2004-312 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040312 Application Number: A20040312
Tax Map No: 523400-295-008-0001-002-000-0000
Permission is hereby granted to: F,T 1,TF,'S C;AFF,
For property located at: 1161 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: MITCHELL A COHEN
PO BOX 21 Commercial Alteration $6,000.00
Total Value $6,000.00
LAKE GEORGE,NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-312
COMMERCIAL ALTERATION
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 28, 2005
(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 TopmAZff Queen ury; ,Fri ay, May 28, 2004
SIGNED BY �AJ2 for the Town of Queensbury.
Director of Building Cod nforcement
Building Permit Application
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. — o�
No inspection will be made until applicant has received a Fee Paid
valid building permit. All applicants' spaces on this Rec.Fee Paid $
application must be completed and must appear on the Reviewed By:
application form.
Applicant: M I ���� � ,, Owner: d) A 4-. !a C
Address: 141 2 G, Address:
QJ4-,c-.%-, 1i ,c - "1-1 i° `-L V f.u2G F
Phone#(s._-Y) 7TY IT iY Phone#
Property Location: Lot Number: / House Number 11&( l S
Subdivision Name: Tax Map Number: V S,
o New Building: residence /commercial Estimated Market Value of Construction: (900
o Addition: residence/ commercial if an Addition,what will use of new addition be?
2 Alteration: residence/ commere
o No change to exterior size: residence/com'l ff
v Other work(describe ) e '1 I e—S
Check OccupancyInformation lotFloor 2° Floor Other flo r Total
Below sq.ft. sq.ft. sq.ft. Square Feet
v Sin a family dwelling
o Two fitmfly dwelling
a Townhouse
o Multifamily dwelling
#of units
o Office
Mercantile k,11L4 rJ k
o Manufactutin
0 1 car detached garage
13 2 car detached garage
0 3 ear detached garage
0 1 car attached garage
c 2 oar attached garage ED F= 'AZA V e
a 3 car attached garage
c Storage building- Iv1 a 1 1
commercial
o Storage building- f OWN OF 0 �® ODE
residential 1 jt4G _
o Other
What is the proposed height of the structure_feet inches
Will any second-hand or ungraded lumber be used? If so,for what?
Type of Heating System: electric/ oil / gas I wood /forced hot air/ baseboard I other:
Number of BmIaces to be installed Number of o stoves to be installed
List below the person(s)responsible for supervision of work as regards to building codes:
Name Address- Phone Number
Builder Me-, a 4^j
Plumber
Mason
Electrician
Declaration: p e e sign below after you have carefully read the statement:
To the best o my knowledge the statements contained in this application,together with the plans and specifications
submitted, a true and complete statement of all proposed work to be done on the described premises and that all
provisions o the Bun Code,the Zoning Ordinance and all other laws pertaining to the proposed work shall be complied
with,wheth specifi or oted,and that such work is authorized by the owner. Further,it is understood that Vwe shall
submit,prio to a cat of Occupancy or Certificate of Compliance being issued,as requested by the Zoning
Administrato or Dire r o uilding and Codes,an AButte Survey by a licensed surveyor;drawn to scale,showing actual
location of all ow
co ct<
Signature: owner,owner's agent,architect,contractor
Town of Queensbury
Fire Marshal's Office
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437 (e 1 l
Fire Marshal's Inspection Report
Request FINSPECTIONON:
L
Received: ermit#
� Q, I AM PM ANYTIME
Name• ��
Ito
Location: All
APPROVED
—_ N A YES NO COMMENTS
EXITS
AISLE WIDTHSAil
EXIT SIGNS-NORMAL_ " j�/ �T C. 1 t
- BATTERY
EMERGENCY LIGHTING
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM
FIRE SPRINKLER SYSTEM _ Ud 1 1r11k Cjt(OA1 5 `-1�'�
FIRE SUPPRESSION SYSTEM ` l'
HOOD INSTALLATION oAaT
INTERIOR FINISHES -� ,��(�ja.
STORAGE
- ___
COMPRESSED GAS -______
CLEARANCE TO SPRINKLERS l CA
CLEARANCE TO HEATING
UNITS
CLEARANCE'TO ELECTRidAL _ A', � n.� �!-y 1�����C'�'y f e
REQUIRED SIGNAGE
EMERGENCY PLAN
MAXIMUM OCCUPANCY SIGN '5.ab
CHIMNEY
MASONRY _ROUGH IN - n
FINAL
CHIMNEY
FACTORY BUILT ROUGH IN
WOOD
STOVE ROUGH IN
T(aw /
FINAL
VENTED GAS
APPLIANCE ROUGH IN
FINAL
FIREPLACE -t- --
MASONRY ROUGH IN OK THIS DATE OK 1+ � � T ®K
_ FINAL
FIREPLACE
FACTORY BUILT ROUGH IN IN INSPEC'1 B
_ FINAL -
COMDEV/CHRISJIWORDILETTERS2007/FIREMARSHALINSPECTIONREPOR 11022001
YELLOW-OCCUPANT COPY
WHITE-BUILDING DEPARTMENT COPY
Town of Queensbury
Fire Marshal's Office
f 742 Bay Roadl-
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspection Report
Request SCHEDULE C - �L
Received: Permit#_ '�� INSPECTION ON: {�
Nanrte: LLi �ry� l_i�' / AM PM ANYTIPrAE
Location: - 09-
APPROVED
- ----- - ----- N JA YES NO COMMENTS
EXITS - JJ
AISLE W1DTHs _ � �. L ((}1�� .�;� i �.
EXIT SIGNS-NORMAL
- BATTERY �yz!�/• /�
EMERGENCY LIGHTING X. G{ t"k
FIRE EXTINGUISHERS
FIRE ALARM SYSTEM / video
FIRE SPRINKLER SYSTEM _ L /r� Pd LCC� t7
FIRE SUPPRESSION SYSTEM
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE
COMPRESSED GAS-
CLEARANCE TO SPRINKLERS G'
CLEARANCE TO HEATINGUNI
],nn
CLEARANCE T®ELECTRICAL_ @ - ' 0,0 V�,1f
REQUIRED SIGNAGE
EMERGENCY PLAN
MAXIMUM OCCUPANCY SICal�1
CHIMNEY
'MASONRY _^ROiJGi•I IN
_ _FINALf
CHIMNEY
FACTORY BUILT - ROUGH IN `j'fN
, '� � L21'l�`�t �L{���� �
WOOD FINAL
STOVE _ _ ROUGHIN
FINAL
b" 1�
VENTED GAS
APPLIANCE _ROUGH IN _ (! 1 � L�✓ fit,
FINAL
FIREPLACE -�—
MASONRY ROUGH IN OK THIS DATE 0 FOR CO <!: NOT OK
FINAL _
FIREPLACE / t
FACTORY BUILT ROUGH IN SPEC
_ FINAL -
_ COMDEVICHRISJMORD/LETTERS2001lFIREMARSHALINSPECTIONREPOR 11022001
YELLOW-OCCUPANT COPY
WHITE-BUILDING DEPARTMENT COPY
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TOWN OF QUEENSBURY FIRE MARSHAL TOWN OF QUIEENSBURY
Based on our limited examination, FIRE NAB .��
compliance with our coamts shall OFFICE'
not be construed as indicating the REVIEWED BY
plans and specifications are In full DATE
compliance with the code. COMMENTS
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