CO-000509-2017 TOWN OF QUEENSBURY
_ 742 Bay Road;Queensbury;NY 12804-5904 (518)761=8201
- : -- Community Development-.Building&Codes. (518)76.1-8256
.CERTIFICATE OF OCCUPANCY
Permit Number: CO-000509-2017 Date Issued: . Thursday,August 31, 2017
This is to certify that work requested to be done as shown by Permit Number CO-000509-2017
has been completed.
Tax Map Number: 302.5-1-1
Location: 15 BURKE DR
Owner: Queensbury Masonic Lodge
Applicant: Ambleside School Adirondacks
This structure maybe occupied as a: C/O Only
Tenant:Ambleside School Adirondacks .
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,
�1
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 12804-5904 (518)761-8201
a'
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CO-000509-2017
Tax Map No: 302.5-1-1
Permission is hereby granted to: Ambleside School Adirondacks
For property located at: 15 BURKE DR
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: Queensbury Masonic Lodge Certificate of occupancy $0.00
Owner Address: 15 Burke DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
C/O Only
Tenant:Ambleside School Adirondacks
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,August 22,2018
(If a longer period is required,an application for an extension must.be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of<ee sb esdt,02017
SIGNED BY: r the Town of Queensbury.
Director of Building&Code Enforcement
CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit#: CGn`GW SG I—-?-o/
ToHn of Clvmcnsbury Permit Fee:$ l�✓ y�
742 Bay Road,Queensbury,NY 12804 Invoice#:—
P:518-761-8206 or 518-761-8205 www.gueensbury.net
C
**This application is for occupancy only, with no wc r i e quiring a w in �'rmit**
CONTACT INFORMATION: Allli 1 201i
TOWN or- tu� Nssu�Y
BUILDING&CCfjr-c,
• Applicant:
Name(s): Ambleside School Adirondacks
Mailing Address, C/S/Z: PO Box 154, Corinth, NY 12822
Cell Phone: 51q 744-5320 Land Line: )
Email: info@amblesideadirondacks.org
• Business Owner(s):
Contact Name(s): Jeanie Petteys
Mailing Address, C/S/Z: 48 Stark Road, Corinth, NY 12822
Cell Phone: ( 518)) 744-5320 Land Line: _( )
Email: Jeanie amb esi ea Iron ac s.org
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Property Owner(s):
Business Name: Masonic Lodge
Contact Name(s): Allan Bryant
Mailing Address, C/S/Z: 15 Burke Drive
Cell Phone: _( 518-36P-7137 Land Line: _( )
Email: ambryant@qmhs.org
Certificate of Occupancy Only Revised June 2017
742 Bay-Road :Queensbury,NY'12804
B:518-761-8206 or518=761-820s .vnvw.gueensbury.net
8USINESSjNFORIVIATION
Name of:b.usiness: Ambleside-School of.th6 Adirondack"s.
Address (including su te,_space, etc ). �57 Hani lton;Avenue, Corinth;NY 12822 seeking.t`o move
to l 5 Burke D.rive;'.Qsby,NY.1 .80
Type.of"bus,iness (Le.: retail,.car re,pair,:etc ):.
Private Charter School
School:
an,accurate layout"of your store showing all walls;exits,stockrooms, rest
rooms,;countersand fixtu:--es-on.a separate sheet of paper.
IMPORANT:,The business_owner is responsible for keeping exits clear:and mamtairiing exit
g -
si ns and emergency`Iiga ts; .Fire extingui.sli -rs,fire 5pnnklef,systems and fife alarm systems
require annual inspections by an outs id.e'coIntractor and:the corresponding documentation,
must'be prouided to the Town,of'Queensbury:Fire.:Marshal.'s.o-ffice. Fire exti-nguishing systems
found in kitchens and gas stations•requi:reserni-annual inspections:, Any violations noted. :
Burin :an.inspection regui- immediate corrective action and a.re-inspection
;Applicant name:
�. Applicant.signature: { ,,
Date: AW17/1.�. .
i. .
Revised June)o17
Certificate 61 Occupancy.Only
I
74rd�.b-ly
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
BUSINESS INFORMATION:
Name of business: Ambleside School of the Adirondacks
Address (including suite, space, etc.): 97 Hamilton Avenue, Corinth, NY 12822 seeking to move
to 15 Burke Drive, Qsby, NY 12804
Type of business (i.e.: retail, car repair, etc.):
Private Charter School
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest
rooms, counters and fixtures on a separate sheet of paper.
IMPORANT: 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 Town of Queensbury 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 and a re-inspection.
Applicant name: leania PettaTc as Director of Ambleside Scboolof the Adiroadac-ks
Applicant signature:
Date: 9/17/17
Certificate of Occupancy Only Revised June 2017
I
i
Town of Qycensbuiy
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
EMERGENCY CONTACT INFORMATION
"THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR
BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND
AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
GAINING ENTRY TO YOUR BUILDING."
PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN
DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL.
Date: 8/17/17
Business Name: Ambleside School of the Adirondacks
Business Location (including suite,space,etc.): 97 Hamilton Avenue,Corinth,NY 12822 seeking to relocate
to 15 Burke Drive,Qsby,NY 12804
Business Phone#: 518-744-5320
1. Contact name: Jeanie Petteys,Director
Main Phone:_( 5( 18-74J-5320 ;Secondary Phone:_( )
Coming from what town/village? Corinth, NY
2. Contact name:
Main Phone:_( ) ;Secondary Phone:_( )
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised June 2017
�i.
EMERGENCY EVACUATION ROUTES {
"Zygmwd j
I
CALL 9-1-1 i
E
Q a gay .�e
ty Roonim
Q 0
CIassroom 3 Bridges
Classn°oonen$ Sipeechl Rfolan°Raei m Office
Staff Room co o
d
ill M
.0Z o
Pi n C3 CO
RendQ co 1" .
Alternate Route 15 bmirke:
302.5-1-1 CO-000509-2017
Ambleside School Adirondacks
15 Burke Drive
Cert. of Occupancy Only
}
Inspection and Testing Form
Date: 8-29-17
Time: 10:33
Name: AMBLESIDE SCHOOL ADIRONDACK
Address: 15 Burke Dr.
Queensbury,NY 12804
Telephone: _518-744-5320
Contact: Jeanie Petteys
Monitoring Entity: Time Warner M
Monitoring Account Reference Number: _613357
Panel Manufacturer and Model Number: MS-5 Firelite
Alarm Initiating Devices and Circuit Information
Quantity Comments
2 Manual Stations
Ion Detectors
_8_ Photo Detectors
Duct Detectors
5 Heat Detectors
Water Flow Switches
Supervisory Switches
Other: Specify:
Alarm Indicating Appliances and Circuit Information
Quantity Comments
Bells
_5 Horns
Chimes
_5 Strobes
Speakers
Other Specify
Number of Alarm Indicating Circuits: 5
Are Circuits Supervised(yes/no):_Yes
The Following did not operate correctly:
System restored to normal operation: Date: 8-29-17 Time: 12:OOpm
This Testing was performed in accordance with applicable NFPA Standards
Name of Inspector: _Tom Lessard
Name of Company: Time Warner Cable Security
New York State License Number: 12000302365
Date: 8-29-17 Time: 12:00
Signature:_Thomas Lessard
AUG 18 2017
--__.,�v� Parl I�Nonnublic Sc' ool�Fire Safety Non Conformance RepSR49 ee
TOWN OF QUEEN A
�u iY
I �1�,� ,
6 dii 111 t :Ql �1! I%L'6'3�� 043uilding Name OMA-1
Part II-B Part 11-13 Part II-B
U U U
d CD
�# O N �
O O f6 O E C C
a� Z U 0 U Z U D U —� z U D U
6 120-2 19E-1 .
p8(3q_ 13A-2 19F-1
8_G_ 13B-2 19G-1
�18Dx 14A-2 191-1-2
_SE= 1413-2 20A-1
09A-2 14C-2 20B-1.
0913-2 14D-1 20C-1
09C-1 14E-1 21 A-3
09D-1 15A-2 22A-3
09F-2 .1513-1, 2213-3
09G-2 15C-2 22C-3
10A-2 15D-2 23A-1
1013-2 16A-2. _ .t5 a 3 2313-1
16B-2
10C-1 16 C-2 23C-1
1 OD-1 17A-3 23D-2
11 A-2 176-2 24A-3
1113-1 17C 2 25A-3
1.1 C-2 17D-2 If any additional
11D-2 17E-1 non-conformances
11E-1 1717-3 are observed,check item
12A-1 17GA 25A-3 and list the Code
12B-3 171-1-2 section below..
12C-2 171-2
12D-2 17J-1
12E-1 17KA
12F-1 17L-1
12G-1 18A-2
121-1-1 1813-2
121.1 18C-2
12A _ 18D-2
12K-1 3 . P 19A-3
12L-1 1913-2
12M-1 _ 19C-1
12N-1 19D 1
-- All schools complete _eca twnTi�only if the building has electric - d fo -tions.
Fire Inspection Performed by:
Local Municipal Code Enforcement Official Signature:
Name(Please Print): ��%C F'ell
Title: �-NI(;: Date '� t Registry#
5
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Ambleside School
15 Burke Drive
CO-000509-2017
8/22/2017
The following comments are based on review of drawings:
• Verify fire extinguisher location and inspection
CO detection required
• Verify operation of exit/Emergency lighting.
• Lock/ latches shall comply with Chapter 10 of 2015 IBC.
• Verify paths of egress
• Verify storage
• Install Knox Box and main entrance for FD use
• Provide report of inspection for fire alarm system
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
fCremarslzal@queensbun1.net zuzuw.queensburt!net