2012-363 ..111111A TOWN OF QUEENSBURY
icw742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120363 Date Issued: Thursday, October 18, 2012
This is to certify that work requested to be done as shown by Permit Number P20120363
has been completed.
Location: 32 WESTERN Ave S
Tax Map Number: 523400-309-007-0001-058-000-0000
Owner: DELWYN & JEAN MULDER
Applicant: MANSFIELD FINANCIAL STRATEGIES, 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
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&Col Tit-lb y ent
or Zoning Board of Appeals.
TOWN OF QUEENSBURY -
`
742 Bay Road,`uccnsbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120363 Application Number: A20120363
Tax Map No: 523400-309-007-0001-058-000-0000
Permission is hereby granted to: MANSFIELD FINANCIAL STRATEGIES, LLC
For property located at: 32 WESTERN Ave S
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: DELWYN &JEAN MULDER
34 HELEN Dr S Certificate of Occupancy(COM)
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans& Specifications
2012-363
CO Only- Mansfield Financial Strategies, LLC
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, August 08, 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 Tow f Que sbu/ W , e l ay, August 08, 2012
i
SIGNED BY f. 41� for the Town of Queensbury.
Director of Building& Code Enforcement
) : Community Development Office ,
.;. Town of Queensbury • 742 Bay Road • Queensbury, New York -12804
S'
David Hatin, Director of Building& Codes 1 U i i ?U� cp
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal
WA q.. L ,
Pill! DP-
ESTABLISHMENT OFA NEW BUSINESS
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit.
TAX MAP# 3 019.7 1 - 5 BLDG. PERMIT FILE#
If applicable
Name of Business: 11A N S�t L L� 1 N A NC I P t. 5 I Ai e 6- IES/ L LC
Address 2 ^��rN 1 d
A�/
of Business: 71-
B O U T �� W L S 1 K e, QUESTIONS? CALL 761-8256 OR
QUEEN S aJ Q y , N .
1. f 24'
4oLf
EMAIL codes{&queensbury.net
IvVISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: 6A 2 y S co F i L L I) INFORMATION
www.queensbury.net
Business Phone Number: 5 f'a - 63 6'05 r0
Type of Business: 1 N S 0 I V A 7••.) (x 5 L 12 Q1 CC'', SI (----.1 'j'J Pc'N S I A L c 1J SJ L j 1 N (T
Owner of Property: 'JG1-V- y 0 H U L 6 E2 Phone Number(s): 29.2.-0()?7 -712-7355-
E944
356E94 !c-<._
Owners Address: 3 V 4 E L E ---DU >E E Als B U Ry
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: �' Date: 7 1 ZJZ
�
Of person s 7b� g this form m-5,9
Notes / Comments:
ee c - 3 (03
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT FAX: 743-2502
PLEASE PRINT
DATE: 'ILj Ly
BUSINESS NAME: A t\JSJJcN(iAL Si AA1-6 It;S LLC
BUSINESS ADDRESS: 32 S0, W e A J e ,
QJc ��s3�Ry� N), y. ( zs„ ,f
BUSINESS PHONE: (61 9) (0 3 (- (Q 5 70
CONTACT is 0112 SCD{- (L HOME PHONE 1 e) 6'6 5" 5°Y°
ADDRESS: LSAAO 6 N . ( Z k
CONTACT 2: -/)e Ln I My
HOME PHONE R Zy 6U 2-7
ADDRESS: 3q" qT c_ LF_ J 2., Q06 ius B U 2'vf, '6?
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 =Periodic Inspection Date: 1f�InYTime: I'43
742 Bay Road,Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 44D CO Inspection Permit#: 1)- 3 G' 3
F e Marshals Representative
x _
MJ Palmer Business Name: Mo,o ie-L_� t -"...-crw,
Location: 3 a- Swte\- -
_ GK Stillman Contact: a. w•T
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 l NOTES
Exit Enclosure FC 1020& FC1029
Exit Discharge FC 1024&FC1029
Locks and latches FC1008& FC1029.2
Sign:Normal FC 1011 &FC1029 Z.-
Sign:
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 / 0 / 0
...7
EVAC Plan FC 404.6 .7 (�-�
TRUSS ID SIGNAGE FC 505.3 /-
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8 / CC
Exterior FC 1006.3
Clearance to Electrical FC 605.3 V.
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 l .
Interior Finishes FC 803-804
Smoke Detectors FC 907 l
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 7
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 I 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 ? Fife M'3 A1 In cCorrpt> (cl
Kitchen Suppression Semi Annual OK to Issue C of +rup2r.cp
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6 -Annual
Knox Box:installed/checked FC506 �3 (+n
\. i U��_
Operating Permit, if required will be issued after j """ F - 1iwl
Completion of Inspection pu 3Ju r..r._ . J.