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2009-009 TOWN OF QUEENSBUR.Y ow742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20090009 Date Issued: Thursday, September 30, 2010 This is to certify that work requested to be done as shown by Permit Number P20090009 has been completed. Location: 118 QUAKER Rd Tax Map Number. 523400-302-007-0001-012-000-0000 Owner. QUEENSBURY QUAKER, L.L.C. Applicant QUEENSBURY QUAKER, L.L.C. This structure may be occupied as a: Certificate of Occupancy(COM) 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, 4 l f Variance, or other issues and conditions as a result of approvals by the Director of Building&Code orceent Planning Board or Zoning Board of Appeals. ��` TOWN OF QUEENSBURY ai Fors 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20090009 Application Number. A20090009 Tax Map No: 523400-302-007-0001-012-000-0000 Permission is hereby granted to: QUEENSBURY QUAKER, L.L.C. For property located at: 118 QUAKER Rd 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: QUEENSBURY QUAKER, L.L.C. 90 STATE St Suite 1411 Certificate of Occupancy(COM) ALBANY, NY 12207-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2009-009 Liberty Tax Service- C/O only $0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,January 27, 2010 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at th(own Qu �rlsbiiy; 7 '_f. i .y,January 27, 2009 SIGNED BY for the Town ofensb Q� m"Y Director of Building&Code Enforcement r s im Community Development Office Town of Queenshurt/ • 742 Bay Road • (2ueensbury, New York •12804 "� ate 6:tamp 5 4' •David Hatin, Director of Building&Codes Craig Brown, Zoning Administrator•Michael J.Painter, Fire Marshal ESTABLISHMENT OF A NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT APPLICATION TAX MAP# .A)l / f Z- BLDG. PERMIT FILE# f applicable Name of Business: gL 4 1 T SCfz- cg- Address i l of Business: 1 1'g el QUESTIONS? CA l EMAIL codest ueensburv.netLL761-8256OR Person in Charge or Manager: Q�,J ali VISIT OUR INFORMATION R MORE 9 9 1`rx Zt Cr 1 ,�� www.oueensburv.net Business Phone Number: 1 g . S - Z3 4=� Type of Business: I \f`'Y cv Owner of Property: IJ o f 1.4,51- 3 N43)t 'hone Number(s): S�$ -Lf 7�" Home Cell Owners Address: t ° cten - St!'-a-L-) H\j k_ 1 411 ) !\ 74 -7 ,✓ , � 1.127 Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters and fixture layout o eparate sheet of paper. ► /�L/�� Signature: � Date: Of person sub g this form Notes/Comments: C,cs " C� �1 S �- i � , rt w °Ns 19_3(4_ o 4-44,- - tc' - PC'i,;- 1,J -5 < *Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit Pir 12?u) O EMERGENCY CONTACT UPDATE TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502 PLEASE PRINT DATE: J '^ \ 2'1 BUSINESS NAME: 1-'1:6.e'61-1-1 BUSINESS ADDRESS: rleg (200--Ci L �3�w ,-.1 ``I • i-1-1(04/ BUSINESS PHONE: I� � "'�3 5 `-) " � HOME CONTACT 1: ►r''",' d ` PHONE S I'll ' X33 '2- ADDRESS: I S3 S �� ` L62 A'` • ( "L 7-‘1 HOME CONTACT 2: PHONE 5a , - 3377 ADDRESS: -C' � c,,C�.� ,<, '-l/ - \\'t�� ) . • This form is used to assist Emergency Service personnel who may be called to your business after hours. Please be sure that the persons listed on this form will be willing and available to respond during off-hours to assist Police and/or Fire personnel in gaining entry to your building. PLEASE BE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACILITATE ENTRY BY POLICE AND/OR FIRE PERSONNEL. TOWN OF QUEENSBLIRY FIRE MARSHAL'S OFFICE P h o n e: 518-761-8206 • F a x: 518-745-4437 firernarshal@queensbury.net • www.queensbury.net S711/0,5 L9,j /P'_ji Jtel._ inspection for Perniit to Occupy pY Fire Marshal's Office Request Reed Permit No. 07- N7 't, Town of Queensbury 742 Bay Road Queensbury,NY 12804 Scheduled Inspection Date: / �-�C /1 Time: • Phone: (518)761-8206 Business Name: L..e ( / /6.9‘ Fax: (518)745-4437 Location: /76- 0v Type of Inspection N/A Yes No e i C�1 1-2 (.2 EXITS: Exit Access Exit Enclosure COMMENTS Exit Discharge AISLES: Main Aisle Width Secondary Aisle Width EXIT SIGNAGE Sign-normal Sign-battery 11/AC signs in rooms TRUSS ID SIGNAGE rf EMERGENCY LIGHTING '� `2 / FIRE EXTINGUISHER: Hung Inspection of extinguisher FIRE ALARM SYSTEM Fan Shutdown FireSprinkler System (FDC) ii /) � Fire Suppression-kitchen Fire Suppression-Gas Nan Generator Hood Installation Elevator Interior Finishes Storage _ Compressed Gas Clearance to Sprinklers Clearance to Electrical Electric Wiring Enclosed/Labeled Combustible Waste Vehicle Impact Protection Knox Box F.D.Signage-Utility Rooms No Smoking Signs Maximum Occupancy Sign Emergency Evacuation Plan ❑ Approved (If no other approvals apply,the B&C Office wi issue the Certificate of Occupancy) ❑ Denied /cap for Recheck Inspected By: L:\FireMa rshal\FM Forms Masters\permitto occupyform.doc Inspection for Permit to Occupy Fire Marshal's Office Request Recd Permit No. Town of Queensbury 742 Bay Road I is 3/Oj 9 I c Queensbury,NY 12804 Scheduled Inspection Date: Time: Phone: (518)761-8206 Business Name: L I fro`r 1 ta-'," (Ji-:1\‘1 i Ct Fax: (518) 745-4437 Location: Caxiia i**.t'\ RC."0 Type of Inspection N/A Yes No EXITS: Exit Access Exit Enclosure Exit Discharge / AISLES: Main Aisle Width -' It Secondary Aisle Width % A DD ) ,s EXIT SIGNAGE f Sign—normal / ,f( 6 C. `"�`/1)/ Sign-battery I Mi 4\ i 4r� Y�I 1 / EVAC signs In rooms TRUSS ID SIGNAGE /` EMERGENCY LIGHTING / 1 C 5-1, 1 I NC, o` SA F FIRE EXTINGUISHER: ,� t / Hung f, b' � '(� , Inspection of extinguisher / FIRE ALARM SYSTEM / \ ID-,i0 -) Fan Shutdown / r 0 fff Fire Sprinkler System (FDC) I 01;414t 1 �4 Fire Suppression—kitchen / Fire Suppression—Gas Islan / Generator // AL), Hood Installation f .,...-- Elevator / Interior Finishes I. ()lcf- `i j�\ '-' Storage ,/ " Compressed Gas Clearance to Sprinklers Clearance to Electrical Electric Wiring Enclosed/Labeled �" Combustible Waste Vehicle Impact Protection / Knox Box / F.D.Signage—Utility Rooms 1 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 Ocyp6ncy) c Denied / call for Recheck / Inspected By: li ---_ L:\FireMarshal\New Folder\permitto occupyform.doc Inspection for Permit to Occupy Fire Marshal's Office Request Recd Permit No. u'.rl ql 71 l .*,- 7 Town of Queensbury 742 Bay Road t ia-3/6/ 9 s Queensbury,NY 12804 Scheduled Inspection Date: / Time: Phone: (518)761-8206 Business Name: Lis FV*7 ---7- .0 t CC Fax: (518)745-4437 Location: Ck eiv (?O+N 0 Type of Inspection N/A Yes No EXITS: Exit Access Exit Enclosure % COMMENTS Exit Discharge AISLES: Main Aisle Width Secondary Aisle Width . Ct) S EXIT SIGNAGE Sign-normal Sign-battery ( Nf YY1N'' 1R l/ e� EVAC signs in rooms TRUSS ID SIGNAGE / L EMERGENCY LIGHTING / —Ft VC: Th NC)J F S4"t— FIRE EXTINGUISHER: /4 61 Maiki i'-i--1 r- Hung // Inspection of extinguisher FIRE ALARM SYSTEM � /� 10.,/ay Fan Shutdown Fire Sprinkler ystem (FDC) /` `f A i- (�`�Are Suppression-kitchen ` V Fre Suppression-Gas Islan / Generator Hood Installation /� e........—,Elevator / Cio, Interior FinishesV L Storage / 4-6(` Compressed Gas / Clearance to Sprinklers / Clearance to Electrical Electric Wiring Enclosed/Labeled / Combustible Waste / Vehicle Impact Protection // r Knox Box / F.D.Signage-Utility Rooms / No Smoking Signs Maximum Occupancy Sign // __ _. Emergency Evacuation Plan ❑ Approved (If no other approvals apply,the B&C Office wil ss the C- ficate of Oc -•ancy) dc---Denied / call for Recheck -'� 1/4 Inspected By: L:\FireMarshai\New Folder\permitto occupyform.doc c..,. ><--e / - ' .1.. '../ , ,...,- / - . .. I -• -_:e. , e .Y .• . -. 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