2015-241 .4�� TOWN OF QUEENSBURY
wojo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20150241 Date Issued: Monday, July 27, 2015
This is to certify that work requested to be done as shown by Permit Number P20150241
has been completed.
Location: 360 QUAKER Rd
Tax Map Number: 523400-303-005-0001-086-000-0000
Owner: NORTHGATE ENTERPRISES INC
Applicant: STATE FARM AGENCY- SEAN AKINS
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 /j
44.
owner of the responsibility for compliance with Site Plan, Variance, or �d
other issues and conditions as a result of approvals by the Planning Board «\
Director of Building&Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
*SI
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150241 Application Number: A20150241
Tax Map No: 523400-303-005-0001-086-000-0000
Permission is hereby granted to: NORTHGATE ENTERPRISES INC
For property located at: 360 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: NORTHGATE ENTERPRISES INC
PO BOX 4514 Certificate of Occupancy(COM)
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-241 C/0 Only
State Farm Agency -- Sean M. Akins
(former chiropractor's office)
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,June 12, 2016
(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 o eens d;! . i e 12,2015
i
SIGNED BY ' %. for the Town of Queensbury.
Director of Building&Code Enforcement
nn,1 It 1
ffice Use Only
Town of Queensbury Fir Marshal
� a Jori 0 2015 U eceived:
ESTABLISHMENT OF A NEW BUSINESSax Map ID: 36')
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION,'Ry Permit No.: 1-0‘1.`'' 2- 41
Permit Fee:
*Note: This application is for occupancy only,with no work requiring a building permit.
Name of Business Cwt,` I' 4 :: t N S Lrm,-1--6' F& n'�� ale v e_
Address 3 5S' &L l'e,W., "lc S, 6'. v<`-e f. t'y N'
Type of Business ''15��v�,z�•CsL k c. F 4i L,5
Manager 'Cv� VV\ _ A iK r ius
OR
Person in charge
Business Phone No. 51 ` - DCS L t I (5, i WSJ 301( 5.1 GI
Property Owner 46,4r '\ - C{.�2 Lvt-kv 1oV,r 5C 5 j_tic -
Address t 4
l
Phone (5 it 2cS _ c�Q (0 I
✓Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters, and fixture layout on a
separate sheet of paper.
Print Name: _ A, Ask Ada ` !v S--
Signature:Signature:
Date: (iV9/
Notes I Comments: L
Ckiry
if 4P Liz-
IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire
extinguishers, fire sprinkler systems, and fire alarm systems require annual inspections by an outside contractor and the corresponding
documentation must be provided to the Fire Marshal's office. Fire extinguishing systems found in kitchens and gas stations require
semi-annual inspections. Any violations noted during an inspection, require immediate corrective action.
CONTACT NUMBERS:
Director, Building and Codes-761-8253 Zoning Administrator-761-8218 Zoning-761-8238
Fire Marshal-761-8206 Planning-761-8220
Town of Queensbury Fire Marshal—New Business Permit 518-761-8206
Inspection Form
,
^/Town of Queensbury Fire Marshal 0 Periodic Inspection Date: " I��11S Time: 1 •
742 Bay Road,Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 JP CO Inspection 'ection Permit#: _ `'
Fi Marshals Representative
MJ Palmer Business Name: SIAN fr V-4Y`-, i S'i-PFTL- inviN
Location: 3S Q%o►Kc.h c .C319
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 f
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 C
FIRE EXTINGUISHER: Hung FC 906 /A21 t qInspection of extinguisher FC 906
EVAC Plan FC 404.2
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING: //��
Interior FC 1006.3&FC1029.8 /t ) L c 1
Exterior FC 1006.3 �/
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1 £:I_Combustibles in Equipment Rooms FC315.2.3V
F.D.Signage- FC 510
No Smoking Signs FC 310.3
Storage FC 315.2
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 APPROXIMATELY
Vacant Buildings FC 311
Emergency Disconnect FC 2203.2 21 DAYS
3rd Party Electrical
SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC
Generator Annual
FM Type Suppression Semi Annual DATE: OK NC
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
Paint Booth Suppression Semi Annual
Sprinkler System Annual
Sprinkler FDC
Fire Marshal In .n Complete
Kitchen Suppression Semi Annual
Fuel Island Suppression Semi Annual OK to Issue Ce ,.�p
�fny
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506 20 '
, itiiikbarr, --,
Operating Permit, if required will be issued after Fire Marshal
Completion of Inspection Town of( ueensbury _4
r
Inspection Form
Town of Queensbury Fire Marshal O Periodic Inspection Date:GIM"� Time:
742 Bay Road,Queensbury NY 12804 c=:'
Re-Inspection i S �1 y I
518 761 8206/518 761 8205 CO Inspection Permit#: o�
Fir Marshals Representative
X MJ Palmer Business Name: 5 +� `i"°^'^^
•
Location: Z5U aacM CIO
GK Stillman Contact: S �
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 / 1 EA I rSE4 y 1 N 41 N
Sign: Normal FC 1011 &FC1029 , (�A YJrJ
Sign: backup FC 1011.5.3&FC1029.7.5 6 UTn `t''iped.6.0
AISLES:
Main Aisle Width FC 1024/1025&FC1029.11 1
Secondary Aisle Width FC 1025&FC1029.11 f � "
FIRE EXTINGUISHER: Hung FC 906 /' 0 l,0 SILO+CKs)
Inspection of extinguisher FC 906
(Wu(Ni ct,a151‘ NeAv ✓
EVAC Plan FC 404.2 / EC Q(14 war
TRUSS ID SIGNAGE FC 505.3 //
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8 /
Exterior FC 1006.3
Clearance to Electrical FC 605.3 /
Electric Wiring Enclosed/Labeled FC 605.3.1 f/'
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
Vehicle Impact Protection FC 312.1 / /
Interior Finishes FC 803-804
Smoke Detectors FC 907 /j
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
Emergency Disconnect FC 2203.2 21 DAYS
3rd Party Electrical
SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC
Generator Annual
FM Type Suppression Semi Annual DATE: OK NC
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
Paint Booth Suppression Semi Annual
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 Inspection9
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