2005-947 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. P20050947 Date Issued: Monday, March 27, 2006
This is to certify that work requested to be done as shown by Permit Number P20050947
has been completed.
Tax Map Number. 523400-309-007-0001-014-000-0000
Location: 10 HOLDEN Ave
Owner. W& T ENTERPRISES, LLC
Applicant: CLARKE'S COMPLETE CARE
This structure maybe occupied as a:
Certificate of Occupancy(COM) By Order of Town Board
T WN OF QLgENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
P Y
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: P20050947 Application Number: A20050947
Tax Map No: 523400-309-007-0001-014-000-0000
Permission is hereby granted to: CLARKF'S C;OMWLETF, CARE
For property located at: 10 HOLDEN Ave
in the Town of Queensbury,to construct or place
at the above location in accordance with application together wide 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: W& T ENTERPRISES, LLC
10 HOLDEN Ave Certificate of Occupancy(CO1V)
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-947 CLARKE'S COMPLETE CARE
CERTIFICATE OF OCCUPANCY
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, January 09, 2007
(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
urZr77r
January , 2006
SIGNEDBY y the Town of Queensbury.
Director of Building&Code Enforcement
Sent By: Adirondack P&M, Inc; f1 518 793 4114; Dec-15-05 7:59AM; Page 3/3
BP File# S
Dept. of Community Development CGl' 10sx-t4e OAr
Town ofQueensbury QCCAxJall(3�p8�'riCllt
742 Bay Road
Queembury,NY 12804
(518) 761-8256
For occupancy only, with no work requiring building permit: no fee required for this permit.
Name of Business: C•��C `S ✓''}�'2 ,
Address: Ci ( Y\yv10����� �Ce-1 y `i �/-J- 1
Person in Charge or Manager. a`rC j eK�
Business Phone Number:
Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing store):
a--�K
Owner of Property: -T EAk&eo n
Address: y o X �;I DS I ei J1) /�'7_ Z
Phone Number: j 3
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters andfibdure layout on a separate sheet of paper.
Signature: Date:
of parson submitting this form,
7-- 1
Property Tax Map No.
Notes/Comments:
Sent By: Adirondack P&M, Inc; 1 518 793 4114; Dec-15-05 7:58AM; Page 1 /3
Town of Qu.eensbui.ry5F4 aw 7
Fire Marshal's Office
EMERGENCY CONTACT UPDATE
LMS 2000
TO: WARREN COUNTY'SHERIFF'S DEPT. FAN: 761-6210
_ PLEASE PRINT
DATE: a 5 0
BUSINESS NAME: T LbL
BUSINESS ADDRESS: Qa to y 56 a Fe, It) :tAl IOU
}BUSINESS PHONE: �l ���� n 3
11 f
5
CONTACT 1.. sus- 3
�r- 7l01-090k
I 1 �t.c,�Cs- PRONE sus- 361--3, 3 �f
TOWN RESPONDING FROM:
- 3 3
�e� ��-� kIOME 1
CONTACT 2• c. C _-- -PHO_TM 3 6 _ F
TOWN RESPONDING FRONT: C>
HOME
CONTACT 3: :-'S�ns PRONL �O��U 0
TOWN RESPONDING FROM: �� �
Fire Marshal Steve Smith, Deputy Fire Marshal Mike.Palmer
Phone 76I-8205, FAX 745-4487
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No.
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: J �� U v Time: yI
Phone: (518) 761-8206 Business Name: L n,� rs vni 1
Fax: (518) 745-4437 Location: i o 4-,(,9C-DS /
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
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher i
Hydro extinguisher
FIRE ALARM SYSTEM
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
<`°< Approved (If no other approvals apply,the B &C Office will issuLtherflificate of Occupancy)
o Denied
❑ Call for Recheck
Inspected By:\[-"\-�
L:\Sue Hemingway\Fire Marshals Office Inppection 08.1 7.2005.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No.
Town of Queensbury OG
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: 1 Time:
Phone: (518) 761-8206 Business Name:
Fax: (518) 745-4437 Location: 10 61 dlv--
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
TRUSS ID SIGNAGE t
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 3�
Storage
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical
Electric Wiring Enclosed
Combustible Waste
Vehicle Impact Protection X,
Fire Lane
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
❑ Approved (If no other approvals apply,the B&C Office will is e the Ce ficate Occupancy)
Denied
Call for Recheck
Inspected By: i
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc