2013-025 TOWN OF QUEENSBURY
vu i
• , / 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
+� C ,
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130025-39575 Date Issued: Tuesday, November 17, 2015
This is to certify that work requested to be done as shown by Permit Number P20130025-39575
has been completed.
Tax Map Number: 279.18-1-6
Location: 1135 Ridge Road
Owner: Mohican Grange Hall CIO Peggy Nobles
Applicant: Starlet Dance Works
This structure may be occupied as a:
By Order of Town Board
C/O Only—dance studio TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ty r q ��
property 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 12804-5902 (518)761-8201
F
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130025 Application Number: A20130025
Tax Map No: 523400-279-018-0001-006-000-0000
Permission is hereby granted to: STARLET DANCE WORKS
For property located at: 1135 RIDGE 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: MOHICAN GRANGE HALL
CIO PEGGY NOBLES Certificate of Occupancy(COM)
1748 RIDGE Rd Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-025 STARLET DANCE WORKS
CO Only -Dance Studio
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, January 28, 2014
(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 ueensb • Mon.ay,January 28,2013
SIGNED BY 4 1/ for the Town of Queensbury.
av
Director of Building& de Er rcement
r
O Community Development Office
3s Town of Queensbury• 742 Bay Road• Queensbury, New York •12804
Date
David Hatin, Director of Building& Codes py
Craig Brown,Zoning Administrator•Michael J. Palmer, Fire Marshal .tAN P
ESTABLISHMENT OF A NEW BUSINESS
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit
�n
TAX MAP# /"T • ( O p ".I ' Lp BLDG. PERMIT FILE# / 3 -6.).05
If applicable
Name of Business: a r let s-n C C /Oaks
S
Address
of Business: 1135 RI d j E RO&CA- QUESTIONS? CALL 7614256 OR
EMAIL codestci!aueensbury.net
VIR WEBSITE
Person in Charge or Manager. eh f►a'rl n CA A . Pcp H SIT OU INFORMATION FOR MORE
www.aueensburv.net
Business Phone Number. a(03 Sc.'7 4 ! Or 71- -575 I
Type of Business: f e_ Jh Oct 1
nn Liz alio 37q,
Owner of Property: Tj rnes ��ILQ beim R'Ap14 Phone Number(s): SIA-798 OSq 3 - 71-4S7S I
t^ r/
,� w � Ca
Owners Address: 10R R4 1/4(h c�*C.l1 (?Je itsf i tc IVU. i aO
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 G�1� V r7_ Date: I'G l{-/3
Of � submittingthis//form
Person
Notes/Comments:
. 8 P !3 -o�5
EMERGENCY CONTACT UPDATE
JAN 2 4 2013
TO: WARREN COUNTY SHERIFF'S DEPT, FAX: 743-2502
PLEASE PRINT
DATE: I' €9AJ i3
BUSINESS NAME: C I-Ar/e* D-nce k r k S
BUSINESS ADDRESS: 1135 d,E a. Cnee(hcJul ry ((J4
BUSINESS PHONE: SIS- 70.C. 753-/8/8.
7
CONTACT 1: Ch r isk in a_ ?I*Pr HOME PHONE ROD 3711
ADDRESS: 6 8 Frf 1 S-1- , 6-1 en s fe I N N. i ao
CONTACT 2: JJvn' es Ap HOME PHONE 798059'3
ADDRESS: 68 841119. glens FA-11s N "Y. la so
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.
' 7
ri
Inspection Form
Town of Queensbury Fire Marshal 0 Periodic Inspection Date:T
j3`/y/2�
'J Time: )
742 Bay Road,Queensbury NY 12804 O Re-Inspection '1
51 B 761 8206/518 761 8205 ® i JCO Inspection Permit#: - �").-Ce-
Fire Marshals Representative
)(MJ Palmer Business Name: SVAo /CT Da I�GviGiitS
Location: 112.c' ‘.Z t< .c Sa
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 j
Locks and latches FC1008& FC1029.2 r
Sign. Normal FC 1011 &FC1029 /// MG�-C-
Sign: backup FC 1011.5.3&FC1029.7.5 / - S f et 1�'1
AISLES:
Main Aisle Wdth FC 1024/1025& FC1029.11
Secondary Aisle Wdth FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906 gJ 051‘41-1 rp Cary. t'C
Inspection of extinguisher FC 906 l
EVAC Plan FC 404.2
TRUSS ID SIGNAGE FC 505.3 '
EMERGENCY LIGHTING:
e� \ WC.)
kVaN ��
Interior /FC 1006.3&FC1029.8 JJ `L
Extenor FC 1006.3 /
Clearance to Electrical FC 605.3 / beGtreaft
Electric Wiring Enclosed/Labeled FC 605.3.1 /
Combustibles in Equipment Rooms FC315.2.3 /
F.D.Signage- FC 510 Itej
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 j
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 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 N__
Sprinkler System Annual --
Sprinkler
Sprinkler FDC Fire Marshal!as.-ctl 9 e
Kitchen Suppression Semi Annual CO m ed a oYw
We ai
an
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506 ' 1 2013
Operating Permit, if required will be issued after Fire Marshal
Completion of Inspection Town-of Queensbury