L=0 :;I‘ 1 s' G
Declaration: please sign below after you have carefully read the statement:
To the best of my imowledge the statements contained in this application,together with the plans and specifications
submitted,are a true and complete statement of all proposed work to be done on the described premises and that all
provisions of the Building Code,the Zoning Ordinance and all other laws pertaining to the proposed work shall be complied
with,whether specified or noted,and that such work is authorized by the owner. Further,it is understood that I./we shall
submit,prior to a Certificate of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrator or Director of Building • •• , odes,an As Built Survey by a licensed surveyor;drawn to scale,showing actual
location of all n co ction. 1
•
Signatur . J avi owner,owner's agent,architect,contractor
NOV-08-2005 11:56 From:CHASE CHIROPRACTIC 5187430973 To:518 745 4437 P.2/2
0JS
Town of Queensbury
Fire Marshal's Office
EMERGENCY CONTACT UPDATE
LTRS 2(}OO
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: c;\/ 6)YJ
BUSINESS NAME: Cy-`- ' ` a
. BUSINESS ADDRESS: C-S1 ��- �� �` '� ����. l 79O`r
BUSINESS PHONE: (-5 « �'-k O I G'
CONTACT 1: 1`1 . e PHONE 3-C.)
ADDRESS: � { �,-t- � _.- Q j Jc .��_� � y 175?'
HOME
CONTACT 2: PHONE.
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.
Fire Marshal Steve Smith, Deputy Fire Marshal Mike Palmer
Phone 761-8205, FAX 745-4437
Commercial Final Inspection Report
Office No.: (518)761-8256 Date Inspection re• es r ce. ed:
Queensbury Building&Code Enforcement Arrive: a p Depart:
742 Bay Road,Queensbury,NY 12804 Inspector's Initia s•
NAME: CA ► Ro C'R.Pk-C\-1C FF 1 C[—PERMIT# Z.
LOCATION: 7,'�j�� j���� DATE: —
COM S:
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish Grade Complete 6"in 10' or Equivalent
Interior/Exterior Guardrails 42 in. Platform/Decks
Interior/Exterior Ballisters 4 in. Spacing Platform/Decks
Stair Handrail 34 in.—38 in./Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq. ft.
All Doors 36 in.w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36(w)x 44"(1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft. or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 ''A doors
> 10%> 1000 sq. ft.
3/4 Hour Corridor Doors&Closers
Firewalls/Fire Separation, 2 Hour, 3 Hour Complete/Fire
Dampers/Fire Doors
Ceiling Fire Stopping, 3,000 sq. ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan, if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters, 34 in., Checkout 36"
Handicapped Ramp/Handrails Continuous/12 in.Beyond
Active Listenint S stem and Sit a•e Assembl S•ace
Final Electrical
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway
Water Fountain or Cooler
Building Access All Sides by 20' /Driveable Surface 20' wide
Okay To Issue Temp. or Permanent C/O
Okay To Issue C/C
Last printed 6/3/2003 9:27 AML:\PamW\Building 8s Codes\Commercial Final Inspection Report.doc
Aft. 1
aix„or Town of Queensbury -
Fire Marshal's Office
(
742 Bay Road -% k r..... i
),
- I Ce..,_ ,
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518)745-4437
f I
Fire Marshal's Inspection Report
t )
Request ,
Received: Permit# 6\; 1 1 5 0 SCHEDULE
INSPECTION ON: - i C)
i
Name: k t'L,P (U Pri (tn 0 0 s6 ____• Al2) PM ANYTIME
' _
Location: f e-
N
APPROVED
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE \ i
EXIT DISCHARGE .
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL
EXIT SIGN,BATTERY
EMERGENCY UGHTING
FIRE EXTINGUISHER HUNG N,
- FIRE EXTINGUISHER
INSPECTION
.,..\
- ' 1 ' L'Jt
FIRE EXTINGUISHER HYDRO \ i
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN '{
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS
ISLAND _ N
HOOD INSTALLATION A
--- ...) A-x•-,:4,, i,1 . 1\, , ,
INTERIOR FINISHES 'N. - Lo -.--.
( r -
STORAGE V
COMPRESSED GAS \ _14- ‘-‘
CLEARANCE TO SPRINKLERS V
CLEARANCE TO ELECTRICAL X
ELECTRIC WIRING ENCLOSED )C
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION
FIRE LANE - C keSC DC
F.D.SIGNAGE-UTILITY ROOMS 0 A-
0 ri hcr,- .
NO SMOKING SIGNS s ; --)S --I .( -() 5..do S, I(-36
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN X F\ 1143 1.1"47
e %
\ e,51' 6
V' '
OK THIS DATE OK FOR CO , NOT OK
\ N
INSPECTED BY
COMDEV/CHFUSJ/WORDILETTERS2001/FIREMARSHAUNSPECTIONREPORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
SSS-
c2.1 p
Commercial Final Inspection Report l
Office No.: (518) 761-8256 Date Inspection re•4 est r- -4: c,/' G s f'
Queensbury Building&Code Enforcement Arrive: • p Depart: 1,1\ am/pa-
742 Bay Road, Queensbury,NY 1 804 Inspector's Initia .
Q rY -
NAME: 'Oki L cJ C e-. PERMIT ••
LOCATION: F2fy DATE:
(„ L K__ COMMEN S:
Y N NA
Chimney/"B"Vent I Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish Grade Complete 6"in 10' or Equivalent
Interior/Exterior Guardrails 42 in. Platform/Decks
Interior/Exterior Ballisters 4 in. Spacing Platform/Decks
Stair Handrail 34 in.-38 in./Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq. ft.
All Doors 36 in.wlLever Handles/Panic Hardware, if required
Exits At Grade Or Platform 36 (w)x 44"(1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft. or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace,Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/z doors
> 10%> 1000 sq.ft.
3/4 Hour Corridor Doors&Closers
Firewalls/Fire Separation, 2 Hour, 3 Hour Complete/Fire
Dampers/Fire Doors
Ceiling Fire Stopping, 3,000 sq. ft. Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
Handicapped Bath/Parking Lot Signage /
Public Toilet Room Handicapped Accessible J
Handicapped Service Counters, 34 in., Checkout 36"
Handicapped Ramp/Handrails Continuous/12 in.Beyond
Active Listening System and Signage Assembly Space
Final Electrical
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway
Water Fountain or Cooler
Building Access All Sides by 20' /Driveable Surface 20'wide
Okay To Issue Temp. or Permanent C/O
Okay To Issue C/C
Last printed 6/3/2003 9:27 AML:\PamW\Building&Codes\Commercial Final Inspection Report.doc
)
Town of Queensbury
.-- Fire Marshal's Office
.... 742 Bay Road 36)
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518)745-4437
Fire Marshal's Inspection Report
t )
Request SCHEDULE
Received: Permit# L)' --LS CI INSPECTION ON: (i' )
Name: tin / ,,,) ' 4k ,-, \ k, 6 il 0 c---) AM PM 'ANYTIME
Location:
( )
APPROVED
-N/A YES NO COMMENTS
EXIT ACCESS \K
EXPT ENCLOSURE \
EXIT DISCHARGE \
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL
- - EXIT SIGN-BATTERY \
EMERGENCY LIMITING FIRE EXTINGUISHER HUNG N.
FIRE EXTINGUISHER
INSPECTION
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN N,It
FIRE SPRINKLER SYSTEM \
FIRE SUPPRESSION-KITCHEN \
FIRE SUPPRESSION-GAS
ISLAND
HOOD INSTALLATION \
INTERIOR FINISHES s<
STORAGE
COMPRESSED GAS
CLEARANCE TO SPRINKLERS
CLEARANCE TO ELECTRICAL
NS
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE '1(
VEHICLE IMPACT PROTECTION
FIRE LANE x
F.D.SIGNAGE-UTILITY ROOMS
NO SMOKING SIGNS ss
MAXIMUM OCCUPANCY SIGN X „
EMERGENCY EVAC PLAN \ LN
-
r ,
—Li i te
OK THIS DATE OK FOR CO NOT 019
,------
‘ Of
‘ '
- 'INSPECTED BY
COMDEWCHRISJ/WORMETTERS2001/FIREMARSHALINSPECTIONREPORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
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J
J
Town of Queensbury
'MibitS Fire Marshal's Office C.-
0 /
742 Bay Road j'� jP•
Queensbury, NY 12804 p
Phone (518) 761-8205 Fax(518) 745-4437
t
Fire Marshal's Inspection Report
Request ` J
(r SCHEDULE _ �,
Received: Permit# ®' 1 INSPECTION ON: Q P, cS
Name: O1\)t (kg($1 Ch( no 9.- PM ANYTIME
47
Location: 'SI rPo t I
_APPROVED
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE (7 156'17
rQJ 5 ( I i
EXIT DISCHARGE 6 <1.Pc( t�\
MAIN AISLE WIDTH q�Jt�m bcI( c71ti�T
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL
EXIT SIGN-BATTERY V b (YN
EMERGENCY LIGHTING
FIRE EXTINGUISHER HUNG )1/4/
FIRE EXTINGUISHER
INSPECTION D. n tPct,LA. c>-3
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM (� ��
FIRE ALARM -FAN SHUTDOWN �'
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS
ISLAND
HOOD INSTALLATION 3 (04Noictl. 5vvok6c,,,,,,,touvov-z-c-r-
INTERIOR FINISHES X(
STORAGE )(
COMPRESSED GAS t Ot rr
CLEARANCE TO SPRINKLERS N(
CLEARANCE TO ELECTRICAL )(
ELECTRIC WIRING ENCLOSED X
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION D C
FIRE LANE n� `(\� rt h 4<,,, 1` L
F.D.SIGNAGE-UTILITY ROOMS v {�
NO SMOKING SIGNS 3 CJ"'t ` p 5`' . i
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN X ?i\ -7613 - to 4 3
I
,, �� OK THIS DATE O FOR CO NOT OK
(�\lug z4,, 50
INSPECTED BY
COMDEV/C HRISJ/WORDILETTERS2001/FIREMARSHALINSPECTIONREPORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
k itar Town of Queensbury i S
Itryf Fire Marshal's Office
742 Bay Road 3 )
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspection Report
Request SCHEDULE
Received: Permit# S�" LI-3 INSPECTION ON' - o
11v
Name: (Pn O v ►c }- C h CZ AM ANYTIME
Location: f7g� Tel-)
_APPROVED_
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE
EXIT DISCHARGE X
MAIN AISLE WIDTH M
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL 1(
EXIT SIGN-BATTERY
EMERGENCY UGHTING
FIRE EXTINGUISHER HUNG �c
FIRE EXTINGUISHER
INSPECTION
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM 1�
FIRE ALARM -FAN SHUTDOWN 'a(
FIRE SPRINKLER SYSTEM +{
FIRE SUPPRESSION-KITCHEN k
FIRE SUPPRESSION-GAS
ISLAND �1
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE
COMPRESSED GAS
CLEARANCE TO SPRINKLERS
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION )(
FIRE LANE �(J
F.D.SIGNAGE-UTILITY ROOMS X
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN —� \ X
c0\cttuk c oK- ec cwv-
OK THIS DATE 0 FOR CO •T
tu(
CTED BY
COMDEV/CHRISJ/WORD/LETTERS2001/F IREMARSHALINSPECTIONRE PORT 11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
Framing / Firestopping Inspection e o IlY1)
Office No. (518) 761-8256 Date Inspection -quest re.- d:
Queensbury Building&Code Enforcement Arrive: am/prs �� -part: IrJ
742 Bay Road, Queensbury, NY 12804 Inspector's Initi.1 • , A
NAME: I---)1\15-japr
'r CAC` Ca O PERMIT#:
LOCATION: � INSPECT ON:
TYPE OF STRUCTURE:
Y N N/A COMMENTS
raming
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more
Headroom 6 ft. 8 in.
Notches/Holes/Bearing Walls
Metal Strapping for Notches Top Plate
1 1/2 (w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft. or less on center
Ice and snow shield 24 inches from wall ,
Fire separation 1, 2, 3 hour
Fire wall 2, 3, 4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side 1/2 inch or 5/8 inch Type X
Garage side 5/8 inch Type X
Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W)
5.7 sf above /below grade
5.0 sf grade
L:\SueHemingway\Building.Codes.Inspection.FORMS\Framing Firestopping Inspection Report.doc January 28,2003
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection re•• d:
Queensbury Building&Code Enforcement Arrive: a Depart: Mir
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials.
NAME: OC_�\C- PIT#:
LOCATION: "_�j `';flC7INVECT ON:
TYPE OF STRUCTURE: C;"E Q t;
Comments
Y N N/A
Footings
•
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place A
Foundation Dampproofing
Foundation/Waterproofing
Type of Dampproofing/Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil of for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\SueHemingway\Building.Codes,Inspcction.FORMS\Foundation Inspection Report.doc January 28,2003