CO-000773-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
� Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000773-2017 Date Issued: Monday, December 18, 2017
This is to certify that work requested to be done as shown by Permit Number CO-000773-2017
has been completed.
Tax Map Number: 302.6-1-51.2
Location: 756 GLEN ST
Owner: The Gym,Flaum Property Management
Applicant: The Gym
This structure may be occupied as a: Certificate of Occupancy Only
Queensbury Plaza, Space IB By Order of Town Board
Tenant: The Gym TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the J4
property owner of the responsibility for compliance with Site Plan, 44t
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.
fr 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-000773-2017
Tax Map No: 302.6-1-51.2
Permission is hereby granted to: The Gym
For property located at: 756 GLEN 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
Tyne of Construction
Owner Name: Ryan Holderman Certificate of occupancy $0.00
Owner Address: 26 FOX HOLLOW LN Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Certificate of Occupancy Only
Queensbury Plaza,Space 1B
Tenant:The Gym
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,December 17,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the exp'ation date.)
Dated at the Town of ueensb 4rida , ,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
CERTIFICATE OF OCCUPANCY ONLY Office use only
APP I E COED VEE _
ermit Fee:$ 5 0 . oO
742 Bay Road,Queensbury,NY 12804 DEC 14 2017 nvoice#: kn __L I �
P:518-761-8206 or 518-761-8205 www.cluetns OF QUEENSBURY
BUILDING&CODES
cry` A-C J
"This application is for occupancy only, with no work requiring a building permit"
CONTACT INFORMATION:
• Applicant:
Name(s):
Mailing Address, C/S/Z:
Cell Phone: SI ) S�JP1 Land Line: � ) I
Email: i2 t CL%YY�
• Business Owners :
Contact Name(s):
Mailing Address, C/S/Z: (161,J OR
Cell Phone:_( Land Line: _( )
Email:
•
Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: ( SIV ) Q Land Line: )
Email:
•
Property Owner(s)-
Business
wners :Business Name: V ry)
Contact Name(s):
Mailing Address, C/S/Z: Z--0 AGtAl,l_ i A
Cell Phone: ( ) Land Lin '• ( ) /4/ ®�
Email: In ,
Contact Person for Building & Code Compliance: AU01,1
Cell Phonies 5 /Y ) Land Lin ( )
Email:
Certificate of Occupancy Only Revised December 2017
742 Bay Road,Queensbury, NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
BUSINESS INFORMATION:
Name of business: G C4,1n"�
Address (including suite, space, etc.):
Type of business (i.e.: retail, car repair, etc.):
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 inspection require immediate corrective action and a re-inspection inspection require immediate corrective action and a re-inspection.
Applicant name: L� CU1A) a/T ----
Applicant signature:
Date: - J�// , _ -
Certificate of Occupancy Only Revised December 2017
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.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:
Business Name:
Busine ocation (including rite, space,etc.):
USS l �cla
Business Phone#:
1. Contact name: I` C
Main Phone:_( ) K Secondary( Phone:_(
Coming from what town/village? c7 G"ITT-�� ' I�/g� Lip
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 December 2017
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
The Gym
756 State Route 9
CO-000773-2017
12/15/2017
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
• Post evacuation plan
• Landlord to secure wiring and J boxes in back room
• Add outlet covers and switch plates as needed
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
-flrentarshal@queensbunj.net - Tez Mqueensbury net
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