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2014-075 , r TOWN OF QUEENSBURY ra742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20140075 Date Issued: Monday, July 14, 2014 This is to certify that work requested to be done as shown by Permit Number P20140075 has been completed. Location: 9 HUNTERBROOK Ln Tax Map Number: 523400-289-015-0001-003-000-0000 Owner: RCILETTI, LLC Applicant: STATE FARM INSURANCE 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 (DJ 4J 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 8c Code Enforcement or Zoning Board of Appeals. TOWN OF QUEENSBURY ea, `� 1 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140075 Application Number: A20140075 Tax Map No: 523400-289-015-0001-003-000-0000 Permission is hereby granted to: STATE FARM INSURANCE For property located at: 9 HUNTERBROOK Ln 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: RCILETTI, LLC 92 MASTERS COMMON NORTH Certificate of Occupancy(COM) QUEENSBURY NY 12804-0000 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2014-075 STATE FARM INSURANCE -Rita Hawkins C/O Only $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, March 27, 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 To of Qu nsb T rs j ' 'arch 27,2014 isti SIGNED BY \ for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only Town of Queensbury Fire Marshal Received: 0,., 27 21114 ESTABLISHMENT OF A NEW BUSINESS Tax Map 16:11 89. /5---/-.3 CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: j1/41•1075- Permit Fee: Spell *Note: This application is for occupancy only,with no work requiring a building permit. Name of Business ' F rm ems_ r __, c 0 R , t.jk1,1 5 Address c 4icy/Pit h k L'ia w Type of Business - Sed-'r/i!- Manager l , / ( � i,,-*i4 5 OR Person in charge Business Phone No. Property Owner R f A- -1-bwic ivt r (view bC. - ?2U term LC-C._ Address Q 4-t-oyttr ent tc_. -etpt ._ Phone 62UCQ,v1r1O r r Ny (2A-D(i sit -Virg 0 if ✓Provide an accurate layout of your store showing all walls, exits,stockrooms, rest rooms, counters, and fixture layout on a separate sheet of paper. Print Name: � ti A cz s tC-ty� Signature: Date: 7 Notes 1 Comments: I &mi' 7-Le ! Pderd 6eIL, IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire extinguishers, fire sprinkler systems, and fire alarm systems require annual inspections by an outside contractor and the corresponding documentation must be provided to the Fire Marshal's office. Fire extinguishing systems found in kitchens and gas stations require semi-annual inspections. Any violations noted during an inspection, require immediate corrective action. CONTACT NUMBERS: Director, Building and Codes-761-8253 Zoning Administrator-761-8218 Zoning-761-8238 Fire Marshal-761-8206 Planning-761-8220 Town of Queensbury Fire Marshal—New Business Permit 518-761-8206 EMERGENCY CONTACT UPDATE TO: Warren County Sheriff's Department 1. 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. 2. 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. PLEASE PRINT DATE: 3124I2_014- BUSINESS NAME: S ci..se ^^ I "f s 012-41,-4 Rt-1 *soca tc_LANIs Acs*&Uf BUSINESS ADDRESS: 1-I Q t tem1c <- € clitay BUSINESS PHONE: 51 S -19g` CONTACT 1: R-'Haig 14143 HOME PHONE 518. 2-3 7-'4°t O ADDRESS: -1 Z. m .5-trec u '""t^^en N3 - Cs�1«-•sia.v - NSI J 12&0`f CONTACT2: drea- M( b(`.HOMEPHONE 51 &' S79 3F.aC ADDRESS: c `` 7 r , Ek-vdsrr Falit f NY 122-31 Town of Queensbury Fire Marshal-New Business Permit 518-761-8206 Inspection Form Qe: *SI Town of Queensbury Fire Marshal 0 Periodic Inspection Date: C7' 742 Bay Road,Queensbury NY 12804 e-Inspection 518 761 8206/518 761 8205 Inspection Permit#: Fire Marshals Representative ✓� Mi Palmer Business Na i'A' atie Lr/ 1 / Location: ,r.. ',6..t Rene /GIL Stillman Contact: frith' 1vK'/�S «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 Sig n• 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 EVACPlan FC 404.2 TRUSSUSS ID SIGNAGE FCC 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.Signage- FC 510 IA 1a� /l, No Smoking Signs FC 310.3 cif 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) /A 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 Emergency Disconnect FC 2203.2 21 DAYS SYSTEMS: FC 901.6 InvOK NC DATE: OK NC Date Generator Annual DATE: OK NC Hood Installation Elevator Semi Annual FIRE ALARM Annual lj 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 Inspection Form Town of Queensbury Fire Marshal 0 Periodic Inspection Date: ON Time://01011 , 742 Bay Road,Queensbury NY 12804 aRe-Inspection 518 761 8206/518 761 8205 eac'CO Inspection Permit#: ty- e) ,?5 Fire Marshals Representative . _ M.1 Palmer Business Name: . - ' 1g __ft..aaJW. -/re-- Location: ? ifirlh je2 a - „sr" KGB Stillman Contact: NP4 1-keePin_S- . Type of Inspection N/A Yes No EXITS: Exit Access FC 1014&FC1029 „,....--"" Exit Enclosure FC 1020&Ed 029 /dd. NOTES 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 .0".. Secondary Aisle Width FC 1025&FC1029.11 ...0"" FIRE EXTINGUISHER: Hung FC 906 ...<.,„, Inspection of extinguisher FC 906 ../ EVAC Plan FC 404.2 1............ ,....e TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTING: Interior FC 1006.3&Ed 029.8 .... rd-KWIreMW-a.: 6, Exterior FC 1006.3 Clearance to Electrical FC 605.3 Electric Wiring Enclosed/Labeled FC 605.3.1 .../... 47,47/3n7 Cf. ,-- .04/ Combustibles in Equipment Rooms FC315.2.3 ,....../ F.D.Signage- FC 510 .../... h1- 4 4. tvi s44.nee.9-., frle.acrki--ak54444CLA No Smoking Signs FC 310.3 ,....../ z Storage FC 315.2 ,....../ Compressed Gas FC 3003 ...,.../. . Vehicle Impact Protection FC 312.1 Interior Finishes Finishes FC 803-804 r)‹.... ...--!.. Smoke Detectors FC 907 •-• porch /\OItsin 14.14 115- ...--- CO detectors FC 610 Clearance to Sprinkler/Ceiling FC 315.2.1 ()ean fee-feri CC- 18" / 24" 'Z ale-5 4n.r.44 Ast-1402. 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 ,---"" Emergency Disconnect FC 2203.2 ../.. 21 DAYS -t- if-41974 225Zi X DATE: OK NC SYSTEMS: FC 901.6 lnsp 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 0 101 -FS/ C19 t i 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 A /0 A '1 Inspection Form (, L/ Town of Queensbury Fire Marshal 0 Periodic Inspection Dale: s ��io � W'742 Bay Road,Queensbury NY 12804 o Re-Inspection ,%/ 518 8h06/518epr se61 8205ao CO Inspection Permit `�� / Fire Marshals Representative 4. MJ Palmer Business Name: Location: 97i /7,r /fid — GK Stillman Contact: n Type of Inspection N/A Yes No �1 r'" /�� EXITS. Exit Access FC 1014&FC1029 NOTES Exit Enclosure FC 1020&FC1029 Exit Discharge FC 1024&FC1029 - ��I ./� /,,,, Locks and latches FC1008& FC1029.2 ..4Z. I ) 1yn2(�K_� / r /12f/LM - Sign Normal FC 1011 &FC1029 � 1 f� � " _ ��� �I Sign.backup FC 1011.5.3&FC1029.7.5 / cS7GfK 1 �5, /�S ��'1 AISLES: r 1- /17ovi aZ/ /fr "9 12 Main Aisle Width FC 1024/1025&FC1029.11 / A" Secondary Aisle Width FC 1025&FC1029.11 — I FIRE EXTINGUISHER: Hung FC 906 1_/64-A-5- Inspection of extinguisher FC 906 / I— t2ee-4 EVAC Plan FC 404.2 / -7_-) gilt t - /.j/ J�e TRUSS ID SIGNAGE FC 505.3 / - 1 EMERGENCY LIGHTING: ,2-3/4., L."-4 _ fl - k Interior FC 1006.3&FC1029.8 J � �'�� Exterior FC 1006.3 / w.�nT Clearance to Electrical FC 605.3 Electric Wiring Enclosed/Labeled FC 605.3.1n A'i --I Jt/ Combustibles in Equipment Rooms FC315.2.3 / ll F.D.Signage- FC 510 / ((( No Smoking Signs FC 310.3 3 J i / Storage FC 3 5.2 y' j -L,�/ Compressed Gas FC 3003 / /,c s!- .` Vehicle Impact Protection FC 312.1 f/� L( ���,?,- 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 Emergency Disconnect FC 2203.2 21 DAYS SYSTEMS: FC 901.6 lnsp 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 Knox Box:installed/checked FC506 Operating Permit, if required will be issued after Completion of Inspection