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CO-0195-2022 i CERTIFICATE OF OCCUPANCY ONLY office Use Only 0--t. Permit#: C 0 APPLICATION Town of Queensbury � ��f""�- Permit Fee:$ 9 ar 0 742 Bay Road,Queensbury,NY 12804 L ice#: �f P:518-761-8206 or 518-761-8205 APR $www. uee s r e I a � °� This application is for occupa r ly��!ncy-owit.IZA fk equiring a building permit BUSINESS INFORMATION: Name of business: Business Address (including suite, space, etc.): 43-0 V`(/ Detailed explanation of business (attach a separate piece of paper, if necessary): * * *Please provide an accurate layout of your space_showing all walls, exits, stockrooms, rest -rooms, counters and fixtures on a separate sheet of paper* * * IMPORANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire extinguishers, fire sprinkler systems, and fire alarm systems require annual inspections by an-outside contractor and the corresponding documentation must be provided to the Town of Queensbury Fire Marshal's office. Fire extinguishing systems found in kitchens and gas stations require semi-annual inspections. Any violations.noted during an inspection require immediate corrective action and a re-inspection. Applicant name: "AL/ 9"",� Applicant signature: Date: ,4 / ? 7— Property Owner name: Property Owner signature: Date: d r— , Certificate of Occupancy Only Revised February 2022 Toim orCLuccnsbun 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.gueensbury.net CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Mar- (nti Mailing Address, C/S/Z: 6 6 �� �' r,��e;-►^-- �Gi� Cell Phone: h l . ) g��2 y L� . Land Line: Email: • Business Owlr(s): Contact Name(s): S-C�Vv­e-� Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: • Manager: Contact Name(s): Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: • Property Owner(s): Business Name: S J Contact Name(s): Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: Contact Perso for Compliance in regards to this project:_M '' IC Cell Phone: � 0'' 6�) I Land Line: Email: v'.te-")S bU -1-- Certificate of Occupancy Only Revised February 2022 � I 1 1 Town of Qrccnsbun 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 'www.gueensbury.net EMERGENCY CONTACT INFORMATION **THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND -AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN GAINING ENTRY TO YOUR BUILDING.** PLEASE BE ADVISED THAT FAILURE TO ASSIST-EMERGENCY SERVICE PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL. Date: Business Name: — .,dam S Jlo ie Business Location (including suite,space,etc:) f 14 Business Phone#: <92 e 6 <�l (. q e 1. -Business contact name: r,66f, h—A-k Main Phone:_( 1 l; ) 6 Jsl �L.G ;Secondary Phone:_( ) Coming from what town/village? �i✓��� S ����� 2. Business contact name:- Main Phone:_( 6 3 �4 2.. 6-71-7 ;Secondary Phone: Coming from what town/village? 'e-os kurq TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE P: 518-761-8206 F: 518-745-4437 FIREMARSHAL@QUEENSBURY.N ET FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE Certificate of occupancy Only Revised February 2022 w WITHIN 48 HOURS OF RECEIVIICIG YOUR PERMIT APPROVAL PACKET YOU MUST CALL S 18-7 61 -8 2 0 6 OR 518-7 6 -8 2 0 5 TO SCHEDULE AN INSPECTION WITH THE FIRE MARSHAL'S OFFICE PLEASE REFER TO THE PLANT REVIEW ENCLOSED III YOUR PACKET PRIOR TO CALLING FOR AN INSPECTION THANK YOU I Certificate of Occupancy Only Revised February 2022 FIRE MARSHAL'S OFFICE Town of Queensbunj 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauty ... A Good Place to Live " ' LANREVhE ' The Shop/Mark Smith & Robin Smith 430 Dix Ave CO-0195-2022 4/19/22 I have reviewed the submitted drawings for the above project;. and offer the following comments: 1) Verify Fire extinguisher.locations & inspection. 2) Locks / latches shall comply with 2020 NYSFC. 3) Verify operation of existing exit/-emergency lights. 4) CO Detection 5) Verify Smoke Detectors Deputy Fire Marshal Tyson Converse 742 Bay Road . Queensbury NY 12804 518 761 8205 garys@queensbury.net Fire Marshal 's Office Phone: 518-761-8206 Fax: 518-745-4437 ;firemarshal fteensbury.net 7mmqueensbuzal net 14 CA kA 303.16-1-62 CO-0195-2022 The Shop/Mark & Robin Smith � . . 430 Dix Ave. . Certificate of Occupancy FOR MDIA USE ONLY FOR MDIA USE ONLY MIDDLE DEPARTMENT INSPECTION AGENCY, INQ.- 7Location7/Add�rpss hip �`�t.�s: �: 1�.�, `�U. ti-� County . •,; t �. State . c ` + r?, -r�, ` (If Located in RuralArea-Please Attach Directions) Pole# Owner ,G-�" �:t e i .1 r �• Phone# Permit# Occupied As -- � r t Building: New ❑ Old [ej'' Occupant r Work Area in Building (Floor#, etc.): App.for:Wiring ❑" Service❑ or: �`;`y 1 I,: 1 _( t Ready for Inspection: Fee Remitted--$ Cash❑ Check❑ - M.O. ❑ Make Payable To: M.D.I.A. Number of Rough Wiring Outlets 500 750 1000 1250 1500 1750 2001) 2250 2500 2750 3000 9 9 Elect. Heat Switches Amp. Service Surface Unit Dishwasher Range Lighting Water Heater Air Conditioner Dryer Pump Receptacles Oven Garbage Disposal Wiring and Controls for Burner Number of Fixtures Amp. Receptacles Fractional H.P.Vent Fans Other Equipment: MOTORS H.P. 1/20 1/12 1/10 1/8 1/6 1/4 1/3 1!2 3/4 1 1'/z 2 3 5 7'/z 10 15 20 25 30 40 50 75 100 Mark Number of Each Size Applicant has read and agrees to terms and conditions on reverse side. Signaturey� , Applicant's License# Permit# T/A /f 7: ( ' t Utility: !!,, Applicants Address: , ;l/. / c r• )`.."e (NAME) (OFFICE LOCATION) (City) <x a _ (State) I /. (Zip) - Service Request# Phone# f '` Cy' 7 l i - Electrician: • DATE RECEIVED: J� DATE INSPECTED: Correct Location: Same as Above❑ or: Red Notice Label El Rough Wiring Outlets Surface Unit Oven t Switches Range Garbage Disposal Receptacles Water Heater Dishwasher t Fixtures Air Conditioner Dryer r . Amp.Service Equipment Burner,Wiring&Controls for Amp. Receptacle Amp.Service Conductors Pump - — Vent Fans MOTOR H. 1/20 11112 1/10 1/8 1/6 1/4 1/3 1!2 3/4 1 11/2 2 3 5 71I2 10 1 2ff 25 30 40 50 75 100 .P. Mark Number 1 LT i of Each Size _ �i l% ) 500 1 750 00 50 1500 1750 2000 2250'2500- Elect.Heat iJ 022 I TnIAIN, --I- I r- .z,jjr-- PJrf ' CERTIFICATIONS USE FOR INITIAL VISIT ONLY NOTIFIED DATE COFEECT} FEE PAID ❑ RW Progress: Inc.❑ LKD 0 Contractor 0 CFT Violation: Work Comp.0 Inc. 0 CASH ❑ ❑ UA Owner Fee CH # ❑ UA Due//.f, MO# ❑ IPA Municipal INV# Date: < < Other Side❑ Utility ApplicantOwner ❑ J Cut in Card 0 Temp# Date ( f Final# Date f, INSPECTORS SIGNATURE` ❑ I APPLICATION FORM NO.250 EL 6/98 ©Copyright 1996 Nov, 10, 2022 8:25RM MDIA No, 0437 P. 3/4 axt That the electrical wiring to the electrical equipment listed below has been examined and is approved as being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date noted below and is issued subject to the following conditions. Owner: Smith Date: 10/28/2022 Occupant: 1st FI. Fit Up/Renovation LocatioW30 Dix Ave. OccupancAon-Residential Queensbury, Warren Co. NY ApplicanLT— -1 Robin Getchell-Smith 56 Nottingham Dr. Queensbury, NY 12804 Joseph AHolmes No. 318014173222EL Equipment; -Switches;4-Receptacles;30-Fixtures C�3 - 0 V)5— 2 0 22_ � "NOV I TOWPI OF Q U E Y BUILDING P, CODES i his certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use,occupancy and above and the installation inspected as of the above noted date based on a visual ownership as indicated herein. Upon a change in the use,occupancy or ownership inspection. No warranty Is expressed or implied as to the mechanical sefety,effi- oP the property indicated above,this certificate shall be immediately null and void. clency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions, be valid for a period of one year from the above noted date. $Mould the electric--] th7s certificate may be revalidated upon reinspection by Middle Department system to which this certificate applies be altered in any way,including but not limit. Inspection Agency,Inc. An application for inspection must be submitted to Middle ed to,the introduction of additional electrical equipment and/or the replacement of Department Inspection Agency,Inc. to initiate the inspection and revalidation any of the components installed as of the above noted date,this certificate shall be process. A fee will be charged for this service.