2005-796 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
42 Community Development- Building &Codes (518) 761-8256
CERTIFICATE (317'r" OCCUPANCY
Permit Number. P20050796 Date Issued: Monday, January 30, 2006
This is to certify that work requested to be done as shown by Permit Number P20050796
has been completed.
Tax Map Number. 523400-302-006-0001-051-000-0000
Location: 756 GLEN St
Owner. THE HOWARD GROUP
Applicant: PAPA GINO'S/D'ANELOS SUB
This structure maybe 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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050796 Application Number: A20050796
Tax Map No: 523400-302-006-0001-051-000-0000
Permission is hereby granted to: PAPA GTNO'S/D'ANF,T.OS ST 1R
For property located at: 756 GLEN St
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: THE HOWARD GROUP
401 NEW I<:ARNER Rd Commercial Alteration $135,000.00
ALBANY, NY 12205-0000 Total Value $135,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-796 PAPA GINO'S/D'ANGELOS SUB
3000 SQ FT COMMERCIAL INTERIOR ALTERATION
$360.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, October 24, 2006
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queenshury before the expiration date.)
Dated at the T Queen ury; o day, October 24, 2005
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
Permit No. , C J
Building & Codes Office-Department of Community Development-Tovm of Queensbury Fee Paid0�
742 Bay Road, Queensbury, NY 12804 Recreation Fee i_I-e.
Dave Hatin,Director codes ueensbury.net
Phone: (5181 761-8256 FAX: (5181 745-4437
Principal Structure Building Permit Application
Application & Plans subiect to review before issuance of a valid permit for construction.
instructions: A permit must be obtained before beginning construction. No inspections will be made until the
applicant has received a valid building permit. All applicants' spaces on this application must be completed and
must appear on the application form.
Kevin Strainer
Applicant/Builder S & S Construction Co. , Inc. Owner. Thomas & Jeremiah Burke
Address: 303 Spraquetown Rd Address: 509 Rt 67
Greenwich NY 12834 Malta, NY 12020
Home Phone: 518-692-2221 Home Phone: Office: 899-4231
Email Address: Email Address:
Cell Phone: 518-365-3601 Cell Phone: Tom: 281-722
FAX Phone: 692-2369 SAX Phone: 899-5622
Person responsible for supervision of work with respect to building and codes compliance:
Name: Kevin Strainer 692-2221 o.
Address: 299 Spraquetown Rd, Greenwich, NY 12834 Phone 365-3601 c.
Location of proposed construction: Lot No, Legal Address: 756 Glen Street
Tax Map Number: 302.6-1-51 Subdivision Name: Queensbury Plaza
Estimated Cost of Construction: $ 135,000.00 ,-
Proposed construction is for: _Residential,Use XX Commercial Use
Name of Business: Papa Gino's / O'Angelos Sub
If proposed construction is an addition, what will use o` new addition be?
New Addition Alteration Proposed Construction 1,+Floor 21d floor Other Total Proposed j
structure (Occupancy Type) Sq, Ft. sq,ft, Sq. Ft. Square feet Height
Ft, &In.
Singie-Family Dwelling
Two-Family Dwelling
Townhouse
Multlfamlly Dwelling
Number of Units:
Office
Mercantile
Manufacturing
Other: Restaurant
Attached Garage 1, 2, 3
type of Heating System: Electric, Oil, Gas, ood, Forced Hot Air, Baseboard, Other:
is a fireplace and/or woodstove being installed, please refer to a separate application. — Yes X No
Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review.
The Building and Codes Office will allow commencement of your proposed project only after
issuance of your permit.
Declaration; Please sign below after you have carefully read the statement:
To the best of my knowledge, the statements contained in the 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 Codes, 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.
'urther, 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 and Codes, an As-Built Survey by a
licensed surveyor, drawn to scale, showing actual location of all new construction,
Date: _ 10/5/05 Applicant/Builder Signature: /
The application of dated is hereby approved and
permission granted for the construction, reconstruction or alteration of a building/and or accessory structure 05 set
forth above.
Date: Authorized Signature:
\Sue Hemingway\Buiiding,Permit.FORMS\Principal Structure Permit Application.doc V:12/14/04
01/30/2006 14:55 15187927497 STAPELS PAGE 01/01
Town of Queensbury
Fire M&rshaFs Office
EMERGENCY CONTACT UPDATE
Lms 2000
TO: WARREN COUNT''SH;EREFF°S DEPT. FAX: 761-6210
'PLEASE PRINT
DATE: I 3 0 T-%
BUSINESS NAME: (a ll �t�17 s � � �v' -2 a
BUSINESS ADDRESS:` C/ �,•• .. Q''ar,._-��� !/ 1l
r
BUSINESS PHONE: ZU —�a,C:7 .�
f ,Q HOME -7 6 -- L16
CONTACT 1: `� i ,�.�.1. !i Cl'C PRONE
TOWN RESPONDING FROM.:
PP IIOME sly ^- I �, �70 4 "/S
CONTACT 2. PHONE
TOWN RESPONDING FROM: Jco�et
HOME
CONTACT 3: 6r PIiONF, ���''3��A
TOWN RESPONDING FROIK.: l��` -✓- ,
Fire Marshal Steve Sinith, Deputy Fire.Marshal Mike Palmer
Phoney 76I-8205,FAX 745-4487
Inspection for Permit to Occupy
Fire Marshals Office Request Rec'd Permit No.
Town of QueensburyO '(
742 Bay Road I /go/o(QQueensbury,NY 12804 Scheduled Inspection Date: JT , Time.
Phone: (518) 761-8206 Business Name:
Fax: (518) 745-4437 Location: -
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal
Sign-batte
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydro extinguisher
FIRE ALARM SYSTEM '
Fan Shutdown
Fire Sprinkler System
Fire Suppression-kitchen
Fire Suppression-Gas Island
Hood Installation
Interior Finishes
Stora e
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical
Electric Wiring Enclosed
Combustible Waste
Vehicle Impact Protection
Fire Lane
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Si n
Emergency Evacuation Plan
4—
.,W�Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
❑ Denied
❑ Call for Recheck
Inspected
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. D,5-7
Town of Queensbury
Bay Road Qu ' Z7%
Queensbury,NY 12804 Scheduled Inspection Date:A ,,,
Time:
Phone: (518) 761-8206 Business Name:
Fax: (518) 745-4437 Location:
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Second Aisle Width
EXIT SIGNAGE
Sign-normal
Sign-batte
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydra extinguisher
FIRE ALARM SYSTEM
Fan Shutdown k /I
Fire Sprinkler System
Fire Suppression-kitchen
Fire Suppression-Gas Island �/ �` S✓- /
Hood Installation
Interior Finishes
Storage
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical
Electric Wirinq Enclosed
Combustible Waste
Vehicle Impact Protection
Fire Lane
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
o Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
o Denied
o Call for Recheck
Inspected (vy:?
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No./T-
Town of Queensbury
Bay Road t fL1
Qu ?�
Queensbury,NY 12804 Scheduled Inspection Date: Time: ` 9�
Phone: (518) 761-8206 Business Name: 1
Fax: (518) 745-4437 Location: - �
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal
Sign-battery 1 (1lfi? A '
TRUSS ID SIGNAGES
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydra extinguisher
FIRE ALARM SYSTEM LCr 1v t f i111I��
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
Fire Lane
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
o Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
�enied
o C r .,
all for Recheck (:::A
Inspected By.
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd �� �- ! 7C
Permit No. ( '
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Dated / l ``�`� Time:
Phone: (518) 761-8206 Business Na e;
Fax: (518) 745-4437 Location: L_'
Type of Inspection N/A Yes No
EXITS: Via'
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal 4 .7 t6,� <e
Sign-battery ,
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun f-- j2q)4*`f
Inspection of extinguisher
Hydro extinguisher
FIRE ALARM SYSTEM ly �►+s'VT � `T5 AFL �/� ` l
Fan Shutdown
Fire Sprinkler System X 3 �1(� Lt u Ze, `
Fire Suppression-kitchen / Z �flol CL ,i,^ t;-4) s't
Fire Suppression-Gas Island I
Hood Installation IT L4006c, Iitt, 4 oo I/p �� t(,(/�",/A;�,
Interior Finishes L
Stora e /Compressed Gas fir' c �1 G C�Y1G'� -4v �� (.,t r„
Clearance to Sprinklers elw
Clearance to Electrical �-%� Cz�2 I �f -
Electric Wiring Enclosedui � � Gx� ri7�=-c tC1� jy �Cj �
Combustible Waste
Vehicle Impact Protection
Fire Lane
F.D.Si na e-UtilityRoomsi1 �t 1 61 b y I vq S �lt
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
❑ Approved (If no other approvals apply,the B&C Office vvill issue the Certificate of Occupancy)
.Denied
❑ Call for Recheck
Inspected y:
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc
Commercial Final Inspection Report
14
Office No.: (518)761-8256 Date Ins ction c i ed: % `�Lt
Queensbury Building&Code Enforcement Arrive: t Depart: an
742 Bay Road,Queensbury,NY 12804 Inspector's Init
NAME: r2 >
PERMIT f f
LOCATION: ,i l DATE:4 fez ,
r
COMMENTS:
Y N NA t
Chimney/"B"Vent/Direct Vent Location r
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 s . ft.
All Doors 36 in.w/Lever Handles/Panic Hardware,if re uired
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 Oka
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum t-\O UJt ` E'
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 s . ft.
3/4 Hour Corridor Doors&Closers
Firewalls/Fire Separation,2 Hour, 3 Hour Complete/Fire
Dampers/Fire Doors
Ceiling Fire Stoppii , 3,000 s . 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 Si a e/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
Handicapped Bath/Parking Lot Si na e
Public Toilet Room Handicapped Accessible
Handicapped Service Counters, 34 in., Checkout 36"
Handicapped Ram /Handrails Continuous/12 in.Beyond
Active Listening System and Signage Assembly Space _
Final Electrical �L� ��-
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req. L I.�b U
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 26
Okay To Issue Temp. or Permanent C/O
OkayTo Issue C/C
LLL
a
att printed 6/3/2003 9:27 AML:\PamW\Building&Codes\Commercial Final Inspection Report.doc
Framing / Firestopping Inspection Report
Office No.(S i 8)761-8256 Date Inspection r st r e ed
Queensbury Building&Code Enforcement Arrive: , m e rt: ' a
742 Bay Road,Queensbury,NY 12804 Inspector's Im i s:
NAME: - PERMIT#: — 15.E
LOCATION: h INSPECT ON: -►p--c'�C
TYPE OF STRUCTURE:
Y N N/A COMMENTS
Framing
Attic Access 22"x 30"minimum
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 '/z(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 water 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 %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
Rough Plumbing / Insulation Inspection Repo
r
Office No. (518) 761-8256 Date Inspection reque re i d: ` All )S
Queensbury Building & Code Enforcement Arrive: /p part: am/ m
742 Bay Road, Queensbury, NY 12804 Inspector's Ini alss
r
NAME: /-VA G) 0 S PE IT #:
LOCATION: - 1 �.t S IN ECT ON:
TYPE OF STRUCTURE:
Y /A
"'Rough Plumbing Nail Plates
Plumbing Vent / Vents in Place
1 1/2 inch minimum Drain Size
Washing Machine Drain 2 inch minimum
Cleanout every 100 feet/ change of direction
Pressure Test
DrainPr
Air
5 S0 ft. above highest connection for 15 minutes
Pressure Test
Water up I iping
Air/ ea
50 P. . for 15 minutes
Insulation / Residential Check / Commercial Check
Proper Vent Attic Vent
Duct / Hot Water Piping Insulation
If required unheated spaces
Combustion Air Supply for Furnace
Duct work sealed properly/ No duct toe
J
C MMENTS:
Q
LAPam Whiting\Building&Codes\Inspection Forms\Rough Plumbing Insulation Report.revised Nov 17 2003.doc Revised February 15,2005
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection Wq-u-'e'sle
Queensbury Building&Code Enforcement Arrive: am/ Depart: e!.,rp
742 Bay Rd., Queensbury,NY 12804 Inspector's
' O
NAME: _ G �. PERMIT#:
LOCATION: � _ INSPECT ON:
TYPE OF STRUCTURE:
Comments
Y N N/A P
Footings
----- _ -------— 1 � �
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
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 roval _
ng Under SIab
PV Vast opper
oundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
LASucHemingway\Building.Codes.Inspecti on.FORM SV'oundation Inspection Report.doe January 28.2003
I - ,-3
Foundation Inspection Report
l
Office No. (518} 761-8256 Date Inspection request received: t t 4' _
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: _
a
os
NAME: _ pj�-p E' IT#: __
`7
LOCATION: C� _ INSPECT ON: .---
TYPE OF STRUCTURE:
( iN
Comments
Y N N/A
Footings -------------______.T_�_
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
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 poly for wet areas under slab
Backfill Approval
umbing Under Sla
_ -7�
VC st/Copper
ndation Insulation Interior/Exterior
Rough Grade 6 inch drop within 10 ft.
LASueHemingway\Building.Codes.Inspection.FORM S\Foundation Inspection Report.doc .January 28,2003
Z TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY, 12804-5902
Memorandum
To Dave Ha1in, File 2005-796
From: MJ Palmer, Fire Marshal
Date: Oct. 13th,2005
Re: Papa Gino's
T have reviewed the submittals of, and have the following comments:
1)Provide NFPA 13 compliant letter for sprinkler modifications
2)Provide detailed drawings of the manual and automatic fire alarm system
3)HVAC shutdown required
Respectfully,
Michael r Palmer
Fire Marshal
Michael J Palmer, Fire Marshal
742 Bay Road
Queensbury, NY 12804
518.761.8206- frremarshal@queensbury.net
4E L TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Memorandum
To: Dave Hahn, Fie 2005-796
From: MJ Palmer, Fire Marshal
Date: Oct. 21 st,2005
Re: Papa Gino's
Plan review of fire alarm system indicates the following:
1) Fire alarm system appliances ok
Fire alarm system must be monitored
3) Complete test reports and system function witness required before CO is issued.
Respectfully,
Michael J Palmer
Fire Marshal
Michael J Palmer,Fire Marshal
742 Bay Road
Queensbury, NY 12804
518.761.8206- firemarshal@queensbury.net
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5902 518-761-8201
Kevin ner October 13, 2005
S & S Construction., Inc
303 Spraguetown Rd.
Greenwich, N. Y. 12834
Dear Kevin,
The following items need to be provided to this office in order to issue a building permit
for the PaPa Gino's renovations:
The rear exit door must be handicapped accessible with a canopy provided over
the door.
2' The food service counter and beverage counter must be handicapped accessible at
34" above finished floor. /V l 7)
We need a fire alarm system layout including all detection and audible/visual
devices including fan shutdown for the HVAC units.
We need 2 sets of revised plans when changes are made.
Once we receive the revisions and they are approved a building permit will be issued.
Thank you for your attention to these matters.
�ee�ely�
David Han
"HOME OF NATURAL BEAUTY . . . A GOOD PLACE TO LIVE"
SETTLED 1763
01-30-2006 08:01 FCSI 5187472518 PACE1
FIRE CONTROL SYSTEMS INC.
104 REYNOLDS RD., kORr EDWARD,NY 12828 P(518) 747-2567 FAX 747-2518
www.firecontrolsystemsine.com email: info(q-),firecontrolsystemsinc.com
�q�R,
TOWN OF �rr k f
ZONING
1/29/2006
Mr. Mike Palmer
Town of Queensbury
742 Bay Rd.
Queensbury,NY 12804
Re: Papa Gino's
Queensbury Plaza
7.50 Upper Glen St.
Queensbury,NY 12804
Dear Mike:
The alterations of the fire sprinkler system that we made 110r the store, at the location above,to the
best of my knowledge conform to the NFPA 13 standard. If you require anything further please give
me a call.
Sincerely,
Richard E. Boucher
Sec-Treasurer
01/25/2006 14:58 5187988305 FORESIGHT ELECTRONIC PAGE 01
Foresight Electronic Monitoring Systems, Inc.
25 Connecticut Ave.
Queensbury, NY 12804
ECF—t\/E
ATTEN: Fire Marshall
JAN 25 2006
SUBJ. Inspections U� uutt-Nz5boRY
�pWN
gD{LD1NC AND CODE
The attached inspections were completed this month.
745-4437
91/9 "/wo
,v on) 0150AW /
COVER&
SIGN:
i RE EQUIPMENT Pre-Engineered System Inspection Report
-- - Ftn[PC1J1Gi:t#SN+JY'�ii11ELi'u'.(
1654 RIVERDALE STREET Date of Service: o: Time: PM
WEST SPRINGFIELD, MA 01089
413-732-4590 877-238-2792 Annual / Semi-Annual/ Recharge,41nstallation tRenovation (circle one)
Customer/Location System Information
Name: Z)A„rYUo.s �, , ,� :r.l4s Make: f, .vsj!
Address: 754 aAkdrr�� sr` Model
City, ST, Zip: v r- /-,XY Size:
Phone: Sd -7cf 3 _�o qs Control Head:
Owner/Manager: 7ew Location of system:
Yes No N/A Yes No N/A
1 System interlocked with building fire alarm. 14 Checked operation of manual release.
2 All tamper seals intact.No evidence of tampering. �' 15 Checked operation of microswitch. k
3 All appliances properly covered w/correct nozzles. ,/( 16 Checked operation of gas valve. ulECHj)ELEC.)
4 Duct(s)&plenum properly covered w/correct nozzles. X 17 Piping/conduit securely bracketed.
5 Hood/duct penetrations properly sealed. I k 18 Nozzles cleaned.
6 Grease accumulation: _excessive _heavy -knormal 19 Proper nozzle caps/covers in place. Qty.
7 Pressure gauge in acceptable range. 20 Exhaust fan in operating condition.
8 Checked cartridge weight. 21 System operational&armed. "
9 Cylinder within hydrotest date. Due: �O/7 �$� 22 Fan warning sign on hood. X
10 Inspected cylinder&mount. X 23 K-Class fire extinguisher in cooking area.
11 Checked operation of detection line. 24 Personnel instructed on manual operation of system. }�
12 #of Fusible links: 360° 450° _500° other(—O) 25 Service&certification tag on system. X
13 Replaced fusible links. X 1 1 71 26 System meets U.L.300 standards.
Cooking Appliances(left to right): ��,`/,>� e
Safety Notice: Non-compliant systems may fail to extinguish/supress a fire.Below are non compliant conditions which require immediate attention.All State Fire
Equipment assumes no responsibility for system performance if these conditions are not corrected and/or verified by an authorized agent of All State Fire Equipment.
Comments/ Non-Compliance: �I �(C) n W t- 4ct
All State Fire Equipment Agent- ' — s% ' ' Date:
Customer's Authorized Agent: Date:
MA-CR 4059 CT-F3-40258 VT-T2-406
�Frii Customer Acknowledgement and UL-300 Safety Alert on reverse Pro `
01/17/2006 15:55 5187988305 FORESIGHT ELECTRONIC PAGE 02
Certificate of Inspection
Foresight Electronic Monitoring Systems, Inc.
25 Connecticut Avenue, Queensbury, NY 12804
2 t3Name: j. jf' �r//(JEJ ' �i` •tl«�Ci
Address • "A),,l ���'l" .C) SA Y//���..�' D 'j�' L�✓"/�
City: �f ��� . -��/ State:
Fire Alarm Inspection Date: •i ,�� / •,ZG��>
J
DESCRIPTION: Inspection of Fire Alarm devices as designated
below.
Panel Model:
QTY Correct/Incorrect
Battery
City Connect
Digital Communicator
Door Release
Smoke Hatch Release _
Elevator Recall
Fan Shutdown
Pull Stations -?
Smoke Detectors -�-
Duct Smoke Detectors
—
Rate of Rise Thermostats
Fixed Temperature Thermostats
r
Audible/Visual devices � .
Flow or pressure devices
time delay
Tamper Switches
Other
Signature of Inspector:
Comments: -:�4 14 1 2L-I-2
signature of Customer Rep:
Foresight Electronic Monitoring Systems, n 5. is duly licensed by
the State of New York_ NYS License number 12000076730
15'HOOD WITH 212'7f12"DUCT
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TABLE TABLE 2 FRYER PASTA
6'x 24"GRIDDLE 14"X 24" COOKER
NOTE: THE SYSTEM WILL MEET UL 300,NFPA 17A,AND MANUFACTURERS SPEC.THERE WILL BE A MANUAL PULL IN THE PATH OF EGRESS
AT 48".THE FUEL VNLL SHUTDOWN ON SYSTEM DISCHARGE.THE SYSTEM WILL ACTUATE THE ALARM IF AVAILABLE (BY OTHERS)
ALLSTATE FIRE EQUIPMENT INC DANGELOSI PAPA GINO$ ANSUL SYSTEM DETAIL 1H c1 FLOW
50 EAST GOOSEBERRY ROAD 756 UPPER GLEN ST R-102 6 GALLON 22 FLOW 219 c 2 FLOW
WEST SPRING FIELD,MA 01089 QU E E N S B U RY, NY MAXIMUM 230 c 2 FLOW
413-732.4590 VT T2-406 1F c 1 FLOW
MAC R 4059 CT F3-40258 DRAWN BY MB NOT TO SCALE 20 c 2 FLOW
MAXIMUM
OCCUPANCY
117 PEOPLE
Occupancy of this space by more than
117 people is illegal and unsafe.
By Order of theQueensbury
Fire Marshal' s Office
Michael J Palmer,Fire Marshal
Gary K. Stillman,Deputy Fire Marshal
Papa Gina's- 2/7/2006
KNOX BOX KEY LIST
X MAIN DOOR ACCESS KEY
X FIRE ALARM PANEL KEY
SPRINKLER ROOM KEY
SPRINKLER LOCK KEY
ELEVATOR MACHINE ROOM KEY
X FIRE ALARM PULL STATION KEY
X FIRE ALARM DUCT DETECTOR KEY
ROOF HATCH LOCK KEY
X FIRE ALARM ROOM KEY
SECURITY GATE KEY
ELEVATOR FIREFIGHTER KEYS
ROOM MASTER KEY (HOTELS)
MASTER LOCKSET KEY
Prepared for Papa Ginos /DeAngelos
Queensbury Plaza