2015-076 TOWN OF QUEENSBURY
742 Bay Road,'Queensbury,NY 12804-5902 (518) 761-8201
Community.Development - Building & Codes (518) 761-8256
. . CERTIFICATE OF OCCUPANCY . ,
Permit Number: . P20150076 Date Issued:,' Monday, Apri1,2.7, 2015
This is to certify that work requested to be`done as shown by Permit Number P20150076
has been completed.
Location: 453 DIXON RD Bldg 2 t
Tax Map Number: 523400-301-0087, 00017014-000-0000
Owner: MBL PROPERTIES LL.0
Applicant: . MB LAW&'CO., CPA P.C.
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 �d
other issues and conditions as a result,of approvals by the Planning Board Director of Building&code Enforcement
or Zoning Board of Appeals.
T . .
:.TOWN "OF-QUEENSBURY .
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development Building&Codes (518),761-8256
BUILDING PERMIT
Permit Number: P20150076 Application Number: A20150076
Tax Map No: 523400-301-008-0001-014=000-0000
Permission is hereby granted.to: MB LAW& CO.. CPA P.C.
For property.located at: 453 DIXON RD Bldg 2
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: MBL PROPERTIES LLC
8.CRA-NBERRY Ln Bldg 2 Certificate of Occupancy(COM)
QUEENSBURY NY 1.280470000 Total value
Contractor or Builder's Name/Address' Electrical Inspection Agency
Plans&Specifications..
2015-076 Evergreen Professional Park .Suite-4
MB Law& Co, CPA PC
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,Apri107;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 n o ueens W
a pril`07;2015
SIGNED BY for the Town of Queensbury.
Director.of Building&Code Enforcement
V �io o-7
Office U,se. nly
Town of Queensbury Fire Marshal _
Receiv
ESTABLISHMENT OF A NEW BUSINESS Tax M p l• -
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permi h U 40
Permi Fee;
�elrJv
*Note: This application is for occupancy only,with no work requiring a building permit. T OF QUEENSBURY
Name of Business
S
Address � 5 3 Q l d71 �d
Type of Business 0-, rP A t'l R M
Manager
OR
Person in charge
Business Phone No. 51 -761- IVIR
Property Owner M M— k P.P ne_S LL.G
Address 1)- eQl� gS77— QLl OWS6t� IL7-0Ll
Phone 51�_161 -- l k 9 ?
✓Provide an accurate layout of your store showing all walls,exits,stockrooms, rest rooms, counters, and fixture layout on a
separate sheet of paper. p
Print Name: 1,�1C.u��q�` 6 LAW
Signature:
Date: `{ S
Notes/Comments:
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
�1
Town of Queensbury Fire Marshal O Periodic Inspection Date: �T I� Time:
742 Bay Road,Queensbury NY 12804 O fie-Inspection rL,
518 761 8206/518 761 8205 CO Inspection Permit#:
Fire Marshals Representative
_ MJ Palmer Business Name: b� _
Location: �
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 404.2
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
�( Interior FC 1006.3&FC1029.8
Exterior FC 1006.3
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3
F.D.Si na e- 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(111 &112)
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 REINSPECTIONDUE 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 =N 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 Inspection
Inspection Form
Town of Queensbury Fire Marshal Periodic Inspection Date: Time:P 1�]
742 Bay Road,Queensbury NY 12804 o R -Inspection
518 761 8206/518 761 8205— O Inspection Permit#:
Fire Marshals Representative
MJ Palmer Business Name: � �, -/�
Location: .`7
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& FC1029.2JAI 1'-z9
Si n: 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
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3
F.D.Si na e- 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 (111 &R2)
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 REINSPECTIONDUE APPROXIMATELY
Vacant Buildings FC 311
Emerqencv Disconnect FC 2203.2 -F 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
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
EMERGENCY CONTACT UPDATE
TO: Warren County Sheriff's Department
-- ---- — — ----- ----- --- -- ----- -----------
1. 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.
2. 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.
PLEASE PRINT
DATE:
BUSINESS NAME: 6 L413 ", Co. UA PC-
BUSINESS ADDRESS: s 3 D 1 -°� kA S ut,It
BUSINESS PHONE:
CONTACT 1: c ` L4-LA) HOME PHONE S7--1qq Zb3�
ADDRESS:
CONTACT 2: HOME PHONE
ADDRESS:
Town of Queensbury Fire Marshal—New Business Permit 518-761-8206
DE c E 0 v E
X �
APR u 7 2015
TOWN OF QUEENSBURY
BUILDING& CODES
� O
l �Op