2015-040 TOWN OF QUEENSBURYc4ro
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Q rY,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20150040 Date Issued: Friday, April 17, 2015
This is to certify that work requested to be done as shown by Permit Number P20150040
has been completed.
Location: 361 DIX Ave
Tax Map Number: 523400-303-016-0001-001-002-0000
Owner: THOMAS & JEREMIAH BURKE
Applicant: NORTH STAR DONUT GROUP LLC
This structure may be occupied as a:
Commercial Alteration By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property (DJ 4 fd4t
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 Enforcement
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: P20150040 Application Number: A20150040
Tax Map No: 523400-303-016-0001-001-002-0000
Permission is hereby granted to: NORTH STAR DONUT GROUP LLC
For property located at: 361 DIX Ave
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: THOMAS &JEREMIAH BURKE
509 STATE ROUTE 67 Commercial Alteration $75,000.00
MALTA,NY 12020-0000 Total Value $75,000.00
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-040 Dunkin' Donuts
Commercial interior alterations
$75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday, March 04,2016
(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 piration da e,
Dated at the Town o rY'�'�+� idoesday, March 04, 2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE I Received
Tax Map ID 3a3 , lip- I - 1 . z--
TAX MAP ID Permit No. {
Permit Fee 94)1 01-t O
ZONING Rec Fee
Site Plan #
HISTORIC SITE Yes No Subdivision #
SUBDIVISION NAME Lot#
TOWN BD.RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS,INCLUDING SINGLE FAMILY DWELLINGS,DUPLEXES
OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR MANUFACTURED &
MODULAR HOMES, BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE.
APPLICANT )07:+1D l �r� a(1--' OWNER Jutonthi I huu
ADDRESS a # '. ■ ADDRESS I I _A _ /7
a LI ► V1, w. 1 L ow / 4
PHONE/E-MAIL II \ I PHONE/E-MAIL !I tha j�( (�, Lt (,( .l (-N
CONTRACTOR (lt ke ld V.�i till COST OF CONSTRUCTION(ESTIMATED): $
ADDRESS: BUILDING ADDRESS: (0S tboc-/-hice....„.sz__,'
PHONE/E-MAIL , 0 . 51T
. ,
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: l kid;LPHONE 7(I
TY : OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New Addition Alteration 151 floor sq. ft. 2nd floor sq.ft. Total sq. ft. Height
Single Family
Two-Family
Multi-Family
(# of units )
Townhouse
Business Office t1/4)6113
Retail - Mercantile ��
��
Factory- Industrial //,„,.._
Attached Garage �{ gecir,cfr,(C�/ -- ? -
(# of ) -` % �
t'�
UJB'�'
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business
Proposed use of building or addition
Source of heat (circle one) - Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys
Are there structures not shown on plot plan?
Are there easements on the property?
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot?
c. Will the grade be changed as a result of construction Yes ✓ No
d. Public water or Private we1L
e. Sewer or Private,Septic S ste
Value of all work to be performed (labor or materials) $
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and department
approval.
3. I certify that the application, plans and supporting materials are a true and complete statement/ description of
the work proposed,that all work will be performed in accordance with the NY State Building Codes, local building
laws and ordinances, and in conformance with local zoning regulations.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of )ccupancy.
vid= n as-built surveybya licensed land surveyor all newly
I also understand that I /we are required to pro y
constructed facilities prior to issuance of a certifif - •f occupanc . _
I have read and agree to the above: PRINT NAM i i a a 1 .' V � � SATE 3 ' 2 '�5
illow,
SIGNATURE: L DATE.2) a . I
FOR OFFICE USE ONLY
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
I
Inspection Form
Town of Queensbury Fire Marshal eriodic Inspection Date: y/17��Time:gilfiti
742 Bay Road,Queensbury NY 12804 Re-Inspection /.5" ---4e)9'()
518 761 8206/518 761 8205 CO Inspection Permit#:
Fire Marshals Representative
MJ Palmer Business Name: i'A ke'1 )313
Location: 36I PIK i,
K Stillman Contact: . /ehe1I
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029NOTES
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 404.2 !
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING: //
Interior FC 1006.3&FC1029.8
Exterior FC 1006.3 ,
Clearance to Electrical FC 605.3 / ' ir
Electric Wiring Enclosed/Labeled FC 605.3.1 / r
Combustibles in Equipment Rooms FC315.2.3 ,� /Aill '�
F.D.Signage- FC 510 r
No Smoking Signs FC 310.3
Storage FC 315.2
Compressed
essed Gas FC 3003
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803-804 ....-
Smoke
/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 315.3REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311
Emergency Disconnect FC 2203.2 / 21 DAYS
SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual ee//
-'FIRE ALARM Annual x 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
iCi-
Operating Permit, if required will be issued after
Completion of Inspection /
Town of Queensbury Building &Code Enforcement
Office No. (518)761-8256 (e3 - Id)
Commercial Final Inspection Report
11\\
Inspection request received: \\ �11�
Name: jUi,r,1�1�; LiS-\ Inspected on: 4,11-1- 5
Location: �` ��Xt.Y�u,� Arrive: q•'ej a.m./p.m.
Permit No.: 15'QztO Inspector's Initials:
•
COMMENTS
Y N NA
Chimney/"B"Vent/Direct Vent Location CkxA(.)
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish/Grade Complete 6"in 10'or Equivalent L21
Interior/Exterior Guardrails 42 inch Platform/Decks
Interior/Exterior Balusters 4 inch Spacing Platform/Decks
Stair Handrail 34 inch-38 inch/Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq.ft.
All Doors 36 inch w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36"(w)x 44"(I)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve, Heat Trap/Water Temperature 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 1/2 doors > 10%> 1000 sq.ft.
3/4 Hour Corridor Doors&Closers
Firewalls/Fire Separation,2 Hour,3 Hour Complete/Fire Dampers/Fire Doors
Ceiling Fire Stopping,3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets/Mirrors
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters,34 inch,Checkout 36 inch
Handicapped Ramp/Handrails Continuous/12 inch Beyond [Both sides]
Active Listening System and Signage Assembly Space
Final Electrical/Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey, New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File k 7;3- 0 y 2 7
Building Number or Tenant Address on Building or Driveway 4" F4-‘11,
Water Fountain or Cooler
Building Access All Sides by 20'/Drivable Surface 20'wide
Special Inspections/Engineer or Architect Approval
Okay To Issue Temporary or Permanent CIO
Okay To Issue C/C
Commercial Final Inspection_11 27 12