2010-466 TOWN OFQ UEENSBURY
if#0 742 Bay Road, NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100466 Date Issued: Thursday, December 29, 2011
This is to certify that work requested to be done as shown by Permit Number P20100466
has been completed.
Location: 3 OGDEN Rd
Tax Map Number: 523400-308-015-0001-055-000-0000
Owner: NYSARC INC. WARREN & WASHINGTON COUN
Applicant: NYSARC, INC. WARREN WASHINGTON CO'S CHAPTER
This structure may be oc*11414klaWASHINGTON ARC
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 Planning Board Director of Building&Code nforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
ET 4y 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100466 Application Number. A20100466
Tax Map No: 523400-308-015-0001-055-000-0000
Permission is hereby granted to: WARREN WASHINGTON ARC
NYSARC, INC. WARREN WASHINGTON CO'S C
For property located at: 3 OGDEN 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: NYSARC, INC. WARREN WASHI
375 BAY Rd Suite 200 Certificate of Occupancy(COM)
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-466
C/O only- Warren Washington ARC
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, October 01, 2011
(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 Town bu ; Fr'•• y LS 5 er 01,2010
4
-4
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
EZ- -
Community Development Office
Town of Queensbury• 742 Bay Road • Queensbury, New York •1 1111
Marilyn Ryha, Executive Director•David Natin, Director of Building&Codes
Craig Brown,Zoning Administrator•Michael J.Palmer,Fire Marshal TOWN OUEENSBURY
e�a14.Du_ .CORES
NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT
APPLICATION
TAX MAP # BLDG. PERMIT FILE#
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apple bie
Name of Business: (rt2Avre„r 6hat.11, •k A ee_.
Address 3 01denr 12r,�►J- ileec,✓s6 r�y' N.31,
of Business: 3 !S -61:ty R.da Svt''- aOD QJecws6rar�,/N QUESTEMAIL cIONSode?s CALL 761-
eensb8256 r
l aC7.aaurv.net
or Manager: / VISIT OUR WEBSITE FOR MORE
Person in ChargeA
9 /CAN"to.,> I- L e C1�11 nLe�.nn ��cam. INFORMATION
w.aueensburv.net
Business Phone Number: 51 i- t)I13'LI0/c(1
Type of Business: k J.* Se„, e 1
UArre V VA1�•��^0,1 4 kC-
Owner of Property: Phone Number(s):578-7`13-Y2o'/ SIT bet-0 IN
N
Home Cell
Owners
Address:dr)c RAI 1?, J Sse.. :tc C ev. r,16tH L /1/41. )2,o'1
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
11 counters and fixture layout on a separate sheet of paper.
Signature: -.6 / � Date: 9-Z0 -/U
// Of person submitting this form
Notes/Comments:
*Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit
/0 --467k
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: Cr a0 -eplQ I a
BUSINESS NAME: w (.) A R Q
' ei,er) Road Iac,ceo� C�,t f n 9
BUSINESS ADDRESS: _ ! !";,���,
BUSINESS PHONE: S I - 53 -Liao
HOME
CONTACT 1: Wick h PHONE 4s%-01(1
ADDRESS: I 141 c,..12_ & &c%J h/'.4) /&k
(� HOME
J
CONTACT 2: eal vN, 041e y PHONE 2 2.3- 06 t/5
ADDRESS: r.,�. ;✓ l - Ed L✓ r✓✓ 'a ' r
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 QUEENSBURY FIRE MARSHAL'S OFFICE
P h o n e: 518-761-8206 • F a x: 518-745-4437
firenaarshal@queensbury.uet • www.queensbury.net
(2 - / -l� 5-Tait)S j /( c)
Inspection Form
Town of Queensbury Fire Marshal C)Periodic Inspection Date: Time:
742 Bay Road,Queensbury NY 12804 o Re-Inspection /() 4' 7
518 761 8206/518761 8205 CO Inspection - ) Permit#:
Fire Marshals Representative
_MJ Palmer Business Name: KI
Location: 3 0(RC.0
, -- Pei
GK Stillman Contact:
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024&FC1029
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
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8 //j7
Exterior FC 1006.3P441-1M-t0
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
// /2eV '144,
No Smoking Signs FC 310.3
Storage FC 315.2 ��Q/'i YJ � ✓f�k4i4 �'J J 11&.:i1i4I
Compressed Gas FC 3003 [
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 APPROXIMATEL
Vacant Buildings FC 311
21 DAYS
SYSTEMS: FC 901.6 Insp 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 -4 J 6jI
Fuel Island Suppression Semi Annual ,p /; � /12/1
Hood Cleaning 3-6-Annual / f `if iCl� ���/ LL
Knox Box:installed/checked FC506 / "
Permit, if required will be issued after 00/y
Operatingq
Completion of Inspection
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
IF0,001, Community Development-Building&Codes (518) 761-8256
Inspections per Permit
Permit# P20100466
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
09/21/2010 Miscellaneous Certificate of Occupancy(COM) JENNIFER HENDERSON Staff
Misc 2010-466
PERMIT ENTERED
12/16/2011 Status Inspection Certificate of Occupancy(COM) JENNIFER HENDERSON Staff
Misc 2010-466
MADE OUT STATUS INSPECTION SLIP
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. w lU - 1"t Co V
Town of Queensbury
742 Bay Road Q la'i''k O
Queensbury,NY 12804 Scheduled Inspection Date: Time:
Phone: (518)761-8206 Business Name: `Jl'Ut}(2 .--
Fax: (518) 745-4437 Location: _Qj -1:Z'0-A 0
Type of Inspection N/A Yes No
EXITS:
Exit Access UL
Exit Enclosure CiL COMMENTS
Exit Discharge Lit
AISLES:
MaiAisle Width aL Y � ..*06
cp,....ct c.
Secondary Aisle Width
EXIT SI -nor (=
Sign-normal f& 01 4 }-
Sign-battery { ' ' l
EVAC signs in rooms v....--
TRUSS
TRUSS ID SIGNAGE `^ ,/
EMERGENCY LIGHTING - DC
FIRE EXTINGUISHER:
Hung
Inspection of extinguisher 4--i
FIRE ALARM SYSTEM
Fan Shutdown '—
Fire Sprinkler System (FDC) `-
Fire Suppression-kitchen '—
Fire Suppression-Gas Islan ...-
Generator ....-
Hood
Hood Installation
Elevator —
Interior Finishes
Storage - g;
Compressed Gas v _
Clearance to Sprinklers
Clearance to Electrical V
Electric Wiring Enclosed/Labeled w�,
Combustible Waste 0
-,)
Vehicle Impact Protection ---
Knox Box —
F.D.Signage-Utility Rooms .-
No Smoking Signs l
Maximum Occupancy Sign , n& ) ,
Emergency Evacuation Plan '--.
Approved (If no other approvals appy,the B 8.C Office vv�ll issue t' ertificat .f Occupancy)
o Denied / call for Recheck
Inspected By:
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L:\FireMarshal\FM Forms Masters\permitto occupyform.doc