2012-561 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: P20120561 Date Issued: Tuesday, December 18, 2012
This is to certify that work requested to be done as shown by Permit Number P20120561
has been completed.
Location: 453 DIXON Rd BLDG 3
Tax Map Number: 523400-301-008-0001-012-000-0000
Owner: S D C ASSOCIATES
Applicant: CENTER FOR LIFE BALANCE, INC.
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 cDavp
owner of the responsibility for compliance with Site Plan, Variance, or
other issues and conditions as a result of approvals by the Planning Board ` or
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: P20120561 Application Number: A20120561
Tax Map No: 523400-301-008-0001-012-000-0000
Permission is hereby granted to: CENTER FOR LIFE BALANCE, INC.
For property located at: 453 DIXON Rd BLDG 3
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. T}Re of Construction Value
Owner Address: S D C ASSOCIATES
Certificate of Occupancy(COM)
453 DIXON Rd
QUEENSBURY,NY 12804 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
2012-561
CO Only - CENTER FOR LIFE BALANCE, INC.
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 30,2013
(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 Queensbury; Friday,November 30,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
c-4
Community Development Office
t. Town of Queensbury • 742 Bay Road • Queensbury, New York •92804
David Hatin, Director of Building& Codes •
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal t. '1
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 # 36 g - 1-I BLDG. PERMIT FILE# 10)- 5 ' d
� r If applicable
Name of Business: C-61P4.---er �i to Lp E..I61-1/1 �7' .
Address �/� �/� p /� I,, QUESTIONS? CALL 761-8256 OR
of Business: 9S� �i XVI �v3 • V�idr� 3 Sup.le l.�'l,,Qt�6YJ(,t{� EMAIL codes(aALL 7 sbury.net
WEBSITE
Ir_YT
Person in Charge or Manager: f�.1 l l 0111
t vim lav VISIT OURINFORMATION FOR MORE
kie--(1 i www.queensbury.net
Business Phone Number: '516* ')9 g"— / L./LIS
Type of Business: } _ t,ICJ/1Q 11RQ ,
Owner of Property: UC -S.Sl,CA deS Phone Number(s): 7q q
Home Cell
Owners Address: Lis 3 (U 1 (,() p_ u-e S[3 C I
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:
Of person submitting this form
Notes / Comments:
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: I )— L7-
BUSINESS
NAME: -co, for 1� t G(, laY)Ce J .1/1C .
BUSINESS ADDRESS: t S3 IO1 X(Y1 'R13 • sat 1 le
C u-e-evisJ 2 rag
BUSINESS PHONE: 5-I — r] q IS-- 7 LP-1 S
CONTACT 1: I ra-Ct. phi ! I fS - HOME PHONE t -L1 W
ADDRESS: 1-7 W i 11 i ( Sf -DY' SIOGLY:9 fly U 12SOL/
CONTACT 2: 1.\-i ( 1 a title- �0 V HOME PHONE 5-/ffs 3 /---96/019
ADDRESS: `t' 6 • I i L 1 L
kAq
/2_60(4
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 )I7'Time:Periodic Inspection Date: G3
742 Bay Road,Queensbury NY 12804 o Re•Inspect!on ®
518/761 8206/518 761 8205 ' CO Inspection Permit#: F - 5(.4
ire'Marshals Representative
BMJ Palmer Business Name: Cts 'w' 1----1C ' 2,i'ti 141,1(A:>
Location: L4 3 P'&-
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 , �/'� i(�
60
Inspection of extinguisher FC 906Ev Y -��S
TRACUSS
Plan ECC 50 n�61f j
TRUSS ID SIGNAGE FC 505.3 � f 1 �
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 A Mir
Compressed Gas FC 3003 V .i 4. .I
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803 -804 l/
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
Insp OK NC DATE: OK NC
SYSTEMS: FC 901.6 Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
HVAC Shutdown
Sprinkler System Annual . •--.. -.• .... . .. . .
Sprinkler FDC I Fire Mar, al lf:,UHCJ;.,ir i ct
Kitchen Suppression Semi Annual p OK to I75tf i r�:2ftifl'd E'^.•i Cr:;;...,-.4N. .
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6 -Annual i ry .
Knox Box:installed/checked FC506 l / 2U''t ,
hY ,
A
.,
Operating Permit, if required will be issued after - — - --
fire Nit,.. :-..
Completion of Inspection Town ofL::':;.;
4....-......_._.__.. ,
Inspection Form
.y
Town of Queensbury Fire Marshal O Periodic Inspection Date:j-J►s IGYTIme: '
742 Bay Road,Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 41115°CO Inspection Permit#: 1 L� S61
3 it Marshals Representative
MJ Palmer Business Name: C .ANA. C-Q A L,n 1.1,,,
Location: Ll s3. 0 �,,..1 R.1::.
GK Stillman Contact: T a roc t
Type of Inspection N/A 7.,.. NoEXITS: Exit Access FC 1014&FC1029 � NOTES
Exit Enclosure FC 1020& FC1029
Exit Discharge FC 1024&FC1029
Locks and latches FC1008 B. FC1029.2 , ‘) Op�2-ep1: 'lam S Co< til
Sign:Normal FC 1011 &FC1029 /
Sign:backup FC 1011.5.3& FC1029.7.5 h'lu i _J C'cui Ii*.v i
AISLES: S l b ya c U 0
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 // a) 't?1 C -- 41,A^ r4 t )
EVAC Plan FC 404.6 rae,h _ J l_(Aryl 01/V+/1-
TRUSS ID SIGNAGE FC 505.3 /// Vb /
EMERGENCY LIGHTING: � �
Interior FC 1006.3&FC1029.8
Exterior FC 1006.3
Clearance to Electrical FC 605.3
a)
Co. 5� -g
Electric Wiring Enclosed/Labeled FC 605.3.1 /
Combustibles In Equipment Rooms FC315.2.3ho�j4; Nog •Crmt1 P/ 4 t'
F.D.Signage- FC 510 / i CCT l (4t4-r-1 i S - 6.-J-l•-
No Smoking Signs FC 310.3
Storage FC 315.2 / -t.A. ; YY ,i1otoS
Compressed Gas FC 3003
Vehicle Impact Protection FC 312.1 /- �, d�UnN
Interior Finishes FC 803-804 ! '
Smoke Detectors FC 907 f
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 /
ExterioVacant StoragBuildings
FC 315.31 /� REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311 S 21 DAYS
Insp OK NC DATE: OK NC
SYSTEMS: FC 901.6 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
•
(�) L ENTRY
U6'x6-1"
BATH
BATH 6.8 x5'-5" STORAGE
Open Area •
7.1
111 LI
1r
CLOSET
7xT-7
Li)
OFFICE OFFICE OFFICE
17x 11'-r 17x13' 12'x1O'
•
EVERGREEN PROFESSIONAL PARK
BUILDING 3 LEFT UNIT