2010-427 41 TOWN OF QUEENSBURY
Foezo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20100427 Date Issued: Wednesday, September 08, 2010
This is to certify that work requested to be done as shown by Permit Number P20100427
has been completed.
Location: 989 STATE ROUTE 9
Tax Map Number. 523400-296-013-0001-022-000-0000
Owner. 697 UPPER GLEN STREET, LLC
Applicant: NEW BEGINNINGS COMMUNITY CHURCH, INC
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 Enforcement
Planning Board or Zoning Board of Appeals.
" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100427 Application Number: A20100427
Tax Map No: 523400-296-013-0001-022-000-0000
Permission is hereby granted to: NEW BEGINNINGS COMMUNITY CHURCH, INC
For property located at: 989 STATE ROUTE 9
in the Town of Queens bury,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: 697 UPPER GLEN STREET, LLC
697 GLEN St Certificate of Occupancy(COM)
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-427
CO only-New Beginnings Community Church, Inc.
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, September 03, 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 To eens ty; i s1 , September 03, 2010
SIGNED BY ' for the Town of Queensbury.
Director of Building&Code nforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Marilyn Ryba, Executive Director•David Hatin,Director of Building&Codes
Craig Brown,Zoning Administrator•Michael J. Palmer, Fire Marshal 1441--
NEW
BUSINESS CERTIFICATE OF OCCUPANCY PERMIT
APPLICATION
TAX MAP # -' / /3 -/ 'z BLDG. PERMIT FILE# /(9—qzIf appli
Name of Business: 444..4) vae;n n b,S l o ryrm rrn. a't-., .L&✓C.
Address c �1 c QUESTIONS? CALL 761-8256 OR
of Business: ��� .� �� .� G+��-nf�. ti /�y /�-��
EMAIL codesAqueensbutv.net
VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: /,jJcr Z.-f. .I). Com/ s INFORMATION
www.queensburv.net
Business Phone Number: -Ca.- 3 0 7 - - 7 V
Type of Business: C /6," •-•
Owner of Property: .Oe-_J 11--c To 5k; Phone Number(s): S),-3 r 3.29/
Home Cell
Owners
Address: 6 7 Utter o'4, shPh Aly t 2-PY�
Please 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 ,7.y&c,''-, Date: SA 7/(0
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
gptO
-4 '-
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: 5/-29/
BUSINESS NAME: /"5/V tYk-C/4V/V/ i/6; s (1�/'-7. 7r C4t'r(1-K jT. r
`�►� /7 4/% nr/> ,7 y /2- ."
BUSINESS ADDRESS: ,�j
BUSINESS PHONE: _C 7a- - 6 5 7 y ce /r
/-72/17,)
HOME
CONTACT 1: PHONE -S/t` -L�
ADDRESS: y�7 �/k 4v� OJ ins G - /11/ (Zgro
/ HOME
CONTACT 2: 4,„7 �7 -r, v��, � PHONE -sib 7V7-3 ):35,
ADDRESS: /��, t�
.)-11: 77,(44-,'‘ (G f /11, I2-
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
fireniarshal@queensbury.nnet • www.queensbury.net
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No._J 412 7_
Town of Queensbury
742 Bay Road 94/o , rei
Queensbury,NY 12804 Scheduled Inspection Date: S Time: v?" '
Phone: (518) 761-8206 Business Name: A -1,1411c 0v"`" 1
Fax: (518) 745-4437 Location: l ��� 9.
Type of Inspection N/A Yes No
EXITS:
Exit Access /' COMMENTS
Exit Enclosure 1/'
Exit Discharge f,/
AISLES:
Main Aisle Width i/'
Secondary Aisle Width V
EXIT SIGNAGE
Sign-normal
Sign-battery V
EVAC signs in rooms
TRUSS ID SIGNAGE IV-
EMERGENCY LIGHTING v
FIRE EXTINGUISHER:
Hung 1.17
Inspection of extinguisher
FIRE ALARM SYSTEM V'
Fan Shutdown e
Fire Sprinkler System (FDC) I/ 1/
Fire Suppression-kitchen
Fire Suppression-Gas Islan V
Generator ✓
Hood Installation V
Elevator
Interior Finishes 17/
Storage (/
Compressed Gas
Clearance to Sprinklers � rr
Clearance to Electrical
Electric Wiring Enclosed/Labeled V
Combustible Waste
Vehicle Impact Protection k
Knox Box f
F.D.Signage-Utility Rooms V /
No Smoking Signs ✓ g
Maximum Occupancy Sign
Emergenc;Evacuation Plan
Approved (If no other approvals apply,the B 8.c Office will issue .- "= - = e cupancy)
i Denied / call for Recheck 4111.Inspecte, By: ih.
r -mum
L:\FireMarshal\FM Forms Masters\permitto occupyform.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Recd Permit No. IV
Town of Queensbury
742 Bay Road Cil i 6 i 3"
Queensbury,NY 12804 Scheduled Inspection Date: Time:
Phone: (518)761-8206 Business Name: 1 `J `. r ji v'-> L-11—.A—
Fax:
A- --
Fax: (518) 745-4437 Location: tz-r-
Type of Inspection N/A Yes No
EXITS:
Exit Access
Exit Enclosure v' COMMENTS
Exit Discharge
AISLES:
Main Aisle Width Is'
Secondary Aisle Width i/
EXIT SIGNAGE
Sign-normal
Sign-battery
EVAC signs in rooms
TRUSS ID SIGNAGE I .
------
EMERGENCY LIGHTING j/ 4 J kir- `,1 Z5 J3C1/
AlIttiel lit 4—
FIRE EXTINGUISHER: �,
Hung 1 �
� , -.
Inspection of extinguisher �(
bAgirrickarr 4)2(,e,
FIRE ALARM SYSTEM f/ �
Fan Shutdown ✓ ...)-05.19e104,‘ A7- 3
Fire Sprinkler System (FDC) I�
Fire Suppression-kitchen 1✓
Fire Suppression-Gas Islan 1�
Generator ✓/
Hood Installation
Elevator I
Interior Finishes ✓
1-44:4C& L t 4ic
145
ce0Cce
Storage
Compressed Gas sC
Clearance to Sprinklers - V'
Clearance to Electrical (/
Electric Wiring Enclosed/Labeled 1/
Combustible Waste ✓ _
Vehicle Impact Protection j/
Knox Box
F.D.Signage-Utility Rooms pc
No Smoking Signs
Maximum Occupancy Sign 1 .
Emergency Evacuation Plan ✓
u A roved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
enied / call for Recheck
Inspect d By: : �
L:\FireMarshal\FM Forms Masters\permitto occupyform.doc
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