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CO-0682-2018 TOWN OF QUEENSBURY Fb y 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development- Building& Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: CO-0682-2018 Date Issued: Thursday, November 1, 2018 This is to certify that work requested to be done as shown by Permit Number CO-0682-2018 has been completed. Tax Map Number: 296.19-1-32 Location: 375 BAY RD Owner: 375 Bay Road LLC Applicant: Jersen Construction Group This structure may be occupied as a: Certificate of Occupancy Only Tenant: Peckham Road Corp 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, it 4 Variance, or other issues and conditions as a result of approvals by the Direct ui ding&Co.: ' or:z ent Planning Board or Zoning Board of Appeals. 1 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 s Community Development - Building& Codes (518) 761-8256 e BUILDING PERMIT Permit Number: CO-0682-2018 Tax Map No: 296.19-1-32 Permission is hereby granted to: 375 Bay Road LLC For property located at: 375 BAY 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 Owner Name: 375 Bay Road LLC Certificate of occupancy $0.00 Owner Address: 6 Industry DR Total Value $0.00 Waterford,NY 12188 Contractor or Builder's Name/Address Electrical Inspection Agency Jersen Construction Group 6 Industry DR Waterford,NY 12188 Plans&Specifications Certificate of Occupancy Only Tenant:Peckham Road Corp $ 0.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,November 1,2019 (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 d.to.) Dated at the Town Quee ury; 4Th rp s •vember 1, 2018 4 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement w .. - IE CERTIFICATE • '��► fir; Office Use Only ; CO— g2- --"te Permit#: A' ' Td3 0 2018 ,s.:n c,d�( rccn: urn Permit Fee:$ W O I O 742 BayRoad,Queensbury,NY 12804 TOWN OF QUEENSBURY Invoice#: ( -1 BUILDING&CODES P:518-761-8206 or 518-761-8205 www.queens•ury.ne **This application is for occupancy only, with no work requiring a building permit** CONTACT INFORMATION: • Applicant: Name(s): 375 Bay Road LLC Mailing Address, C/S/Z: 6 Industry Drive Cell Phone: ( 518- )779-7702 Land Line: ( Email: acioffi@jersen.com • Business Owner(s): Contact Name(s): Peckham Road Corp Mailing Address C�/S/Z: 375 Bay Road Queensbury NY 12804 Cell Phone: 81 22b-3138 _( ) Land Line: ( 518 )792-3157 Email: m • Manager: Contact Name(s): Mark Petramale Mailing Address, C/S/Z: Cell Phone: ( 518-245-3138 Land Line: _( Email: mmetr@peckham.com • Property Owner(s): Business Name: 375 Bay Road LLC Contact Name(s): Angela Cioffi Mailing Address, C/S/Z: 6 Industry Drive Waterford NY 12188 Cell Phone: _( 518 )779-7702 Land Line: _( Email: acioffi@jersen.com Contact Person for Building & Code Compliance:Angela Cioffi Cell Phone: ( 518 )779-7702 Land Line: ( Email: acioffi@jersen.com Certificate of Occupancy Only Revised December 2017 742 Bay Road,Queensbury, NY 12804 P: 518-761-8206 or 518-761-8205 www.queensbury.net BUSINESS INFORMATION: Name of business: Peckham Road Corp Address (including suite, space, etc.): 375 Bay Road Suite 201 Queensbury NY 12804 Type of business (i.e.: retail, car repair, etc.): Office 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. Angela Cioffi Applicant name: Applicant signature: A Date: \ 0 1¢ Certificate of Occupancy Only Revised December 2017 Town of Queens►urm 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: 10/29/18 Business Name: Peckham Road Corp Business Location (including suite,space, etc.): 375 Bay Road, Suite 201 Business Phone#: 518 792-3138 1. Contact name: Mark Petramale Main Phone:_( 518-22p-8593 ;Secondary Phone:_( Coming from what town/village? Glens Falls 2. Contact name: Angela Cioffi Main Phone: ( 518 )779-7702 ; Secondary Phone:_( Coming from what town/village? Middle Grove 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 INSPECTION WORKSHEET (007794-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal CO-0682-2018Permit Case Number:Case Module: Thu Nov 1, 2018Passed Inspection Date:Inspection Status: Mike PalmerGeneral (Fire Marshal) Inspector:Inspection Type: 375 BAY RD296.19-1-32 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName Primary Owner375 Bay Road LLC Granted Permission375 Bay Road LLC ContractorJersen Construction Group ApplicantJersen Construction Group Checklist ItemPassedComments Fire Marshal NotesYES Exit AccessYES Exit EnclosureYES Exit DischargeYES Locks and LatchesYES Sign: NormalYES Sign: backupYES Nov 01, 2018Page (1) INSPECTION WORKSHEET (007794-2018) Checklist ItemPassedComments Main Aisle WidthYES Secondary Aisle WidthYES Fire Extinguisher HungYES Inspection of ExtinguisherYES EVAC PlanYES Energency Lighting InteriorYES Electric Wiring EnclosedYES Combustibles in Equipment RoomsYES No Smoking SignsYES StorageYES Vehicle Impact ProtectionYES Interior FinishesYES CO DetectorsYES Clearance to Sprinkler/CeilingYES Fuel Station Emer ProceduresYES ElevatorYES Nov 01, 2018Page (2) INSPECTION WORKSHEET (007794-2018) Checklist ItemPassedComments FIRE ALARMYES HVAC ShutdownYES Sprinkler SystemYES Sprinkler FDCYES Knox Box: Installed/checkedYES AngelaPalmer, Mike (Inspector) Nov 01, 2018Page (3) FIRE MARSHAL'S OFFICE . .._...,_,_,,,, Town of Queensbury 742 Bay Road, Queensbury, NY 12804 IV.'- 1 dllIll— " Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW Peckham Road Corp 375 Bay Road, Suite 201 Road CO-0682-2018 10/31/2018 The following comments are based on review of drawings: • Verify fire extinguisher locations • Verify function of exit and emergency lighting • Verify paths of egress • Verify storage • CO detection required , to be verified • Locks and latches shall be compliant w/ Chapter 10 IFC .4\c\\"e ._.----;s1Z2..... 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 firemarshal@queensbury.net • www.queensbury.net INSPECTION WORKSHEET (007794-2018) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal CO-0682-2018Permit Case Number:Case Module: Thu Nov 1, 2018Passed Inspection Date:Inspection Status: Mike PalmerGeneral (Fire Marshal) Inspector:Inspection Type: 375 BAY RD296.19-1-32 Job Address:Parcel Number: Queensbury, NY 12804 Contact TypeCompany NameName Primary Owner375 Bay Road LLC Granted Permission375 Bay Road LLC ContractorJersen Construction Group ApplicantJersen Construction Group Checklist ItemPassedComments Fire Marshal NotesYES Exit AccessYES Exit EnclosureYES Exit DischargeYES Locks and LatchesYES Sign: NormalYES Sign: backupYES Nov 01, 2018Page (1) INSPECTION WORKSHEET (007794-2018) Checklist ItemPassedComments Main Aisle WidthYES Secondary Aisle WidthYES Fire Extinguisher HungYES Inspection of ExtinguisherYES EVAC PlanYES Energency Lighting InteriorYES Electric Wiring EnclosedYES Combustibles in Equipment RoomsYES No Smoking SignsYES StorageYES Vehicle Impact ProtectionYES Interior FinishesYES CO DetectorsYES Clearance to Sprinkler/CeilingYES Fuel Station Emer ProceduresYES ElevatorYES Nov 01, 2018Page (2) INSPECTION WORKSHEET (007794-2018) Checklist ItemPassedComments FIRE ALARMYES HVAC ShutdownYES Sprinkler SystemYES Sprinkler FDCYES Knox Box: Installed/checkedYES AngelaPalmer, Mike (Inspector) Nov 01, 2018Page (3)