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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