2012-277 4111111hi TOWN OF QUEENSBURY
vero742 Bay Road,Queensbury,NY
12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY {
Permit Number: P20120277 Date Issued: Friday, August 17, 2012
This is to certify that work requested to be done as shown by Permit Number P20120277
has been completed.
Location: 123 QUAKER Rd
Tax Map Number: 523400-296-019-0001-002-000-0000
Owner: MRK COMMUNITY COLLEGE HOUSING, LLC
Applicant: MRK COMMUNITY COLLEGE HOUSING, LLC
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 4 41,5t
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
IF
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120277 Application Number: A20120277
Tax Map No: 523400-296-019-0001-002-000-0000
Permission is hereby granted to: MRK COMMUNITY COLLEGE HOUSING, LLC
For property located at: 123 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: MRK COMMUNITY COLLEGE HOU Certificate of Occupancy(COM)
6 CHELSEA P1 Total Value
CLIFTON PARK,NY 12065-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-277 Suites 106 & 107
CO Only- Roof&Restoration Services of America, LLC
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 06,2013
(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 of ensbury; Wed e d ,June 06,2012
SIGNED BY4
for the Town of Queensbury.
Director of Building&Cod Enfo\ment
:a.-•/.1).-/"-p--(24-1"
.i\_.
�,,,,�. Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •128041 ,v� 1 l J
,,.: J
David Ha tin, Director of Building& Codes
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal • -T= i 4 r
icv
s
ESTABLISHMENT OF A NEW BUSINESS ,Z.,
JT ,,rs
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION �� �vi---
,et':-"1-1
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*Note: This application is for occupancy only, with no work requiring a building permit. (pr-
TAX MAP # 2 vl Co - 1 1 v ' — Z BLDG. PERMIT FILE# I .% ---e:;\
c (2 . ( (� If applicable
Name of Business: � ' 0 A S1--%3v- I-1 ', . ., �,t' J b c l T 1 ) f"'-7 Pr' c n , 1,Ce...
Address
of Business: l 1.1 q u n k(.,.,/ 2 )ti i �, /v/,
6 4---/07 QUESTIONS? CALL 761-8256 OR
�,{ / EMAIL codes(a queensbury.net
t" i Lkae� VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: 1 ( r In C? I I I b 1 )'/� INFORMATION
1 l� t ll,Ke P; Z
O www.queensbury.net
Business Phone Number: 50 LI I 3 Z 1 c 3
"V' SSSS-ci5�v�
Type of Business: S A-0 r, WI 'R 1.S I-0 f'(9 1 3 n
Owner of Property: 0-1(Z << I`i, I Qr'9€r Phone Number(s): 3 3 L1 t 0 F(..\ g- 9.12- D
Home �) Cell
Owners Address: 6 C e `I L1 n a Y' i c l i _f'!",^ T(�nrI< (o il
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: -) • )lam Date: .1/?/ Z
Of person submitting this form
Notes / Comments:
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: f/ // Z
BUSINESS NAME: ° ° / EJ T O fa �h SerIf v I 4/97e,--•
BUSINESS ADDRESS: / Z 3 (Qvn / /2c 1-itr /i2 '� Jo?
BUSINESS PHONE: " L/ / Z F3
I
CONTACT 1: 076,r ( // h CI•HOME-PHONE 5-61-) 9/ 3 z
ADDRESS:
CONTACT 2: (0C 1(' W) /1 H E-PHONE Prk 9 s Z
ADDRESS: Cit( / ,/ C/ I/A
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.
Inspection Form
Town of Queensbury Fire Marshal o Periodic Inspection Date: f) I16412--Trme:1 '> /7T
742 Bay Road, Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 COl4 Inspection Permit#: 42— 7 77
Fire Marshals Re resentative /' - 2--
MJ Palmer Business Name: �- { es 'z.-a, _ __ , Ah4-,)
Location: /2-6 Ode—,, ,.L 26, '.
/4GK Stillman Contact: 7/ e.,.- G-//i,i$
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
Locks and latches FC1008& FC1029.2 /'j
Sign:Normal FC 1011 & FC1029
Sign:backup FC 1011.5.3&FC1029.7.5 --------
AISLES:AISLES:
Main Aisle Width FC 1024/1025&FC1029.11
Secondary Aisle Width FC 1025&FC1029.11 /f
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 /
Exterior FC 1006.3
Clearance to Electrical FC 605.3 .f
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3 ------
F.D.
F.D. Signage- FC 510
No Smoking Signs FC 310.3 ./ -r
Storage FC 315.2G(�
Compressed Gas FC 3003 ��
Vehicle Impact Protection FC 312.1 ----- ��
Interior Finishes FC 803-804
Smoke Detectors FC 907 1.
CO detectors FC 610 ,------
Clearance
Clearance to Sprinkler/Ceiling FC 315.2.1
--------.-
18"
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
_—Exterior Storage FC 315.3 'f REINSPECTION DUE APPROXIMATELY
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 Seml 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
a`; )i . i'Ci4,
Inspection Form
Town of Queensbury Fire Marshal O Periodic Inspection Date: 1.' 4,10
742 Bay Road, Queensbury NY 12804 o Re-Inspection Z-Z� -7
518 761 8206/518 761 8205 ,- CO Inspectio _ Permit#: / /
Fire Marshals Representative J
_ MJ Palmer Business Name: �6O . 1- r'?�) '-y'A1),1 , W../4 G /Leviie:-,,1
Location: i 2-.3 �%�<. K.. '(.4...z,(2_ . ,, its, 1 )�7
/'K Stillman Contact: /-77�';-='f �'///r2s'
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
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: / r j - k\L
Interior FC 1006.3& FC1029.8 i-f �G / /��t jJ' f`�- J
Exterior FC 1006.3 / a t.r>cs5-1 t C PA ,''r`r�vc
Clearance to Electrical FC 605.3 •
Electric Wiring Enclosed/Labeled FC 605.3.1 ��lC� hive / ''—( e-
Combustibles in Equipment Rooms FC315.2.3
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
/CO detectors FC 610
Clearance to Sprinkler/Gelling FC 315.2.1
.-----------
18"
/18" / 24"
EVAC SIGNS IN Rooms FC 404.6 (R1 &R2) ..----"e _
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5 ....----- `
Exterior Storage FC 315.3 ./_f REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311 2I DAYS
SYSTEMS: FC 901.6 lnsp 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