2005-220 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: P20050220 Date Issued: Friday, May 27, 2005
This is to certify that work requested to be done as shown by Permit Number P20050220
has been completed.
Tax Map Number: 523400-303-016-0001-061-000-0000
Location: 438 DIX Ave #32391
Owner: MAPLEWOOD ICE CO., INC.
Applicant: A MIRROR'S IMAGE
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,
Variance, or other issues and conditions as a result of approvals by the Director of Building&C of ment
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: P20050220 Application Number: A20050220
Tax Map No: 523400-303-016-0001-061-000-0000
Permission is hereby granted to: A MIRROR'S IMAGE
For property located at: 438 DIX Ave 432391
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. Tyne of Construction Value
Owner Address: MAPLEWOOD ICE CO., INC.
#32391 Certificate of Occupancy(COM)
Total Value
PO BOX 62
WHITEHALL, NY 12887-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-220 A MIRROR'S IMAGE
CERTIFICATE OF OCCUPANCY
$0.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, May 06, 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 o uee ury, ri y, May 06, 2005
SIGNED BY 4for the Town of Queensbury.
Director of Building&Code Enforcement
• BP File# f—�—ocj
New B1.iS121E':SS
Dept.of Community Development Certiflca'te of
42Bof���' Occupancy Permit .
Queensbwy,IVY 12804
(518) 7614256
For occupancy only, with no work requiring buildingpermit. no fee required for this permit.
RECEl ve®
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Name of Business: b (^S TOWN OF QUFENSBURy
. ING AND CODE
Address: q Mo X
Person in Charge or Manager. I(Xi'1'1 sl �— JCY1P
Business Phone Numb4 Ito u
Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing store):
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Owner of Property: Q t� �-• �v. , �nC
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_ Address._
Phone Number.
Please provide an accurate layout of your store showing all walls,exits,stockrooms,rest rooms,
counters and fixture layout on a separate sheet ofpaper.
Signature: Date:
of sub 'g
Property Tajo Map No.
Notes/Comments:
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Town of Queensbury
Fire Marshal's Office
EMERGENCY CONTACT UPDATE
LTRS 2000
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE:
BUSINESS NAME: b/' l yY7�GP
BUSINESS ADDRESS: I i
BUSINESS PHONE: 7 �
—"—` HOME
CONTACT 1• 10-MnI PHONE► q � 9
ADDRESS: n
. � HOME
c l#-34 -3/7/
CONTACT 2:
._ PHONE L-90 -:
n -- - --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
Fire Marshal Steve Smith, Deputy Fire Marshal Mike Palmer
Phone 761-8205, FAX 745-4437
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Town of Queensbury
Fire Marshal's Office _
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspection Report -
Request SCHEDULE
Received: Permit# t INSPECTION ON: -
---- -�-- rt,--F
Name: '3 AM PM ANYTIME
Location:
APPROVED _
N fA YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE
EXIT DISCHARGE _
MAIN AISLE WIDTH i
SECONDARY AISLE WIDTH
EXIT SIGN NORMAL
EXIT SIGN-BATTERY
EMERGENCY LIGHTING
FIRE EXTINGUISHER HUNGy�
FIRE EXTINGUISHER
INSPECTION _ "_ � ' -�°-�- \J ` t
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS
7
ISLAND
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE
COMPRESSED GAS Y ,
CLEARANCE TO SPRINKLERS—
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION _.._ ..
FIRE LANE
F.D.SIGNAGE-UTILITY ROOMS I
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN
1
1
l I OK THIS DATE OK Ff
PR CO NOT OK
1 ( J
-' INSPECTED BY
COMDEVICHMSJM ORD/LETTERS2001/FIREMARSHALINSPECTIONREPORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
Town of Queensbury
Fire Marshal's Office
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspection Report
Request SCHEDULE
Received: Permit# O S a y INSPECTION ON: 0
�v
Name: M I R n0 f,S rAJMPM ANYTIME
Location:
J cr'
APPROVED
N/A YE NO COMMENTS
EXIT ACCESS c
EXIT ENCLOSURE J �L �'J :v� I
EXIT DISCHARGE r
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH _
EXIT SIGN-NORMAL
EXIT SIGN-BATTERY
EMERGENCY LIGHTING
FIRE EXTINGUISHER HUNG
FIRE EXTINGUISHER
INSPECTION '
FIRE EXTINGUISHER HYDROr -
FIRE ALARM SYSTEM v�
FIRE ALARM -FAN SHUTDOWN
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS
ISLAND
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE
COMPRESSED GAS
CLEARANCE TO SPRINKLERS
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE _ _
VEHICLE IMPACT PROTECTION K
FIRE LANE - -
F.D.SIGNAGE-UTILITY ROOMS
NO SMOKING SIGNS n
MAXIMUM OCCUPANCY SIGN_
EMERGENCY EVAC PLAN
OK THIS DATE O R CO T OK
orw
INSPECTED BY
COMDEV/CHRISJIWORD/LETTERS2001/FIREMARS HALT NSPECTIONRE PORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY