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CO-000799-2016 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building& Codes (518)761-8256 BUILDING PERMIT Permit Number: CO-000799-2016 Tax Map No: 309.11-1-46 Permission is hereby granted to: North Country PHC For property located at: 16 MAIN ST 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 Owner Name: North Country PHC Certificate of occupancy $0.00 Owner Address: 16 MAIN ST Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications Certificate of Occupancy Only Tenant:North Country PHC $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,November 28,2017 (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 bury; n Mot r 28,2016 SIGNED BY: VlIXfor the Town of Queensbury. Director of Building&Code Enforcement Office Use Onlv TF' O t(enst lr�F tB xs��, ff Received: ESTABI( M�}M 10�!� "W BUSINESS Tax Map ID: - - CERTIFICAT� OF OCCUPANCY PER MIT.APPLICATION Permit No.: Cv ^UUG7 —ZU I ` - Permit Fee: , G 'Note: This applicatioq Is for'de�upangy o.Wj,.wilh no work requirinU building permit. Name of Business P/4 r✓ o� Address / �C;? v v </ Type of Business — C i Manager OR I Person in charge -!evpe_ 67zlcker Business Phone No. Property Owner Address Phone S/S,' QG22- of�g 4 ✓Provide an accurate layout of your store showing all walls,exits,stockrooms,rest rooms,counters,and fixture layout on a separate sheet of paper. i Print Name: Signature: Date: Notes I Comments: j y ITOWN CEO �l 1E NOV 1 8 2016 OF QUEENSBURY ILDING 8 CODES 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 309.11-1-46 CO-000799-2016 North Country PHC 16 Main Street C/O only EM1:KUtNk.;Y CONTACT UPDATE Please print clearly IE DATE: 1 7� D /� � (Q 0 NOV 18 2016 BUSINESS NAME: _A� �ft OF QUEENSBURY UILDIN BUSINESS ADDRESS: ) BUSINESS PHONE: tf/S3 - x/09- 37/ 0 (1�L0 PHONE 1: .28 /0 - CONTACT 1: PHONE 2: S/ - J TOWN/VILLAGE RESPONDING FROM: ' PHONE 1:4/� -��— CONTACT 2: _ter i x' 11, ✓ PHONE 2:�2cr lzrI C . TOWN/VILLAGE RESPONDING FROM• 5 ��. 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 QUEENSBURY FIRE MARSHAL'S OFFICE Phone: 518-761-8206 • Fax: 518-745-4437 fi'ernarshal@queensbunl.net • 71ROW.queensburu.net Fire Marshal Michael J Palmer Deputy Fire Marshal Gary K Stillman FIRE MARSHAL'S OFFICE Town of Queensbury 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauty ... A Good Place to Line " PLAN REVIEW North Country PHC 16 Main Street CO-000799-2016 Plan review based on site visit: • Verify fire extinguishers locations • Add CO detection (1) in the space • Verify exit and emergency lighting compliance • Locks / levers to be compliant R,r4, Michael J Palmer Fire Marshal 742 Bay Road Queensbury NY 12804 firemarshal@queensbury.net Fire Marshal's Office • Phone: 518-761-8206 • Fax: 518-745-4437 ftremarsluil@giieensbury.net • www.queensbuni.net 309.11-1-46 CO-000799-2016 North Country PHC 16 Main Street C/0 only t !i Cl" `SV 19 Nom' LL to Qa 00 N IN IE