2011-489 iA TOWN OFQ UEENSBURY
titipo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110489 Date Issued: Tuesday, November 08, 2011
This is to certify that work requested to be done as shown by Permit Number P20110489
has been completed.
Location: 1043 STATE ROUTE 9
Tax Map Number: 523400-296-009-0001-002-000-0000
Owner: GARY & JILL WILSON
Applicant: JP RE-PLAY SPORTS
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, ,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code nfor ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FiVO
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110489 Application Number: A20110489
Tax Map No: 523400-296-009-0001-002-000-0000
Permission is hereby granted to: JP RE-PLAY SPORTS
For property located at: 1043 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: GARY&JILL WILSON
Certificate of Occupancy(COM)
6 BROWNS Path
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-489
JP Re-Play Sports -CO only
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,October 05,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tgvrn ueens)ry;a iNyedlpesday, October 05,2011
f t1 J�i..ff
SIGNED BY �, '„��r r'V r; for the Town of Queensbury.
Director of Building g Codetnforcement
rt n 1
Community Development Office C
Town of Queensbury• 742 Bay Road • Queensbury, New York•1 1 t - �;
David Hatin, Director of Building& Codes �� 1% S , •
Craig Brown,Zoning Administrator• Michael J. Palmer, Fire Marshal u •
; r �
T 41Q1"3Fla'JEEN€ 1-i
ESTABLISHMENT OF A NEW BUST
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit.
TAX MAP# �� , I — BLDG. PERMIT FILE# (J
1/-:plicab e 7 •
Name of Business: .TP Re-
' P 1 e,y S p o RTS
Address
of Business: /0 % SQATi". R V1? q QoeQ
S jC
S�'.1 IJ;)/• QUESTIONS? CALL 7614256 OR
EMAIL codesrdaueensbury.net
VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: ..10(11 N DA)N tJ INFORMATION
www.queensbury.net
Business Phone Number: 79 3 - p 4A
Type of Business: A)Q tom) A a use d ;PO 05 n, 9,0 o ds
Owner of Property: qt u,kkiI el.gc t.. Phone Number(s): 99B-3167 7 210---9 it
/ /� ` Home Cell
Owners Address: W TR,bWPS ?i�'CE!- a_00 ti-)SeU9-1-( 1�a 1. t 7-7014
Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature: 1) Date:
Of rson submitting this form
Notes/Comments:
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: Q ,2_ - 1 I
BUSINESS NAME: —7-P RQ- Hitky S ogl—S
BUSINESS ADDRESS: /0113 1 Ra Uri g J(1v QNS 6 uRy N• In°y
BUSINESS PHONE: 7q3 J 610.7
CONTACT 1: DIc(V/`J HOME PHONE tc9(`L 7-9$
ADDRESS: /t(6- DilR/Y/vV Reg,, 5GN1 Cheek' , ova, I2 7?
CONTACT 2: 6-ARr (4/d lco A) HOME PHONE 7cg-376'7
ADDRESS: tS E2owNS PR's, OVegNS6vRy , NY P.8"0/
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.
Inspection Form
Town of Queensbury Fire Marshal O Periodic Inspection Date: 1111k Time: 112
742 Bay Road,Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 CO Inspection Permit#: 11 4
eq
Fire Marshals Representative
`, MJ Palmer Business Name: ? 2k1 Sly cyci-S
Location: 1 oll3 11. 1'
f GK Stillman Contact: 01-4 (01
Type of Inspection N/A Yey No
EXITS: Exit Access FC 1014&&FC1029 � NOTES
Exit Enclosure FC 1020 FC1029
Exit Discharge FC 1024&FC1029 7,
&
Locks and latches FC1008 FC1029.2
Sign:Normal FC 1011 &FC1029
Sign:backup FC 1011.5.3&FC1029.7.5
AISLES: �'^^
Main Aisle Width FC 1024/1025&FC1029.11 41 Y
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906 , / et
Ci/ 0\0 S.
EVAC Plan FC 404.6 .7
TRUSS ID SIGNAGE FC 505.3 / /--
-
EMERGENCY LIGHTING:
Interior FC 1006.3 B.FC1029.8 /
Exterior FC 1006.3
Clearance to Electrical FC 605.3 ,/:
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315,2.3
F.D.Signage- FC 510
No Smoking Signs FC 310.3 l /
Storage FC 315.2
Compressed Gas FC 3003 j
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803,-804
_ Smoke Detectors FC 907
CO detectors FC 610
Clearance to Sprinkler/Ceiling FC 315.2.1
18" / 24"
EVAC SIGNS IN Rooms FC 404.6(R1 &R2)
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 / REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
21 DAYS
SYSTEMS: FC 901.6 lnsp OK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
HVAC Shutdown
Sprinkler System Annual
Sprinkler FDC
Kitchen Suppression Semi Annual
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
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