CC-000159-2016TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-82014WLCommunityDevelopment-Building& Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CC-000159-2016 Date Issued: Monday, August 21, 2017
This is to certify that work requested to be done as shown by Permit Number CC-000159-2016
has been completed.
Tax Map Number: 303.16-1-58
Location: 446 DIX AVE
Owner: First Tracks LLC
Applicant: Jay Salmon
This structure may be occupied as a: CAMERON'S DELI
4064 sq. ft.Retail-Mercantile bldg. By Order of Town Board
Cross Ref. SP PZ-0060-2016 TOWN OF QUEENSSBBURY
4t-property
Issuance of this Certificate of Occupancy DOES NOT relieve the f/
owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: CC-000159-2016
Tax Map No: 303.16-1-58
Permission is hereby granted to: Jay Salmon, First Tracks LLC
For property located at: 446 DIX AVE
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 e of Construction
Owner Name: First Tracks LLC Retail-Mercantile-New $700,000.00
Owner Address: 451 Lockhart Mt. RD Total Value $700,000.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans& Specifications
CAMERON'S DELI
4064 sq. ft.Retail-Mercantile bldg.
Cross Ref, SP PZ-0060-2016
$ 934.72 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,July 27, 2017
(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 uee ury; ,�Ved d Jul 27, 2016
SIGNED BY; ////Q�/ for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
Date:
s, Tax Map ID
Zone Historic? s ANS 8 �-� c 1~
Subdivision Name L vSi�te Pit
T;DWW07UMEEqNSWIR' ' ion
Project Location qy& 0 h
TOWN BD.RESOLUTION 86-2013: $850 recreation fee for new dwel ing units—single family,duplexes/two-family, multiple family,
apartments,condominiums,townhouses,and/or manufactured&modular homes,but not mobile homes. This is in addition to the
permit fee(s).
Primary Owner(s) �— r
Address
Luctl,�c T t2a 1,4 IzeC w; �S s
Phone/Email {� i
i C5-G1 GdM
Applicant
Address / �}
t�lr� c,r �-(7- 62D c'r f S
Phone/Email
Civ c
Contractor
Address
Phone/Email
Contact Person for Building & Codes Compliance: � -� Phone Vg-z-ab(o3
TYPE OF CONSTRUCTION
✓Check all that apply New Addition Alteration 1s1 floor sf 2"floor sf Total sf Height
Single Family
Two-Family
Multi-Family
(#of units�)
Townhouse
Business Office
Retail -Mercantile -� yo r` Y r _ ` r3
1 1 7
Factory-Industrial
Attached Garage
(1, 2, 3, 4+)
Other
Town of Queensbury Building&Codes Principal Structure Application revised January 2016
If commercial or industrial please indicate name of business l�c0� L►
Proposed use of building or addition
Source of Heat(circle one) as Oil Propane Solar Other
Fireplace: Complete a separate application for Fuel Burning
Appliances&Chimneys tilt
Are there structures not shown on plot plan? !V U
Are there easements on the property?
Site Information:
a. Dimensions or acreage of lot
b. Is this a corner lot? _((�Yes No
c. Will the grade be changed as a result of construction Yes No
d. Public water or Private well(circle one) Pubh Private
e. Sewer or Private Septic System(circle one) Sewerrivat
Value of all work to be performed(labor or materials) 1 $_200,000
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be
completed within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. I certify that the application, plans and supporting materials are a true and complete statement /
description of the work proposed, that all work will be performed in accordance with the NYS
Building Codes,local building laws and ordinances,and in conformance with local zoning regulations
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate
of occupancy.
5. I also understand that I /we are required to provide an as-built survey by a licensed land surveyor of
all newly constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above:
PRINT NAME: r.A) DATE: /+
SIGNATURE: r'C- DATE41
For office use only
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
Fuel Burning Appliance & Chimney Application Office Use only
Received
DATE: 3 z Z I Tax Map ID
TAx MAP ID: 3 O 3 • RL-/ - Permit No.
ZONE: r Permit Fee
OWNER -- S
LLC- PHONE/E-MAIL5-S--C-k y
ADDRESS i' lei ¢Ke, 6"rec, If g^ZJ r s ntwc e �'
INSTALLER/ HONE -MAIL
BUILDER
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: _ �•¢�., Srtt vti+. �,.�
PHONE/E-MAIL ��S��fv(a �( f r-5 A vicAr1t..C_i15 BUILDING ADDRESS LI �rX Ave- Q ee y3l v
�y
ROOM OF INSTALL: PLANNED INSTALL DATE:
FUEL BURNING APPLIANCE INFORMATION WOOD COAL PELLET GAS OIL NOTE: ROUGH-IN&
STOVE FINAL INSPECTION ARE
FIREPLACE INSERT REQUIRED.
FIREPLACE,FACTORY BUILT*
NOTE:
MANUFACTURER'S
FIREPLACE,MASONRY
INSTALLATION MANUAL
FURNACE(GARAGE ONLY) MUST BE AVAILABLE AT
TIME OF INSPECTION
*If factory built provide manufacturer name: ; Model#:
Listed by: Number:
CHIMNEY INFORMATION
Masonry** (check one) BLOCK BRICK STONE
Flue TIE STEEL Size in inches
Material DOUBLE WALL TRIPLE WALL INSULATED
** If non-masonry provide manufacturer name: ;Model#:
DECLARATION: Construction/installation must conform to NYS Fire Prevention & Building Code and/or
manufacturer requirements. The applicant or owner agrees to comply with all applicable laws, ordinances,
regulations,and all conditions that are part of these requirements and also will allow inspector's to enter premises
to perform required inspections.
I HAVE READ AND AGREE TO THE ABOVE:
PRINT NAME: DATE: f 2 2-h
SIGNATURE: DATE: 3
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DATE: 3 f Z II So Tax Map ID
TAx MAP ID: 303. 1 (" "l -$" Permit No.
Permit Fee
ZONE: �1 "' CM
APPLICANTLam_ 99 grr HONE/E-MAIL t 8 {S'1S ,fo
ADDRESS 5! 40 c kJtc r 4- • T L.l (oEai 2_8v 3
INSTALLER/ P /E-MAIL
BUILDER
OWNER r
l/c.G�c
ADDRESS j �iL JL`c ct/4 — ICCr 6`/ C (o v
CONTACT PERSON FOR BUILDING,&CODE COMPLIANCE:
PHONE/E-MAIL §LK j 6 rr^ �'IC& .Let W5�- C--0!'C4,._%_
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980 or older Garbage grinder installed Yes No
1981-1991 Spa or Hot Tub installed Yes No
1992-Present
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature V- Sand DC Loam Clay Other
Groundwater At what depth:
Bedrock/Impervious material At what depth:
Domestic Water Supply L—Municipal Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: A M,n per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size /�gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
System Absorption f eld with#2 stone Total length U V ft.;Each Trench
Seepage Pit with#3 stone How many: ;Size
Alternative System Bed or other type:
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will
no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the
septic system layout on file—no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure
to make a material fact or circumstance known by or on behalf of an applicant,shall be void.I have read the regulations and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: DATE: — 3 /Z 2-/ 16
SIGNATURE: DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised January 2016