87-599 f
CERTIFICATE OF OCCCU- P.,A►.NC'i'
i
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
E)ate December 1
!9
This is to certify that ,�, 0k 7`5�3 9
requested to be done as Shown by Pcrmit ? >s x 4
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has been cornpieted.
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This structure may be o"upiedas a Restaurant
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Fite . 4 4 SAS. 1
f..dcaLocation �(''`��
Owner McDonald ' s Corp .
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By Order Town Hoard
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TOWN OF QUEENSBURY
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Blii1.d1l1a' III' 'f.0111ng Inspector
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BUILDING PERMIT
TOWN OF QUEENSBURY
No. $7-599 �
WARREN COUNTY, NEW YORK CD
PERMISSION is hereby granted to McDonald ' s Corporation i
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OWNER of property located at Rt e 9 Street, Road or Ave.
in the Town of Queensbury, To Construct or place a Alteration to inside of building
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
I. OWNER'S Address is McDonald r s Corporation
1 Computer Drive South
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2. CONTRACTOR or BUILDER'S Name
Machnick Builders
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3. CONTRACTOR or BUILDER'S Address Z3
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1 West Dr . m
Green Island , N . Y , o
4. ARCHITECT"S Name
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5_ ARCHITECT'S Address m
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6. TYPE of Construction — (Please indicate by XI
) Wood Frame ( ) Masonry i ) Steel ( } y
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7. PLANS and Specifications
No. Alteration to existing building to include new office area between
service booths . 0
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8. Proposed Use d
Alteration to inside of existing building ,
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$S . 00 C /o m
$ 18 . 96 PERMIT FEE PAID — THIS PERMIT EXPIRES April 1 , 1988 Q
(If a io er riod is ng pe required application for an extension must be made to the Building and Zoning inspector of the p
town of Queensbury beforea
the expiration dam.) Uq
Dated at the Town of Queensbury this y�10th Day/of [ ]Sept . Zg 87
SIGNED BY // / cr y 62A£ - for the Town of Queensbury
Building and Zoning Inspector op(f4ee
TO BE COMPLETED BY BLDG . DEFT .
�J Application No .
... 1'O"ln o/ Qutee"JA"ry Permit Issued 19Ws , :; h v
BUILDING and ZONING DEPARTMENT Permit Expires 19
Bay and HaViland Road, R. D. 1 Box 98 zoning Designation k
Oueensbury, New York 12801 variance No .
Site Plan Review No . j � ,^� � izi01
f "7 Approved _
G'� FO ./I rt � 3d i, s
�� APPLICATION R � � ,_ ., . _• __
FhU I LD I NG AND Z[JN I NG PERMIT LW
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION . ANSWER ALL OF THE FOLLOWING .
The undersigned hereby applies for a Building Permit to do the following work which will
be clone in accordance with the description, plans and specifications submitted , and such
special conditions as may be indicated on the Permit .
The owner of this property is : M { �4y) h S 5
P . O. Address_ 1 -GyrYti {� t�-C6('�- 4 � ilw , ��c7 + + ri Tel .
Property Location : ( `� �i `!r- �� i 1 '� � L� Tax Map
Street number or building lot number
Subdivision name (if applicable)
THE PERSON RESPONSIBLE FOR SUPERVISION of WORK AS REGARDS BUILDING CODES IS :
Name P . D . Address Tel . No ,
Name of builder.in { c 1dI,1Ts_iCr_: LL&04ddress l l r� SC E E-Az� +-SL- 1 .
Name of plumber Address Tel .
Name of mason Address Tel .
NATURE OF PROPOSED WORK : * ZONING INFORMATION :
_Construction of a new building * A PLOT PLAN MUST BE PREPARED AND SUBMITTED '
Addition to a building * drawn reasonably to scale and attached hereto .
_)Alteration to a building * showing clearly and distinctly all buildings ,
(no change to exterior dimensions) * whether existing or proposed and indicate all
other work (describe) .�4- e'/ set-back dimensions from property lines . Give
street and number or lot number and indicate
* whether interior or corner lot . Show location
FOR DEMOLITION PERMIT , STATE SIZE AND * of water supply and location and configuration
LOCATION OF STRUCTURES AFFECTED . * of septic disposal area .
*
COMPLETE INFORMATION RE_QUIR11�'� ?Q2, ""'^-
* Size of property. Cyr ft x ft .
* Existing building ( s) Size ft x ft .
PROPOSED BUILDING AND USE : * Existing building (s ) Use
Size of new structure ft X ft
Foundation-pier/slab/crawl/partial/full * Proposed building , distance from property line
(circle one ) * Front yard ft Rear yard ft
No . of stories (habitable space ) Side yards ft and ft
Height ( grade to ridge ) ft ' If on corner , setback from side street ft
if residential , no . of families * OCCUPANCY INFORMATION
No . of rooms ( excluding baths )
*
*
No . of bedrooms PRIMARY BUILDING No . of bathrooms One family dwelling
Primary heating system Two family dwelling
Type of fuel Multiple dwelling / Number of units
No . of fireplaces to be installed * permanent occupancy
Will a wood stove be installed? ransient occupancy
Central Air conditioning? Business
BUILDING STYLE, PRIMARY STRUCTURE * Industrial
Other
Ranch Contemporary Log cabin If addition , what will use be?
Raised ranch Mansion Duplex
Split level Old style Bungalow
Cape Cori Cottage Other ACCESSORY BUILDING-
Town House * Detached garage/one car/ two car/ car
Colonial Row car
( * Attached garage/one car/ two car/
CIRCLE ONE PLEASE ) � -
* * * * * * * * * * * * private storage building
ESTIMATED MARKET VALUE OF * Other
CONSTRUCTION $
INFORMATION ON BUILDING .SFECIFICATIONS , ON REVERSE SIDE OF THIS SHEET TO BE COMPLETED !
Form BPA 4/86 mmd-vl
BUILDING PERMIT APPLICATION CONTINUED -
BUILDING SPECIFICATIONS :
Type of construction , wood frame , fire safe , etc . � (���
Will any second-hand or ungraded lumber be used? If so , for what ? �}
Foundation wall material. �,r���""'t���� Thickness
Depth of foundation below grade (to bottom of footing ) r.7
Will there be a cellar?_V 0 Heated or unheated? LAC Vloor sq. footage sq ft
Will there be a basement? �Ljy will any portion be used as living space?
( If so , what portion? sq , ft . - - Ty e of use .
Type of roof - sloped/flat/shed/otherL'n Material. of roof
Size , wood studs�_'"X�" spat ng "o . c . length � ft .
Joists ( floor beams ) 1st . floor "x It
spacing "o . c . span ft .
Jois is ( floor beams ) 2nd . floor _ "x spacing '"o . c , span ft .
Overlays (ceiling beams ) ""x '" spacing "o . c . span ft .
Roof rafters '" spacing o . c . span f t .
Roof trusses (pr engineered) spacing "' o . c . span ft .
Exterior wall finish Of what material?
Interior wall finish
If a garage is to be attached , describe materials to be used for FIRE SEPARATION :
Is there to be an opening between garage and dwelling? If so will a Fire-rated
door , enclosure , and self-closing device be provided?
will a flue-lined chimney be installed? Height above roof ft .
Depth of chimney foundation below grade ft .
Depth of fireplace hearth ft . in .
Water supply - Municipal or private well
SEPTIC SYSTEM _ Distance from ANY private well { including Adjoining properties ft _
(A separate application is necessary for any repair or new installation of septic system)
Town of
County off Warren I A F F T D A V T STATE OF NEW YORK
Warren
I swear that to the best of my knowledge and belief the statements contained
in this 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 CODE , THE ZONING OR.DINAICE , and all other laws pertaining to
the proposed work shall be complied with, whet he specified or not , and that such work is
authorized by the owner .
SWORN TO BEFORE ME THIS. Signature _
-own erK owner ' s -age , arcnxre , contract _
day of 19
Notary Public , Warren County , N . Y .
* * * * * * * * * . * * * * * * * . * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
SPECIAL CONDITIONS OF THE PERMIT :
TA jog ISSUE DATE (MMIDDIY'Y)
® lk 12 /{33 /
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
COOL INSURING AGENCY NC NO Rlf#HT$ UPON THE CERTIFICATE BOLDER. THIS CERTIFICATE DOES NOT AMEND,
EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO BOX 2074�
GLEN'S FALLS. NY 12901 COMPANIES AFFORDING COVERAGE
COMPANY A F I REMANS FUND INS CC)
LETTER
COMPANY
INSURED LETTER
MACHNIGK BUILDERS. LTD. COMPANY
G
& GREEN ISLAND EQPT CORD
1 WEST STREET COMPANY
GREEN ISLAND, NY 12183 LETTER
COMPANY E
LETTER
•
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWFTH$TANDWO ANY REOUIREMENT, TERM OR CONOJTION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY
BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDI-
TIONS OF SUCH POLICIES,
POLICY EFFECTIVE POLICY EXPIRATION LIABILITY LIMITS IN THOUSANDS
00 TYPE OF INSURANCE POLICY NUMBER DATE (MMfDO/W) DATE (MMA)DIYY) EACH p[,.(,aREGATE
LTR OCCURRENCE
A GaNERAL LIABILITY BINDER 1 645 1 1 / 29/86 1 1 /29/®7 BODILY
X COMPREHENSIVE FORM INJURY $ $
X PREMISES/OPERATIONS PROPERTY
UNDERGROUND DAMAGE $ $
EXPLOSION & COLLAPSE HAZARD
X PRODUCTSICOMPLETED OPERATIONS
X CONTRACTUAL COMBINEo $ 2, Ch�1C3 $ 2. Ci{3{?
X INDEPENDENT CONTRACTORS
V1 BROAD FORM PROPERTY DAMAGE
PERSONAL INJURY PERSONAL INJURY $ 2 i 000
A AUTOMOBILE LIABILITY HINDER 1646 1 1 /29 /86► 11 /29 /87 I --R�. . . ..
X ANY AUTO IPER PERsoNI $
ALL OWNED AUTOS (PRIV_ PASS.) BODILYKJURY
-
OTHER THAN) PER ACMNTI $
X ALL OWNED AUTOS ( PRIV. PASS. 1
X HIRED AUTOS PROPERTY pDAMAGE $
NOWOWNED AUTOS
GARAGE LIABILITY BI 8 PD
COMBINED $ 2, 000 ^
EXCESS LIABILITY PO
UMBRELLA FORM B 8 COMBINED
OTHER THAN UMBRELLA FORM
STATUTORY
WORKERS' COMPENSATION (EACH ACCIDENT)
� AND B INI3ER 1647 1 1 /29/H6 1 1 /29/E37 � $140
. $ (DISEASE-POLICY LIMIT)
EMPLOYERS' LIABILITY $ (DISEASE-EACH EMPLOYEE)
OTHER
DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESISPECIAL ITEMS
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX-
Town 4 Q u 4 E? Ti S b ll r PIRA 710
DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR Tp
Y MAIL 3 DAYS WRITTEN NOTICE TO T E CERTFYI TE HOLDER NAMED TO THE
QueeI# S 'bury . N . Y . LEFT, FAILURE TO MAIL SUCH NO NOOBLIGATION OR LIABILITY
OF AND UPON THE COMPANY ENT$ O PRESENTATIVES.
AUTHORIZED REPRESENTATIVE
TOWN OF QUEENSBURY
BUILDING AND CODES DEPARTMENT
BAY & HAV7LAkD ROADS
QUEENSBURY, NEW YORK 12811E--
TELEPHONE (518) 792-5832
BUILDING INSPECTOR' S REPORT
,REQUES INSPECTION RECEIVED
NAME
LOCATION
DATE �.JJ' t PERMIT #
APPROVED
YES I NO
FOOTING/PIERS
MONOLITHIC POUR FORMS
FOUNDATION/DAMP-PROOFING
BACKFILL APPROVAL
ROUGH PLUMBING
FRAMING
ELECTRICAL ROUGH-IN
INSULATION_
FOUNDATION
FLOORS
WALLS
CEILING
FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/STEPS
STAIRS-CLEARANCE & RAILS
PLUMBING FIXTURES/RELIEF VALVE
INTERIOR TRIM/PRIVACY DOORS
FINISHED FLOORS
GARAGE FIREPROOFING
DOOR CLOSER (S)
SMOKE DETECTORS
FINAL ELECTRICAL INSPECTION
FINAL APPROVAL OF CONSTRUCTION
A SIGNED CERTIFICATE OF OCCUPANCY MUST BE
OBTAINED .FROM THE BUILDING DEPARTMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS: f,
rL} ,� lC) ✓{5 SQL �'
AT SPECTOR
2, MIN
THE NEW YORK BOARD 4F FIRE UNDERWRITERS
BUREAU OF ELECTRICITY (�i� - 5 47 +�
41 STATE STREET, ALBANY. NEW YORK 12207 t7
Rote Application No, on file
THIS CERTIFIES THAT
only the electrical egssipment a clescribed below and introduced by the applicant uansed on the above opp/iontion number in the prensiaea of
, ir .lp . '. 1 T), e. ; ', f T r' .'. T 1 T 1
in thefollowing loeatiq a {st El )at Fl. ❑ $+sd Ft. Section Stock tat
„ i:; , .
was examined on and found to be in compliance with the requirensents of this Sward.
FIXTURE EFTACU SWITCHES FIXTURES RANGES coOKIHG DECKS OVENS bil WASHERS EXHAUST FANS
041TtErs I NCANDESCEWt FLUORESCENT OTHER MAT. K. W. MAT. C W. MAT. K.W. AMT. K. W. AMT, H. r,
DRYERS FURNACE MOTORS FUTURE AM"PACE FEEDERS SFECRAl REC'FT TIME CLOCKS I Rill UNIT HEATERS MULTI-OUTLET DIRA
AMT. K, w. M H. P. oAS H. ►. AMT. NO. A. W. G. AMT. AMP. AMT. 141hr5. TEAKS. MAT. M. P, SYSTEMS AMT.No. OF Fir MT. W
SERVICE DISCONNECT N0. CIF S E R V I C E
AMT. AAAF, TrrE AISTIR1 x zw 1 X 9Mr a x 3w s x Aw ^p OF CC'tcallo. OF cr cowD. No, GF rw,ltc C*A #iEc No. OF NEUTRwi,S Of i,rtu i'"
OTHER APPARATUS:
. ; F `
BRANCH MANAGER
Per I —s
This certificate must not be altered in any manner. return to The office of the Board if incorrect. Inspectors may be identified by their credentials.
COPY FOR BUILDING DEPARTMENT, THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER.
TOWN OF QUEENSBURY CD
BUILDING AND CODES DEPARTMENT
BAY & H44VXLAND ROADS
QUEENSBURY. NEW YORK 12801
TELEPHONE (5I8) 792-5832
BUILDING INSPECTOR " S REPORT
REQUEST R PECTXON RECEIVED�2
NAME jG � �
LOCATION7" /
DATE Az PERMIT #I_ __-
APPROVED
YES NO
FOOTING/P RS
MONOLITHIC POUR FORMS
FOUNDATXON AMP—PROOFING
BACKFILL AP VAL
ROUGH PLUMBItI(G
FRAMXNG
ELECTRICAL RO H—IN
XNSULATXON:
FOUNDATION
FLOORS
WALLS
�EILXNG `
L./FINAL INSPECTION:
CHIMNEY HEIGHT
ROOFING
SIDING
EXTERNAL PORCHES/S PS Lr
STAIRS—CLEARANCE &I I it s
PLUMBING FIXTURES/RE EF VALVE 0
INTERIOR TRIM/PRIV DOORS
FINISHED FLOORS
GARAGE FIREPROO NG
DOOR CLOSER (S) Zos YAP
SMOKE DETECT S
FINAL E'LECTRI L XNSPECTIO
FINAL APPROV OF CONSTRUCT±QN
A SIGNED RTXFXCATE OF OCCUPA CY MUST BE
OBTAINED ROM THE BUILDING DEPA TMENT BEFORE
THESE PREMISES ARE OCCUPIED!
REMARKS:
(fir ro
I PECTOR
` �[ ' BUILDING and ZONING DEPARTMENT
q of S Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
BUILDING ,INSPECTOR ' S REPORT
NAME Q,7
LOCATION
Date Permit NO .
✓ = APPROVED - YES NO
L41ooting/Pier Forms
Foundation
Waterproofing
Backfill
Framing
Roofing
Siding
Masonry Veneer
Rough Plumbing
Relief Valves
Ext . Porches
Finished Floors
Interior Trim
Stairs & Railings
Cellar Drain Tile
Concrete Floors
Plbg . Fixtures
Gar . Fireproofing
Door Closers
Smoke Detectors
Chimney
INSULATION :
Foundation
Floors
Walls
Ceiling
FINAL ELECTRICAL INSPECTION
DRIVEWAY APPROVAL
Final Building Survey
Next scheduled inspection ( call when ready )
Remarks ,r'; / ],�.� � ] 4 fn . r'-
Building Inspector
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GENERAL NOTES:
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1. McDonald's Road Sign and Base are by the Sign Contractor. p
Conduit and Wiring are by the General Contractor.
2. Bases, Anchor Bolts, Conduit, and Wiring for All Other
Signs are by the General Contractor. H
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3. %/ Empty Conduit to Locations Shown at the Lot Peri-
meter for Lot Lighting is by the General Contractor. Lighting > a ' Q
Fixtures, Bases, Poles, Conduit, and Wiring are by the � m Z
Owner/Operator. Q y
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4. Bases for Flagpoles are by the General Contractor. Anchor Q
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Bolts are by the Flagpole Supplier. 0.
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5. Proposed Utilities are Shown in Schematic Only. Exact
Locations shall be Field Determined to Allow for the Most f
Economical Installation.
6. The Contractor shall Coordinate with All Utility Companies c a
to Determine Exact Point of Service Connection at Existing c
Utility. Refer to the BuildingElectrical and Plumbing .V O
Drawings for Utility Service Entrance Locations, Sizes, and
Circuiting.
7. All Elevations Shown are in Reference to the Benchmark
and must be Verified by the General Contractor At
Groundbreak. 0.
8. Finish Walk and Curb Elevations shall be 6" Above Finish
Pavement. Ma I
9, All Landscape Areas shall be Rough Graded to 6" Below
Top of All Walks and Curbs. Finish Grading, Landscaping, sss��l
and Sprinkler Systems are by the Owner/Operator.
3�
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PAVING SPECIFICATION: ��►►
(Minimum 3" Total Compacted Asphalt Thickness.) p
r 3
r 72
m
N
4 78
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Note McDonald's Engineer Reserves The Right To Request A Compac-
tion Test And/Or A Core Sample. If Tests Prove Correct, Per =
Above Specifications, Tests Will Be At The Expense Of McDonald's,
Otherwise, G.C. Will Be Charged. t
H
LOT LIGHTING RECOMMENDATION:
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Note. Electrical Contractor To Circuit Lot Lighting As Noted.
PARKING INFORMATION:
Total 49 hPACES 9 x '10, @ ? Sif__
Spaces: -_ Spaces I I x 2d @ 75
51 Spaces x @
Spaces x
UTILITY INFORMATION:
Size: Type: Location: 71
Z
Sanitary Sewer 3 V
Water j C
Storm Sewer FQ- Ln (a a*
rA
Electric Z %
Q m
J
Gas a �y
SURVEY INFORMATION:
Prepared By:
;l
t
Dated:
1
LEGEND: I
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Sanitary Sewer S - Gas G o
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N
Water W Lot Light 0—'a LP:30 r; �.
Storm Sewer ST Existing Elevation (76.5) 0
cc
O►y 1.4 a
Electric E Proposed Elevation 77.0
'11r
PLAN SCALE: 1" = 20'
STREET ADDRESS: REGIONAL DWG. NOr
hAYh AOul F. °l 4� I AT OH PiOA � M 0"1
CITY: STATE:
Q u L E N% f-b u CORPORATE DWG. NO.:
COUNTY:
SP
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