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2013-102 TOWN OF QUEENSBURY Few742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20130102 Date Issued: Tuesday, April 02, 2013 This is to certify that work requested to be done as shown by Permit Number P20130102 has been completed. Location: 79 GLENWOOD Ave Tax Map Number: 523400-296-019-0001-042-000-0000 Owner: PRIME GLENNWOOD, LLC Applicant: HIGH PEAKS HOSPICE & PALLIATIVE CARE, INC. This structure may be occupied as a: Certificate of Occupancy (RES) By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Occupancy DOES NOT relieve the property (DJ 4 41-&-. 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. 0164 TOWN OF QUEENSBURY 01 . 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20130102 Application Number: A20130102 Tax Map No: 523400-296-019-0001-042-000-0000 Permission is hereby granted to: HIGH PEAKS HOSPICE& PALLIATIVE CARE. INC For property located at: 79 GLENWOOD 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: PRIME GLENNWOOD, LLC Certificate of Occupancy(RES) 79 GLENWOOD Ave Total varve QUEENSBURY,NY 12804-0000 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2013-102 HIGH PEAKS HOSPICE& PALLIATIVE CARE, INC. CO Only- 2nd Floor $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 29,2014 (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 of Que sbu Fr' y arch 29,2013 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement RX Date/Time 03120/2013 12:57 5187430544 P.001 03/20/2013 12:39 5187430544 HIGH PEAKS HOSPICE W PAGE 01/03 e Community Development Office .;. .Town of Quecnsbury • 742 Bay Road • Queensbury, New York •12804DOA S r >4 David Hal in, Director of Building&Codes Michael J.Palmer,Fire Marshal Craig Brown,Zoning Administrator- NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT APPLICATION MAR 2 0 7013 TAX MAP# l9+ 1�• BLDG. PERMIT FILE# /3-/ba If applicable Name of Business: :�+ �1 '"r ��S /�`='74‹ Address / QUESTIONS? CALL 761-8266 OR of Business: 9 G•��,� r �. EMAIL codesatspeensburv.nat '- Cc� f� 6-77•47,74- VISIT OUR WEBSITE FOR MORE / Person in Charge or Manager: / 7 Lu�/'�'' INFORMATION www.cmeensburv.net Business Phone Number. ' 2 y-—,6 2 a M gC)vnt,J C2.l be ( f "p .0 rcs. Type of Business: /a?, Owner of Property: ( (/ ZCac Phone Number(s): lir 770D Home CCN Owners n p Address: / Lw�� Please 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: Date: 3/26/) Of person submitting this roan Notes/ Comments: Ger. Tye) r /`-~� ✓�Q<�, xcxr . RX Date/Time 03/20/2013 12:57 5187430544 P.002 03/20/2013 12:39 5187430544 HIGH PEAKS HOSPICE W PAGE 02/03 EMERGENCY CONTACT UPDATE Please print clearly DATE: 3 Z J 3 BUSINESS NAME: 4.,..- BUSINESS ADDRESS: BUSINESS PHONE: ?l - /G 7Z COro PHONE 1: CONTACT 1: PHONE 2: z/- 9 7V) TOWN/VILLAGE RESPONDING FROM: 1'.k y t 1-7 PHONE 1: CONTACT 2: PHONE 2: TOWN/VILLAGE RESPONDING FROM: 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. TOWN OF QUEENS .BURY FIRE MARSHAL'S OFFICE P h o n e: 518-761-8206 F a x: 518-745-4437 firemarshal@queenshry.net www.queensbury.net Fire Marshal Michael. J Palmer Depuhj Fire Marshal Gary I< Stillman Inspection Form _ Town of Queensbury Fire Marshal O Periodic Inspection Date:11P/13 Time: 9- 742 Bay Road,Queensbury NY 12804 o Re-Inspection l 3 - 1 (:).2-- 518 761 8206/518 761 8205 =CO Inspection Permit#: xFi Marshals Representative MJ Palmer Business Name: - tui e-Pcqii--- Hc>sc,cer Location: rJ 9 C kNIw -Pi-LfG Stillman Contact: 1(tj — Type of Inspection N/A Yes No EXITS: Exit Access FC 1014&FC1029 /' NOTES Exit Enclosure FC 1020&FC1029 irz Exit Discharge FC 1024&FC1029 / Locks and latches FC1008& FC1029.2 / Sign: Normal FC 1011 &FC1029 Sign: backup FC 1011.5.3&FC1029.7.5t ` ti V AISLES: �/t' Main Aisle Width FC 1024/1025&FC1029.11 7, 1I � Secondary Aisle Width FC 1025&FC1029.11 r CO4 FIRE EXTINGUISHER: Hung FC 906 / Inspection of extinguisher FC 906 EVAC Plan FC 404.2 TRUSS ID SIGNAGE FC 505.3 r Al EMERGENCY LIGHTING: Interior FC 1006.3&FC1029.8 „ , WV Exterior FC 1006.3 'K F Clearance to Electrical FC 605.3 Electric Wiring Enclosed/Labeled FC 605.3.1 Combustibles in Equipment Rooms FC315.2.3 •.7 F.D.Signage- FC 510 r No Smoking Signs FC 310.3 . - Storage FC 315.2 Z Compressed Gas FC 3003 .7:� Vehicle Impact Protection FC 312.1 Interior Finishes FC 803 -804 / Smoke Detectors FC 907 ..” 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 Exterior Storage FC 315.3 Vacant Buildings FC 311 / REINSPECTION DUE APPROXIMATELY I I 21 DAYS — SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC Date Generator Annual DATE: OK NC Hood Installation Elevator Semi Annual I1!la FIRE ALARM Annual 311 k DATE: OK NC HVAC Shutdown Sprinkler System Annual Sprinkler FDC ° Fire Ma::. :d I:1SileO,i_!! %,,I .;ei.c Kitchen Suppression Semi Annual ! O1. t)1S5,i"C r.%:%`r'"f oc:.•!`-, `), • Fuel Island Suppression Semi Annual C Hood Cleaning 3-6-Annual Knox Box:installed/checked FC506 .0} 20. 1 Operating Permit, if required will be issued after -- ,;-_ ;---•---•- ._ • Completion of Inspection , ^_w. Town of';1.•f -., 1.; ..._ i i CD X � v m133 pe,r W � N.) •ff/c In/c[iO( ? . • L,11 � o Ln NI 0 D A r iiftOm 44° ir, a. :1/1111 I; XFICHEN wit � �"•akr Ii W ,, C6Fic =- e_ 07.-..k E 5 1., I _ f� tli p „_s_213. _ • * `�'�®®©®ate• - - _ __ .� ' �p _ ( y tr C i Cf FIC= .) D t,/ J . .�cesY ■� _ . A 3"`" I11_ . II �i . � i R� I ' } lGIIh b V! A s. ni 0 i i1 (i _,: . j lit•'-q '_:,giq 1 = o Iii _ I `!,At -13 ' ' u, rib 5' ,..i zi 2,..v. ,7,1:11 Ou — ii n , 1 - _.N i ar -.©- • — d __ tin...-.... CONFERENCE_11 CC1IFEREIICU_'!-Z_' -- - _ -r I �.:. _ rcraeasm — 11 11111 Ali C� i 11 it�0 0 , OFFICE 7 • 4P Mir I H I OFFICE R rr4FtCE I OFFICE 2 , ':'` ' "-..„— in �� NMI c 2: ,;�, 1 i�,OFFICE .OFFICE.f l OFFICE i f I. :. ILL.: Ems114.161a116:4 ! * �_ Y CYDras'n Cly: HP . I - IT}Cal MTS PROPOSED OFFICE FLOOR PLAN 00/e. 7.24.06 =AIL: sro--r-r rz. Job No:060778-- t0-1 -0 5heef No: m CD -0 co A �� o m 0