2007-628 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF 0CCUP-A-N- CY
Permit Number. P20070628 Date Issued: Monday, November 26, 2007
This is to certify that work requested to be done as shown by Permit Number P20070628
has been completed.
Location: 53 LUZERNE Rd
Tax Map Number. 523400-309-010-0001-088-002-0000
Owner. A & Q HOLDINGS INC
Applicant: OXY-I INC
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 they
property owner of the responsibility for compliance with Site Plan,
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,Queensbwy,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070628 Application Number. A20070628
Tax Map No: 523400-309-010-0001-088-002-0000
Permission is hereby granted to: A & Q HOLDINGS INC
For property located at: 53 LUZERNE 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. Tyne of Construction Value
Owner Address: A& Q HOLDINGS INC Certificate of Occupancy(COM)
10 SAGAMORE St Total value
GLENS FALLS, NY 12801-0000
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2007-628
certificate of occupancy
$50.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Sunday,November 09, 2008
(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 To Mbu Fr y,(N! v tuber 09,2007
SIGNED BY r for the Town of Queensbury.
Director of Building&Code Enforcement
%s-----si-i-----s-ii---
I
Community Development Office 7'o
Town of Queensburij • 742 Bay Road - Queensbury, New York -12
•David Hatin,Director of Building&Codes OCT ����
Craig Brown,Zoning Administrator•Michael J.Palmer;Fire Marshal 04
'- --
ESTABLISHMENT OF A NEW cc� s
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
TAX MAP# -�CQ�. 10 _ �'z�.,ZLDG. PERMIT FILE# a 7
It PP Ica e
Name of Business: e
Address L/�, ( �-z �_��
o "_/� t'-- QUESTIONS? CALL 761-8256 OR
f Business:
EMAIL codes(ftueensburV.net
WEBSITE
Person in Charge or Manager ' S �_ VISIT OUR INFORMATION FOR MORE
` 2 www.queensbury.net
Business Phone Number: ,5 �7 l / 95 0 J
Type of Business:
Owner of Prope P;V(, fig( Phone Number(s): I r 3
Home Cell
Owners
Address: Q C( "ore S-� len's F—a//'S
Please provide an accur e layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signat C I I /
Of person submitting this forth
Notes /Comments:
"Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: /C z /
BUSINESS NAME:
BUSINESS ADDRESS:
BUSINESS PHONE: (/S 19) 30
�( YI SSO( �a06/,q 1 HOME -yl lq 2 _L)'7?J 3
CONTACT 1: PHONE
ADDRESS: I ( 1(�,e-e
CONTACT 2 Yld re W HOME
HONE 2- J C o7
ADDRESS: I / _� re Lark �/l��'OmL ,/ y � / 20,52
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
P h o n e. 518-761-8206 F a x: 518-745-4437
firemarshal fteensburt/ net www.gueensburj.net
13P
53 Luzeme Road Queensburtl New York
Window Window
tr
G 21' (�
oset->
<-Closet
11'
Door Door
Closet Bathroom
Half wall
• Stairs to
Basement Bathroom
Pole Pole Pole
45'
Bade Door
Coffee Station
Door Door
--closet
close[->
<-Door->
12.5' 12.5'
Window Window
STAIRS
DOOR DOOR
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No.
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: 1 I -Z(o �� Time:
Phone: (518) 761-8206 Business Name: Q
Fax: (518) 745-4437 Location: �.•2 L �- '
Type of Ins ecHon N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Fait Discharge
EVAC Plan
AISLES:
Main Aisle Width
Secondary Aisle Width t=ire Marshal Ins bon Complete
EXIT SIGNAGE
OK to Issue Cero Ca upancy
Sign-normal
Sign-battery �` 1`
EVAC signs in rooms N 1'
TRUSS ID SIGNAGE `
EMERGENCY LIGHTING F111A Marsha
FIREEXTINGUISHER: wn of QUGellsbu
Hun
Inspection of extinguisher
Hydro extinguisher
FIRE ALARM SYSTEM
Fan Shutdown
Fire Sprinkler System
Fire Suppression-kitchen
Fire Suppression-Gas Island
Hood Installation
1
Interior Finishes
Storage
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical
Electric Wiring Enclosed
Combustible Waste
Vehicle Impact Protection
Fire Lane
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
Approved (If no other approvals apply,the B&C Office will issue je)ite of Occupancy)
❑ Denied
o Call for Recheck
Inspected By:
L:\FireMarshal\insptopermitto occupyform.doc
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. ���v 26
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled inspection Date: D (/�_ Time:
Phone: (518)761-8206 Business Name:Oxv
Fax: (518) 745-4437 Location:
Type of ins action N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondar Aisle Width /,g� j,,
EXIT SIGNAGE ' 4
Sign—normal I I
Sign-batter VIP
EVAC si ns in rooms
TRUSS ID SIGNAGE `
EMERGENCY LIGHTING Slbh �V� GN'1�'f�
FIRE EXTINGUISHER:
Hun
inspection of extinguisher bs
FIRE ALARM SYSTEM ] `
Fan Shutdown /' ) 41
Fire Sprinkler System (i /
Fire Suppression—kitchen k
Fire Smpression—Gas Islan
Generator
Hood Installation
Elevator
Interior Finishes PG 7
Storage `
Compressed Gas d11
Clearance to Sprinklers
Clearance to Electrical
Electric Wiring Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection
Knox Box
F.D.Si na e—Utility Rooms
No Smoking Signs_
Maximum Occupancy Si
Emergency Evacuation Plan
❑ Approved (if no other approvals apply,the 8&C Office will issue the Certificate of Occupancy)
gk--'Denied / call for Recheck
InspCdedy: ----
L:\FireMarshal\New Folder\permitto occupyform.doc