2013-084 0.4 TOWN OF QUEENSBURY
teitto.
wo/ro 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130084 Application Number: A20130084
Tax Map No: 523400-296-019-0001-002-000-0000
Permission is hereby granted to: PRENTISS & CARLISLE
For property located at: 123 QUAKER 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: MRK COMMUNITY COLLEGE H01
6 CHELSEA PI Certificate of Occupancy(COM)
CLIFTON PARK,NY 12065-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2013-084 PRENTISS & CARLISLE
CO ONLY Suite 107
Type of Business: Land Management/manages timber forestry
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,March 12, 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 iration date.
Dated at the To of Q e nsb •-,,i ; -arch 12,2013
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay RoadQueensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20130084 Date Issued: Thursday, March 28, 2013
This is to certify that work requested to be done as shown by Permit Number P20130084
has been completed.
Location: 123 QUAKER Rd
Tax Map Number: 523400-296-019-0001-002-000-0000
Owner: MRK COMMUNITY COLLEGE HOUSING, LLC
Applicant: PRENTISS & CARLISLE
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 ' 4,4A04
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&Code Enforcement
or Zoning Board of Appeals.
f ri Community Development Office
4 •
— ` Town of Queensbury • 742 Bay Road • Queensbury, New York •92804 ;
David Hatin, Director of Building& Codes � . O r7
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal : 'r: : .
_ : Fj 2013
ESTABLISHMENT OF A NEW BUSINESSd-l 'i a()1,/
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit.
TAX MAP # agip, I-).- i a BLDG. PERMIT FILE# ) �v 21
y If applicable
d
Name of Business: P r en 1 s f r 1 i s i► to
Address
of Business: / 2 3 9./4 ki I r^ [2 d '�t 7 /
t' 7 QUESTIONS? CALL 761-8256 OR
EMAIL codes(a)queensbury.net
(� (/ VISIT OUR WEBSITE FOR MORE
Person in Charge or Manager: 1 ' l l �' e I v e r' l h INFORMATION
www.queensbury.net
Business Phone Number:
Type of Business: t ilk, �ii,-7 g ,/141/7
At...,.._„�� ,. _ )
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m a G h 4 , 1 kIA,J j c,,„ !l 1/
Owner of Property: t "7AC edi ,o('Gr Phone Nu ber(s):5 l ? 7 J L1 a ��� f�0
(/' J Hcell
Owners Address: CA e l 4 p/4c , e /,I F/', (A'4 /1/ 1/
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: e,,_ /- Date: Z/Z v//3
Of person submitting this form
Notes / Comments:
EMERGENCY CONTACT UPDATE 1,3--Og4
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: .z `/ / 7
I i
BUSINESS NAME: c't 4-) /��'�` f
� ni?'tBUSINESS ADDRESS: 17 ? ,. lit /07
:7-4-1% 7/3_��� 1 . �
BUSINESS PHONE:
�
I 6--e CONTACT 1: I dI Y j n HOME PHONE 19
ADDRESS: ___k;171-
46-e_ 7
CONTACT 2: /14414/ /1141/1/G2- HOME PHONE c 7 3 "116
ADDRESS: 7,%2n) //� `- ael
r ckd W,00/2
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.
--/-ho 3/E3
Inspection Form -
5J(2I� �'
Town of Queensbury Fire Marshal O Periodic Inspection Date: 1 Time:
742 Bay Road, Queensbury NY 12804 'o Re-Inspection [
518 761 8206/518 761 8205 Xi CO Inspection Permit#: 7-01 3—eigi-
Fire Marshals Representative Z' _ /'
MJ Palmer Business Name: gr/077 - �i/,//'//f/v
Location: Jc t3 /11 7z- R.J94C, 57Z /v7
.,YGK Stillman Contact: ft 4at:L tiJ
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
Locks and latches FC1008& FC1029.2 l
Sign: Normal FC 1011 &FC1029
Sign:backup FC 1011.5.3&FC1029.7.5
AISLES: � >
Main Aisle Width
1024/1025
Secondary Aisle Width FC 1025&C1029 11 -;> --------
��Z '7" �' 2l
FIRE EXTINGUISHER: Hung FC 906
Inspection of extinguisher FC 906XISIe.
EVAC Plan FC 404.2
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING: _
Interior FC 1006.3&FC1029.8
Exterior FC 1006.3 /-.
Clearance to Electrical FC 605.3 .-----i.
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 ./ / 1 I
Storage FC 315.2 /- / // 1
Compressed Gas FC 3003 -� / J
Vehicle Impact Protection FC 312.1 -T--7,)^
41 l(
Interior Finishes FC 803-804 �I ! ' J �' I
Smoke Detectors FC 907 Cl
CO detectors FC 610 l�
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 , -
ExtVacant StoragBuildings
FC 315.3311REINSPECTION 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 eg* i� 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 -,,/ %'j L./
Operating Permit, if required will be issued after
Completion of Inspection