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2013-085 1_ TOWN OF QUEENSBURY ir-111011W 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20130085 Date Issued: Friday, April 26, 2013 This is to certify that work requested to be done as shown by Permit Number P20130085 has been completed. Location: 276 DIX Ave Tax Map Number: 523400-303-015-0001-032-000-0000 Owner: NEW YORK JOB DEVELOPMENT AUTHORITY Applicant: KENYON PIPELINE INSPECTION 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 owner of the responsibility for compliance with Site Plan, Variance, or '-� °G 4 other issues and conditions as a result of approvals by the Planning Board Director of Building& Code Enforcement or Zoning Board of Appeals. TOWN OF QUEENSBURY A 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 TO Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130085 Application Number: A20130085 Tax Map No: 523400-303-015-0001-032-000-0000 Permission is hereby granted to: KENYON PIPELINE INSPECTION For property located at 276 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. Type of Construction Value Owner Address: NEW YORK JOB DEVELOPMENT f 633 THIRD Ave Certificate of Occupancy(COM) NEW YORK,NY 10017-6754 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2013-085 KENYON PIPELINE INSPECTION CO ONLY $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 15,2014 (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 f Que sbu F ,��` arch 15, 2013 SIGNED BY r' for the Town of Queensbury. Director of Building&Code Enforcement r lit: ' Community Development Office 0 7 2O1 Town of Queensbury • 742 Bay Road•• Queensbury, New York •92804 ; t --, e ; .alfa, David Hatin, Director of Building& Codes Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal , t Jl ri}c 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. 303- I - /-3a. TAX MAP# 1/O. / 2'/. 27 BLDG. PERMIT FILE# /, —0 g S(applicable Name of Business: i<err" 17,(J�e//bile_ _i�15Pec. )D w /►lal h,/f of dress Business: !! l Drl,J e_ a / / .� 9�/2 O / QUESTIONS? CALL 761-8256 OR U of Business: �2 `?Q-I//e� l,.e P�5�j�� "V oUr rrcL off! 2 7(D Dr J( 4tl-- a-ee�5Lkr /AlV/X6-D4/ EMAIL codes(�queensbury.net ;� VISIT OUR WEBSITE FOR MORE Person in Charge or Manager: S e,S o 1\ • e- 1-'-}o ti-- INFORMATION c'�7// www.queensburv.net Business Phone Number: 51 -- - 9 26 —?F--q 3 Type of Business: Pi-Deli•r1� CieQK/no / rnspeth0h Gvlp,( Xe�air //T4/76ki 4r 5fiofW\wa12✓ + Oct 5(ec fere and It)ale✓ 51S74e S Owner of Property: -�r)�Pe�Uelo i& r 1I10f/l// Phone Number(s)Sl6-773'7600 Sly 3io l '),29,_ b /�Jea)eY,(jE Home Cell Owners Address: . , r , lr I 14(,) /O4 ID?)D?) 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: x/71 Date: 3 7-5---/ 0 person submitting thi orm Notes / Comments: e) 3 -oss EMERGENCY CONTACT UPDATE MAR 0 7 2013 TO: WARREN COUNTY SHERIFF'S DEPT FAX: 743-2502 PLEASE PRINT DATE: .3 —S —/ 3 e� °n /, e =/E r� spec/ v!� BUSINESS NAME: / � /�� c� BUSINESS ADDRESS: '42- /1-e1evi Zc,'(i ate tsb c by /UV/2S-01/ BUSINESS PHONE: 5/ 5- - 26 - 9 b / 3 CONTACT 1: (2-` Sav\- Newt/6r\- HOME PHONE 545---9 2-6 3 ADDRESS: ) )-- I4-dee,. e_ ee�.SL -7 AY( /2 i s o15/S---,5Z-Y$Z -257 CONTACT 2: J � e�� a� HOME PHONE si ADDRESS: / 2 aeehs ljpx aee/15 .r y / /V i2.-0 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. i Inspection Form qr- Town of Queensbury Fire Marshal o Periodic Inspection Date:U��'f I} Time: i v 742 Bay Road,Queensbury NY 12804 Re-Inspection 518 761 8206/518 761 8205 `et3r CO Inspection Permit#: 1 3 Fi �Marshals Representative MJ Palmer Business Name: E-' �r �i Location: ? X., 1) i-k flt./ GK Stillman Contact: - 1 cid 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 P AISLES: Main Aisle Width FC 1024/1025&FC1029.11 , ,^� Secondary Aisle Width FC 1025&FC1029.11 111 C V ` FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC 906 --C EVAC Plan FC 404.2 ,n/� TRUSS ID SIGNAGE FC 505.3 "� `(� EMERGENCY LIGHTING: Interior FC 1006.3&FC1029.8 X. Exterior FC 1006.3 Clearance to Electrical FC 605.3 j 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 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) 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 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 :-- �. _..;., .• :..,a.; _ :�:,: Kitchen Suppression Semi Annual t r:Irp Issu i ''.��.(� 'it3t i1eC iI*� Fuel Island Suppression Semi Annual F �)k ti)ISsLie irtifl.sae in VeCt.1�ef1Cy Hood Cleaning 3-6-Annual t Knox Box:installed/checked FC506 ? AP ,1l j 11 \ i Operating Permit, if required will be issued after 1 _^_ _ Completion of Inspection Fire ;vars`..I 'own of Qt'E,,t .T,'..�_..__.� Inspection Form Town of Queensbury Fire Marshal (Z, Periodic Inspection Date:iqP.)--1) Time: 1 742 Bay Road,Queensbury NY 12804 =Re-Inspection 13 p�� 518 761 8206/518 761 8205 CO Inspection Permit#: e Marshals Representative F' e MJ Palmer Business Name: yt. 11 QLL1(4.-: Location: 14,3\A Ail` GK Stillman Contact: Type of Inspection N/A 7 No EXITS: Exit Access FC 1014&FC1029 NOTES Exit Enclosure FC 1020& FC1029 Exit Discharge FC 1024&FC1029 /zr Locks and latches FC1008& FC1029.2 Sign:Normal FC 1011 &FC1029 Sign:backup FC 1011.5.3& FC1029.7.5 ‘/ CH/ 1,-Ar.. AISLES: Main Aisle Width FC 1024/1025& FC1029.11 Secondary Aisle Width FC 1025&FC1029.11 / 1010P; 61)54- 4-(4110 FIRE EXTINGUISHER: Hung FC 906 , Inspection of extinguisher FC 906 'j EVAC Plan FC 404.6 bGc.1O TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTING: y Interior FC 1006.3& FC1029.8 j Exterior FC 1006.3 If 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 Compressed Gas FC 3003 4 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) 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 SYSTEMS: FC 901.6 Insp OK C 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