2014-023 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: P20140023 Date Issued: Monday, March 03, 2014
This is to certify that work requested to be done as shown by Permit Number P20140023
has been completed.
Location: 375 BAY Rd
Tax Map Number: 523400-296-019-0001-032-000-0000
Owner: 375 BAY ROAD LLC
Applicant: JERSEN CONSTRUCTION GROUP
This structure may be occupied as a:
Commercial Alteration By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the property 1 „ -
owner of the responsibility for compliance with Site Plan, Variance, or � Of
P tY P � �
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
0.k TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140023 Application Number: A20140023
Tax Map No: 523400-296-019-0001-032-000-0000
Permission is hereby granted to: JERSEN CONSTRUCTION GROUP
For property located at: 375 BAY 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: 375 BAY ROAD LLC Commercial Alteration $30,000.00
6 INDUSTRY Rd Total Value $30,000.00
WATERFORD NY 12188-0000
Contractor or Builder's Name/ Address Electrical Inspection Agency
JERSEN CONSTRUCTION GROUP
518-233-0600
6 INDUSTRY Dr
WATERFORD NY 12188-0000
Plans&Specifications
2014-023 Mountain Lakes Regional EMS Council
Comm. Alteration
$481.40 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,February 11,2015
(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 f Quee sbu / /J Tu: r a /_ • • uary 11,2014
SIGNED BY t for the Town of Queensbury.
Director of Building&Code Enforcement
UPDATEEMERGENCY CONTACT
Please print clearly
DATE:
BUSINESS NAME:
BUSINESS ADDRESS:
BUSINESS PHONE: _ J R - 793 - ea-UO
PHONE 1: 0 a 2
CONTACT 1: J;�cl v i`_S ��acp PHONE 2:
TOWN/VILLAGE RESPONDING FROM: &.,)CL Kr-&--yc S La mac,
PHONE-1: 30? -z3 3g
CONTACT 2: c� o� c.1 1`� �C�t� C�� PHONE 2: -104?
TOWN/VILLAGE RESPONDING FROM:_ (2 J e.+_c.S' l S
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
-P__OlI_CE AND/OR FIRE PERSONNEL.__`_ ----------...-_-. . __..
TOWN OF QUEENS .BURY FIRE MARSHAL'S OFFICE
Phone: 518-761-8205 - Fax: 518-745-44.37
firemarshal@queensbua .net - wzya).queensbuni.net
Fire Marshal Michael J Palmer Deputy Fire Marshal Ganj Stillman
Office Use Only
Town of Queensbury Building & Codes Received: ;�G � )q_ 1.3a
PRINCIPAL STRUCTURE APPLICATION Tax Map ID. JA:4 3 (l ?U14
Permit No.; /4-1 - 0/ 3
A permit must be obtained before beginning construction Permit Fee: $ ry g/, yD
Please read: *TB resolution 86-2013(1-28-2013): $850 recreation fee for new dwelling xRec Fee: $ A) in
units, including single-family dwellings, duplexes or two-family dwellings, multiple family Site Plan No.:
dwellings, apartments, condominiums, townhouses, and/or manufactured and modular Subdivision No.:
homes,but not including mobile homes. This is in addition to the permit fee.
Date /' 29'• ZO/5/ Applicant ,� e5&sL Tt)' `Q'U (-gm)?
Tax Map ID 29G./9 ^1 --3 Z Address j. /+kiBt>s7 Y` ,
Zoning G I /Alk '(.. , , ( / c' s'
Phone/E-mail t�." 12 ) 2.32 Ac) Jkar(Property Owner 375 93A`( A. , Contractor/Agent ..94.14 A, t r4 r""
Address /4/4) 2)4, Address
In/4t
Phone/E-mail (51/) 2. 4 ) Phone/E-mail
Contact Person for Building &Code Compliance: J044 r rxr Day Phone:()233-V690
Building Street Address: 37S
Subdivision Name: Lot#: Historic Site: Yes $- No
Estimated cost of construction: $ 39, fl
Type of Construction:
Check all that apply Please indicate measurements as required below: -
:a 1st Floor 2nd Floor Other Total Height 1
F ¢ a
Single Family
Two-Family
Multi-Family(#of
units )
Townhouse
Business Office Y- 2 (o 7 z go I 96
Retail-Mercantile
Factory-Industrial
Attached Garages(# )
Other
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
If commercial or industrial indicate name of business othgrAi N lAle R" DAitiL EkS
,.Ot9N4/1—
Proposed use of building or addition
D F1^t '
Source of heat(circle one) 491 Oil' Propane Solar Other
Fireplace-complete a separate application for"Fuel Burning Appliances&Chimneys' Yes t—No
Are there structures not shown on plot plan? /
Are their easements on the property? N
Site Information
a. Dimensions or acreage of lot fq
b. Is this a corner lot? j4 /06"
c. Will the grade be changed as a result of construction: Yes V—No
d. Public water or Private well
e. Sewer or Private Septic System
Value of all work to be performed(labor and materials) $ /—
Declaration:
I acknowledge no construction activities shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval. 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 NY State Building Codes, local building laws and ordinances, and
in conformance with local zoning regulations. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a
certificate of occupancy. 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: •J- r
Signature: /6 - Date: / ' Z6//Y
FOR OFFICE USE NLY:
Operating Permit Issued: _Yes _No
Occupancy Type:
Construction Classification:
Assembly Occupancy Limit:
Special Conditions:
Town of Queensbury Building&Codes Principal Structure Packet 518-761-8256
Town of Queensbury Building&Code Enforcement N\0161.aoy
Office No. (518)761-8256
Commercial Final Inspection Report
Inspection request received:
Name: (4-n LaFt . s iMS Inspected on: `3 14
Location: ') 5 (4!Ct ?cL Arrive: - Air 4114p.m.
Permit No.: o� Inspector's Initials:
• COMMENTS
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete _
Exterior Finish/Grade Complete 6"in 10'or Equivalent
Interior I Exterior Guardrails 42 inch Platform 1 Decks
Interior/Exterior Balusters 4 inch Spacing Platform/Decks
Stair Handrail 34 inch—38 inch!Step Risers 7"!Treads 11"
Vestibules For Exit doors>3000 sq.ft. /
All Doors 36 inch w!Lever Handles!Panic Hardware,if required
Exits At Grade Or Platform 36"(w)x 44"(I)!Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay _
Relief Valve,Heat Trap I Water Temperature 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy!Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/2 doors >10%>1000 sq.ft.
3/4 Hour Corridor Doors&Closers
Firewalls!Fire Separation,2 Hour,3 Hour Complete I Fire Dampers I Fire Doors
Ceiling Fire Stopping,3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets I Mirrors
Handicapped Bath I Parking Lot Signage C i T -\ 1 R))t-W
Public Toilet Room Handicapped Accessible
Handicapped Service Counters,34 inch,Checkout 36 inch \ "�;>�>M s V
Handicapped Ramp 1 Handrails Continuous/12 inch Beyond[Both sides]
Active Listening System and Signage Assembly Space
Final Electrical/Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req. _
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway 4"
Water Fountain or Cooler
Building Access All Sides by 20'!Drivable Surface 20'wide ,!
Special Inspections!Engineer or.ArchitectAppro al
Okay To Issue Tempora or Permanent C/O )_._
Okay To Issue C/C �` \ 1, 5 C
Commercial Final Inspection_ 11 27 12
Town of Queensbury Building&Code Enforcement
Office No. (518)761-8256
Commercial Final Inspection Report
Inspection request received:
Name: S-L,'✓c f ��. I ` 2C1�nspected on:
Location: 7i 7 J ��,a'/ It"4 Arrive: lb,�
Permit No.: -- CO-2 7 Inspector's Initials: '1/'
•
COMMENTS
Y N NA
Chimney/"B"Vent I Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish/Grade Complete 6"in 10'or Equivalent
Interior/Exterior Guardrails 42 inch Platform/Decks
Interior!Exterior Balusters 4 inch Spacing Platform/Decks
Stair Handrail 34 inch—38 inch/Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq.ft. Y
All Doors 36 inch w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36"(w)x 44"(I)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve,Heat Trap!Water Temperature 110 Degrees Maximum
Boiler!Furnace Enclosure 1 hour or Fire Extinguishing System
Fresh Air Supply for Occupancy!Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within-30 ft.o.Within Line Of Site I I
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.),1 '/2 doors >10%>1000 sq.ft.
%Hour Corridor Doors&Closers
Firewalls I Fire Separation,2 Hour, 3 Hour Complete I Fire Dampers!Fire Doors
Ceiling Fire Stopping,3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan,if required
Elevator Operation and Signage!Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets/Mirrors
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters, 34 inch,Checkout 36 inch
Handicapped Ramp!Handrails Continuous/12 inch Beyond[Both sides]
Active Listening System and Signage Assembly Space
Final Electrical/Flex Gas Piping Bonded
Site Plan 1 Variance required
Final Survey,New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway 4"
Water Fountain or Cooler ��
Building Access All Sides by 20'/Drivable Surface 20'wide
Special Inspections/Engineer or Architect Approval _ C
Okay To Issue Temporary or Permanent C/O "'
Okay To Issue C/C111.
Commercial Final Inspection_ 11 27 12
1-5
Inspection Form _
Town of Queensbury Fire Marshal Periodic Inspection Date: 2 21"•1°rTime,
742 Bay Road,Queensbury NY 12804 2.Re-Inspection r
518 761 8206/518 761 8205 CO Inspection Permit#:
Fire Marshals Representative J �
MJ Palmer Business Name: Ml 7 k >
Location:
►.✓''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 a
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 `� f
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906 7 v
EVAC Plan FC 404.2
TRUSS ID SIGNAGE FC 505.3 `t GUt)% ;� t°) �t( �", �-
EMERGENCY LIGHTING: / r �r
Interior FC 1006.3&FC1029.8 ' '`
Exterior FC 1006.3 �.®
Clearance to Electrical FC 605.3 ! t t g t yam, ��,
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3
e No Smoking Signs FC 310.3
Storage FC 315.2 "'
Compressed Gas FC 3003 f
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 404.6 111 &112) r,��"" I p; y
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 REINSPECTIONDUE APPROXIMATELY
Vacant Buildings FC 311 21 DAYS
Emergency Disconnect FC 2203.2 0' "
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
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual VVV
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
Inspection Form
Town of Queensbury Fire Marshal CD Periodic Inspection Date: -z3e' .A Time: r
742 Bay Road,Queensbury NY 12804 o Re-Inspection
518 761 8206/518 761 8205 'CO Inspection Permit#:
Fire Marshals Representative
_ MJ Palmer Business Name: 1/1,111
Location:
�zGK Stillman Contact:
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 NOTES
Exit Enclosure FC 1020&FC1029 ,,p`
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
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
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3 -
F.D.Si na e- 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 r
CO detectors FC 610 '° ,r
Clearance to Sprinkler/Ceiling FC 315.2.1 .d `
18" / 24" r��'�5I ✓' 1
EVAC SIGNS IN Rooms FC 404.6(RI &R2
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5
Exterior Storage FC 315.3 Buildings
uild REINSPECTIONDUE APPROXIMATELY
Vacant Buildtn s FC 31111 .,,�"'
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 S stem Annual ",✓
—Sprinkler FDC fir .
Kitchen Suppression Semi Annual
Fuel Island Suppression Semi Annual
Hood Cleanin 3-6 -Annual
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Horace of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Mountain Lakes EMS
2014 - 023
2/11/2014
The following comments are based on response to review of drawings:
• Egress door will require compliant hardware,paddle or lever device
• P ovide key for Knox Box
• Verify all fire alarm devices in place and functioning. Addition of a wall may change
the layout of devices
•/ Fire extinguisher locations to be discussed
Exit/Emergency lighting layout appears Combo pak ategress door and an
emergency lighting fixtures in the space will be adequate, and a function test will be
required with FM office
• Verify sprinkler head locations are correct with addition of the wall
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office Phone: 518-761-8206 • Fa a:: 518-745-4437
iremarsluil@queensburj.net • WWW.queensbuni.net
P.O. BOX 508 BURNT HILLS, N.Y. 12027 (518) 885-1115 FAX(518)885-0526
i
February 28,2014
Mr.Michael Palmer
Fire Marshall
Town of Queensbury Building Department
742 Bay Road
Queensbury,NY 12804
Re: The existing Wet Pipe Sprinkler System, 375 Bay Road Tenant Mountain Lakes Regional EMS
Council
Mike:
We inspected The above mentioned Existing wet pipe system protecting the Mountain Lake tenant
needed no modification and is in accordance to NFPA-13-07 as referenced by the current New York
State Building Codes.
If.you have any questions,please do not hesitate to contact me
James M. Fantauzzi
'g?44W mr
President
Cc/ John Fry,Jersen Construction Group
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