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2012-332 TOWN OF QUEENSBURY 742 Ba•Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20120332 Date Issued: Friday, September 07, 2012 This is to certify that work requested to be done as shown by Permit Number P20120332 has been completed. Location: 384 QUAKER Rd Tax Map Number: 523400-303-005-0001-083-000-0000 Owner: DEMETRIOS KOLIOS Applicant: DEMETRIOS KOLIOS 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 Planning Board Director of Building&Co e Enfoement or Zoning Board of Appeals. TOWN OF QUEEN SBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20120332 Application Number: A20120332 Tax Map No: 523400-303-005-0001-083-000-0000 Permission is hereby granted to: DEMETRIOS KOLIOS For property located at: 384 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: DEMETRIOS KOLIOS Certificate of Occupancy(COM) 28 SPA Dr Total Value SARATOGA SPRINGS,NY 12866 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2012-232 CO Only- Quaker Road Restaurant Corp. d/b/a Jim's Cafe $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 10,2013 (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 o nsbury; Tuesd.y,July 10, 2012 SIGNED BY G' d / for the Town of Queensbury. Director of Building&Co, • Enf>; ement Community Development Office Town of Queensbury - 742 Bay Road • Queensbury, New York •92804 % ' ,-. 1? David Hatin, Director of Building& Codes Craig Brown, Zoning Administrator- Michael J. Palmer, Fire Marshal Stamp ESTABLISHMENT OF A NEW BUS/NESS CERTIFICATE OF OCCUPANCY PERMIT APPLICATION *Note: This application is for occupancy only, with no work requiring a building permit. TAX MAP # 303. 05 - 1 - 3 BLDG. PERMIT FILE# 1 _ 3 If applicable \ Name of Business: 4 u C (�DQ C, ran"q/it► Irons C k Address of of Business: 34 1,- 1 ON C0.1.e� AUG U QUESTIONS? CALL.761-8256 OR EMAIL codes(&queensbury.net VISIT OUR WEBSITE FOR MORE Person in Charge or Manager: fir^\kTI os ‘c0 I v S INFORMATION www.queensbury.net Business Phone Number: (5 l<1 3C0a�p Type of Business: -ReS�(Aro cc), Owner of Property: 1401, 0', Phone Number(s):C`J I<l 5 )7-l0\i2. ( 1 ) I "' L110 ci Home Cell Owners Address: . ;> `i , ', )D 14 f Sett At k.) f1 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: 9-4116k t9-1 V _ �If� tl Date: Of person submitting this form Notes / Comments: 6P EMERGENCY CONTACTL.?- 3 3.6' E��'L�A.TE TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502 PLEASE PRINT DATE: ' BUSINESS NAME: G U -Ae¢ Rvac) TZes- ,c-Rk}- 6-rap p / ),ri c ck, DBA BUSINESS ADDRESS: 3S4 U(3.-Ee,2 koctc) BUSINESS PHONE: (31 )--)q 3— 3l13 CONTACT 1: �e►n-4n ciS Vt. I,�s HOME PHONE S2 1 6 2- ADDRESS: g S. 6 • 1de -be __ N I 2_51-14 CONTACT 2: M-PcIA/- tHOME PHONE Sti -6(52 ADDRESS: ..tv k 1 t6 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. FIRE MARSHAL'S OFFICE •. Town of Queensbury IF 742 Bay Road, Queensbury, NY 12804 "� " Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW Jim's Cafe 2012-332 7/9/2012 The following comments are based on plan review of submittals 1) Add " K " style extinguisher in kitchen 2) Locks / Latches must comply with FC 1008.3 3) All exit signs must be compliant with battery backup 4) All means of egress must be illuminated 5) Fire extinguishers throughout to have current inspection 6) FM office will provide max occupancy signage x\ix\de ..--Z:L. Michael J Palmer Fire Marshal 742 Bay Road Queensbury NY 12804 firemarshal@queensbury.net Fi re Marshal 's Office • Phone: 518-761-8206 • F a x: 518-745-4437 fireniarshal@queensbury.net • www.queensbury.net Inspection Form Itt Town of Queensbury Fire Marshal 0 Periodic Inspection Date: • Time: t 742 Bay Road,Queensbury NY 12804 o Re-Inspection 518 761 8206/518 761 8205 ''CO Inspection Permit#: I • F e Marshals Representative MJ Palmer Business Name: tt Location: t Q v e - n 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: i _`+(,, i Nir 1 1..„ /.<1 4 G 4 C b li Main Aisle Width FC 1024/1025&FC1029.11 Secondary Aisle Width FC 1025&FC1029.11 iNV4k- f, 6' FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 EVAC Plan FC 404.6 LULA cit 1 opt L. TRUSS ID SIGNAGE FC 505.3 �L 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.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 21 DAYS (DcSYSTEMS: FC 901.6 Insp OK NC DATE: C)=70)� OK Date Generator Annual DATE: OK NC t Hood Installation Elevator Semi Annual 44.2 >p FIRE ALARM Annual bfrE: OK NC HVAC Shutdown Sprinkler System Annual Sprinkler'FDC Kitchen Suppression Semi Annual -7 1 Fuel Island Suppression S Annual Hood Cleaning 3 6 Annual "7 Id Knox Box:installed/checked FC506 Operating Permit, if required will be issued after Completion of Inspection Inspection Form Town of Queensbury Fire Marshal c Periodic Inspection Date: IC) Time: 742 Bay Road,Queensbury NY 12804 Re-Inspection 518 761 8206/518 761 8205 ''CO inspection Permit#: F' Marshals Representative MJ Palmer Business Name: Location: 3 s-i Xe/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 ti C-t t L� t.*t AISLES: cAtOCAS Main Aisle Width FC 1024/1025&FC1029.11 ���� �� 7 Secondary Aisle Width FC 1025&FC1029.11 ,,fk v+-t06�' FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 EVAC Plan FC 404.6 ��., ®1�-- ©LE. TRUSS ID SIGNAGE FC 505.3 O Lt 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.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 21 DAYS SYSTEMS: FC 901.6 Insp OK NC DATE:c) Y)Ty O C 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 -7 i Fuel Island Suppression Srual Hood Cleaning 3 - nnual �,� K Knox Box:installed/checked TFC506 Operating Permit, if required will be issued after Completion of Inspection Inspection Form � Town of Queensbury Fire Marshal o Periodic Inspection Date:9 1r Q�P- Time: V 742 Bay Road,Queensbury NY 12804 o Re-Inspection t Z • 3 a 518 761 8206/518 761 8205 CO Inspection Permit#: Fire arshals Representative MJ Palmer Business Name: . ►vy-Is CP9 r� Location: 36y G1,,,ax n .f�ba o GK Stillman Contact: ---5,w. 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 K. 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 Q 0 tt fr 4•c.-s Coln cc-tr.-0 _FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 EVAC Plan FC 404.6 TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTINGOK..._- �• 1 Interior FC 1006.3&FC1029.8 �fExterior 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.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 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 � rinSuppression Seml Annual Fire Marshal InspectUll Complete KitOK to issu Fuel Island Suppression Semi Annual e CWtlficate of Occupancy Hood Cleaning 3-6 -Annual Knox Box:installed/checked FC506 . - ../;_i" U Operating Permit, if required will be issued after Completion of Inspection i RR9 Town or q -ei—.----. Inspection Form Town of Queensbury Fire Marshal O Periodic Inspection Date: 1 )1me:1'Ti2115 7147 742 Bay Road,Queensbury NY 12804 o Re-Inspection � 518 761 8206/518 761 8205CO Inspection Permit#: AR-3`--'C Fire Marshals epresentative ____---> MJ Imer Business Name: !''h 'S CLQ,, Location: 3 Cc 2'4 (ice. GK Stillman Contact: t., 1c7S' iii 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 --- i cr J4rp ,/J ,a",/,,,W) , Gi Sign:Normal FC 1011 &FC1029 Sign:backup FC 1011.5.3&FC1029.7.5 X AISLES: X -j � Main Aisle Width FC 1024/1025&FC1029.11 �f .r �^ Tet Secondary Aisle Width FC 1025&FC1029.11 / ""a+l � f T/ rte- 2.'6T>d FIRE EXTINGUISHER: Hung FC 906 i dl 11„ll X1 77 Inspection of extinguisher FC 906 r,/ , EVAC Plan FC 404.6 te r. ii: C _.e iii A' 1- - i•i-517 iti TRUSS ID SIGNAGE FC 505.3 ,. . g> !2. ecce i2_ CF QI1'l , EMERGENCY LIGHTING: � 7; Interior FC 1006.3&FC1029.8 .>< i' ""`n`T p Exterior FC 1006.3 Clearance to Electrical FC 605.3 �' y_ $.R� I CO�bo _j�4 r_ d 00'�. 1 Electric Wiring Enclosed/Labeled FC 605.3.1 ./ ' Combustibles in Equipment Rooms FC315.2.3 iZ 45 I ISG.ea. F.D.Signage- FC 510 ..------ No f St Smoking Signs FC 310. _/r 1 v �f� 4m i Q„-T - • Storage FC 315.2 -s-1 [mac �G.J y/- Compressed Gas FC 3003 �/ t2';" T Jk(YXJ n/rl' ) r,<1 � Vehicle Impact Protection FC 312.1 Interior Finishes FC 803-804 ..----"' ia- eC- ' - z Smoke Detectors FC 907 If V.i L',Q'2 FIT G1Al7r CO detectors FC 610 y Clearance to Sprinkler/Ceiling FC 315.2.1 / 2) Y► g4C- 18" / 24" / �l! -,5' 5cr_,ss� 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 3 311 Vacant Buildings FC 311 REINSPECTION DUE APPROXIMATELY 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 1/1,-...X1 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 Pre-Engineered Restaurant Fire Suppression Systems Report SERVICE COMPANY 1. All appliances properly covered w/correct nozzles 2. Duct and plenum covered with/correct nozzles 3. Check positioning of all nozzles ✓ f�� 4. System installed in accordance w/MFG UL listing A RiCAN SAFETY PRODUCTS Q, 2012 5. Hood/duct penetrations sealed w/weld or UL device V of Empire State Rt SO 6. Check if seals intact, evidence or tampering Gansevoort.N.Y. 12831 7. If system has been discharged, report same q141; Al Rose X18- 4183 8. Pressure gauge in proper range (if gauged) 9. Check cartridge weight (if applicable) .-T\' CUSTOMER 10.Hydrostatic test date �' ►^ti S CCS'� 11.6 year maintenance date Name �Q 12.Inspect cylinder and mount Address 3 8- Y c l� A'Ky n Q/'" 13.Operate system from terminal link V 1 14.Test for proper operation from remote City Q0egyi s 60 Jay aeo `I 15.Check operation of micro switch ,fr 16.Check operation of gas valve v! Telephone -7,3 - 3 - Store No. 17.Clean nozzles V 18.Proper nozzle covers in place 'V Owner S M nag= DP J T1Q I as ,&p1-I 19.Check fuse links and clean ✓ 20.Replaced fuse links 1/� 21.Check travel of cable nuts/S-hooks DATE 0 SERVIC TIME AM PM 7 _ Z / 22.Piping&conduit securely bracketed ✓ ANNUA SEMI-ANNUAL RECHARGE INSTALLATION RENOVATION 23.Proper separation between fryers and flame 24.Proper clearance-flame to filters ✓ LOCATION OFYSTEM CYLINOFiRS /-, 25.Exhaust fan in operating order ✓ b 14fl0 LA/ 26.All filters replaced __I fAANU ACTURER MODEL NUMBER WET DRY CHEMICAL 27.Fuel shut-off in on position V Otte' L. 6 no i.--- 28.Manual&remote set/seals in place ✓ CYLINDER SIZE MASTER / CYLINDER SIZE SLAVE CYLINDER SIZE SLAVE 29.Replace system covers 5 G'/ 30.System operational &seals in place t .FUSE LINKS 360•F FUSEiINKS 50'F FUSE LINKS 500°F OTHER 31.Slave system operational ir FUEL SHUT-OFF ELECTRIC GAS SIZE 32.Clean cylinder&mount 1/" -1.------- 33.Fan warning sign on hood ✓ SERIAL N B 2 n cco LAST YDR o DATE LAST RECHARGE DATE 34. Personnel instructed in manual operation of system 1B (to,..a.,_, 35.Proper hand portable extinguishers ✓ MANUFACTURER'S MANUAL REFERENCE 36.Portable extinguishers properly serviced ✓. 37. Service & Certification tag on system ✓ PAGE NUMBER DRAWING NUMBER: NOTE DISCREPANCIES OR DEFICIENCIES BELOW COOKING APPLIANCE LOCATIONS:LEFT TO RIGHT 13, mover INP ArbII 010-1-/ ri y COMMENTS On this date,the above system was tested and inspected in accordance with procedures of the presently adopted editions of NFPA 17, 17A, references to Fire Suppression Systems contained in NFPA 96, and the manufacturer's manual, and was operated according to these procedures with results indicated above. X il /,' ( ei, SE' ICE TECHNICIAN PERMIT NO. D TIME AM PM CUSTOMER' AUT OR ED AGENT The above service technician certifies that the system was personally inspected and found conditions to be as indicated on this report. 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