2012-261 TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120261 Date Issued: Saturday, June 22, 2013
This is to certify that work requested to be done as shown by Permit Number P20120261
has been completed.
Location: 309-313 BAY Road
Tax Map Number: 523400-302-008-0001-007-000-0000
Owner: FRANCIS T COLLINS
Applicant: LA COSINA MEXICANA LLC
This structure may be occupied as a:
Certificate of Occupancy (COM) 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,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.
TOWN OF QUEENSBURY
FoN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120261 Application Number: A20120261
Tax Map No: 523400-302-008-0001-007-000-0000
Permission is hereby granted to: LA COSINA MEXICANA LLC
For property located at: 309-313 BAY Road
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: FRANCIS T COLLINS
1399 PILOT KNOB Rd Certificate of Occupancy(COM)
KATTSKILL BAY NY 12844-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-261
CO Only for La Cosina Mexicana LLC, 313 Bay Rd, Queensbury
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 31,2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before the expiration date.)
Dated at the To of Q e nsb •r ► ay 31,2012
SIGNED BY - \ for the Town of Queensbury.
Director of Building& Code Enforcement
• /5 f-' v<Olc -046/
! .
, "I Community Development Office� I Town of Queensbury• 742 Bay Road• Queensbury, New York •12804
David Hatin, Director of Building& Codes ,
` (� Craig Brown,Zoning Administrator•• Michael J. Palmer, Fire Marshal ' Stamp #
5 ,
ESTABLISHMENT OF A NEW BUSINESS
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Note: This application is for occupancy only, with no work requiring a building permit.
TAX MAP# 3° , .2' "I -7 BLDG. PERMIT FILE# /c)ita-ppaSeg
Name of Business: Z 6514 01 t c k C n ,v
Address
of Business: 3 (3 644<4 (2I) , Q t4 r=b/v S e Gl g i QUESTIONS? CALL 761-8256 OR
�
EMAIL codesl�aueensburv.net
�� L Cr' O VISIT OUR WEBSITE FOR MORE
person in Charge or Manager: I?GL ft (3 6 01. ff q >✓-Z. INFORMATION
2 -h, T duo' a e'd. ate 1-14-f www.aueensburv.net
Business Phone Number.
'LA di L
,may/
Type of Business: inn'n'((P✓lip/ Arriq c /t 5--)51 Li-7 5
6)
X Owner of Property: F 1 I< do L L(i(//� Phone Number(s):
Home cell
X Owners Address: POZr(/' KC= es ( 6, N y
Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters a d ll Lure layout on a separate sheet of paper.
Signature:`-------- Date: -7 / / v
Of submitting th' form
Notes I Comments:
--rb �a�/i.P,v4.
EMERGENCY CONTACT UPDATE g610f
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE:
BUSINESS NAME: L BUSINESS ADDRESS:ADDRESS: 3 13 ' / 4 , Q CA ��A/s op I 11 /2 gpcf
BUSINESS PHONE: J I 6 - 7 S64 Z
CONTACT 1: dl-c S/I rn . Viq S clZq c Z HOME PHONE
ADDRESS: t.(f S7'I17 ci r` E 41, ( 17 a i (7; ( j.I , 3
CONTACT 2: 4vo V41 - HOME PHONE$7S S -
ADDRESS: 30g1- S%R Z ado rE• 4, (44, Dfed ��,((f l J�'"; , f 2 �3
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.
June 6, 2012
QUEENSBURY BUSINESS INSPECTION: Request
La Cosina Mexicana, 313 Bay Road,Queensbury, NY (Former Lazio Restaurant)
Owner: Celsa M.Vasquez
DOH will be doing inspection tomorrow Thursday June 7, 2012 at 10 am.
Target Open date: Wednesday,June 13, 2012
I can be reached at 518-221-1487 for setting appointment.
John Crawford
jpCrawford Associates
94 Bay St.
Glens Falls, NY 12801
518-221-1487
SP c2O/c -a��
FIRE MARSHAL'S OFFICE
Town ofQueensbury
Q 9
742 Bay Road, Queensbury, NY 12804
" Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
LaCosina Mexicana
2012- 261
5/30/2012
The following comments are based on plan review:
1) Exit and EL,s to be verified with a function test.. All exit signs must be
compliant with battery backup feature. All lighting shall be clearly identified
in service panel(s) for future testing
2) Locks / latches to comply w/ FC1008
3) Fire extinguisher locations to be discussed
4) Hood, duct, fan cleaning to be provided
5) Kitchen suppression system inspection to be provided
6) Appliance layout to be provided
7) EVAC plan to be posted
4\t„,e
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 Form
Town of Queensbury Fire Marshal O Periodic Inspection Date: 41 24/2 Time: I I lb/4M
742 Bay Road,Queensbury NY 12804 a Re-Inspection
518 761 8206/518 761 8205 )<CO Inspection Pgrmti ti: / D-a f, I
Fire Marshals Representative r
MJ Palmer Business Name: itt7
g 1/11 1/-,,A L
Location: , /; _ ly Rea'
1 K Stillman Contact: _4;i V4 i/.
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014 S.FC1029 NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024&FC1029 ./'
Locks and latches FC1008 a FC1029.2 /
Sign:Normal FC 1011 L FC1029 .,/
Sign:backup FC 1011.5.3&FC1029.7.5 -------
AISLES:
Main Aisle Width FC 1024/1025&FC1029.11 /—
Secondary Aisle Width FC 1025&FC1029.11
FIRE EXTINGUISHER: Hung FC 906 ��
Inspection of extinguisher FC 906
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3 ��
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8
Exterior FC 1006.3
Clearance to Electrical FC 605.3 /�
Electric Wiring Enclosed/Labeled FC 605.3.1
Combustibles in Equipment Rooms FC315.2.3
F.D.Signage- FC 510
No Smoking Signs FC 310.3
Storage FC 315.2
Compressed Gas FC 3003 /
Vehicle Impact Protection FC 312.1 I
Interior Finishes FC 803-804 ....--
Smoke Detectors FC 907 .------
CO detectors FC 610
Clearance to Sprinkler/Ceiling FC 315.2.1 /
18" / 24"
EVAC SIGNS IN Rooms FC 404.6(R1 a R2) .ram
Fuel Pump Warning Signs FC2205.6
Fuel Station Emer Procedures FC2204.3.5 ,/
Exterior Storage FC 315.3 �p
Vacant
REINSPECTIONDUE APPROXIMATELY
r Bu ngs FC 31111 � gk�,�
21 DAYS
Insp OK NC DATE: OK NC
SYSTEMS: FC 901.6 Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
HVAC Shutdown
Sprinkler System Annual
Sprinkler FDC
Kitchen Suppression Semi Annual 4,. /
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual 'pill
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
Inspection Form
Town of Queensbury Fire Marshal O Periodic inspection Date: Time: .€ //10
742 Bay Road,Queensbury NY 12804 Inspecfion /
518 761 8206/518 761 8205 CO Inspection Permit#: l
Fire Marshals Representative
MJ Palmer Business Name: 4A- &1 S//kGL- /"l C/ 2--
Location: . j l i
GK Stillman Contact: 1!1Si9 019-S- z O V f 47 6 ‘
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 NOTES
Exit Enclosure FC 1020&FC1029 ,---
Exit Discharge FC 1024&FC1029
Locks and latches FC1008& FC1029.2
Sign:Normal FC 1011 &FC1029
Sign:backup FC 1011.5.3&FC1029.7.5 ,i
AISLES:
Main Aisle Width FC 1024/1025&FC1029.11 .
Secondary Aisle Width FC 1025&FC1029.11 ��
FIRE EXTINGUISHER: Hung FC 906 x ^ /YJ tni .
Inspection of extinguisher FC 906 _ •/ � 5J L/"
1
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8x Ali 2,6n7- ifs- s;SC.vSSA
Exterior FC 1006.3 ----- i m. K) te:_N
Clearance to Electrical FC 605.3
Electric Wiring Enclosed/Labeled FC 605.3.1 /
Combustibles in Equipment Rooms FC315.2.3 / —0 iM 1r ite-tek c 2v2 Q bqck
F.D.Signage- FC 510 ,....----
No Smoking Signs FC 310.3 ------- ifttell
Storage FC 315.2 j
Compressed Gas FC 3003
Vehicle Impact Protection FC 312.1
Interior Finishes FC 803-804
Smoke Detectors FC 907
CO detectors FC 610 ...---
Clearance to Sprinkler/Ceiling FC 315.2.1
18" / 24" •/ c
EVAC SIGNS IN Rooms FC 404.6(Rl &R2) -/ 7 4
Fuel Pump Warning Signs FC2205.6 / 6�
Fuel Station Emer Procedures FC2204.3.5 (.1Ai 0 h S
Exterior Storage FC 315.3 REINSPECTION DUE APPROXIMATELY
Vacant
Ba to s�Fc 311otel Pe1 X 21 DAYS
SYSTEMS: FC 901.6 insp OK NC DATE: OK NC
Date
Generator Annual DATE: OK NC
Hood Installation
Elevator Semi Annual
FIRE ALARM Annual DATE: OK NC
HVAC Shutdown
Sprinkler System Annual
Sprinkler FDC �j�// �j /_,
Kitchen Suppression Semi Annual 5�Z ✓ �� ' "r''�"" '` ®°/ t Gar '
Fuel Island Suppression Semi Annual
i Hood Cleaning 3-6 -Annual y`/j /ff frflea
-�J v Knox Box:installed/checked FC506
Operating Permit, if required will be issued after �J /./ -i-ize �40�2 ,
P P
Completion of Inspection l/
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