2005-109 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NIT 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
C-TRTIFICATE OF OCCUP-A-N- CY
Permit Number. P20050109 Date Issued: Monday, May 23, 2005
This is to certify that work requested to be done as shown by Permit Number P20050109
has been completed.
Tax Map Number. 523400-309-011-0002-011-000-0000
Location: 17 MAIN St
Owner. RPS PROPERTY HOLDINGS, LLC
Applicant: ADIRONDACK REHABILITATION MEDICINE, LLC
This structure maybe occupied as a:
By Order of Town Board
Commercial Alteration TOWN OF QUEENSBURY
Director of Building&C6cV Enfo ment
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050109 Application Number: A20050109
Tax Map No: 523400-309-011-0002-011-000-0000
Permission is hereby granted to: ADIRONDACK REHABILITATION W..DIC'1NF,. P
For property located at: 17 MAIN 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 Value
Owner Address: MARY A WELCH
Commercial Alteration $7,000.00
17 MAIN St Total Value $7,000.00
PO BOX 2053
GLENS FALLS, NY 12801
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
A2005-109 ADIRONDACK REHABILITATION MEDICINE, PLLC
353 SQ FT COMMERCIAL INTERIOR ALTERATION
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, March 18, 2006
(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 Town of Queensbury; Friday, March 18, 2005
SIGNED BY for the Town of Queensbury.
—i5irec� or of Buildi C Enforcement
Permit No. �-L(D
auiiaing&codes office-Department of Community Development-Town of Queensbuv Fee Paid � / lzy
742 Bay Road,Queensbury,NY 12804 Recreation Fee
Dave Hatin,Director codes@aveen5burv.net
Da 1
Phone: (518) 761-8256 FAX: (518) 745-4437 � �0
Principal Structure Building Permit Applicatibn
Application & Plans subject to review before issuance of a valid permit for construction.
Instructions: A permit must be obtained before beginning construction. No inspections will be made until the
applicant has received a valid building permit. All applicants' spaces on this application must be completed and
must appear on the application form.
Applicant/Builder Owner:
Address: Address:
Home Phone: SIR- 761-4CO Home Phone: �'- -cn�
Email Address: ah. n Email Address: „�..
Cell Phone: $- r21- Cell Phone:
FAX Phone: 2;78--79$-vglh FAX Phone: _
Person responsible for supervision of work with respect to building and codes compliance:
Name: 2�A
Address: Phone
Location of proposed construction: Lot No. Legal Address:
Tax Map Number: `�In ( • / I - _- I—
Subdivision Name:
Estimated Cost of Construction: $ 3
Proposed construction is for: _Residential Use Commercial Use ; if °% ` '.i J`
Name of Business:
If proposed construction is an addition,what will use of new addition be?
New Addition Alteration Proposed Construction 1 d Floor 2nd floor Other Total Proposed
structure (Occupancy Type) Sq. Ft. sq.ft. Sq.Ft. Square feet Height
Ft.L In.
Single-Familly Dwelling
Two-Family Dwelling
Townhouse
Multifamily Dwelling
Number of Units:
Office
Mercantile
Manufacturing
Other:
Attached Garage 1, 2, 3
Type of Heating System: Electric, Oil, Gas, Wood, :orced Baseboard, Other:
Is a fireplace and/or woodstove being installed, please refer to a separate application. +Yes .)CNo
Applications are subject to Zoning Administrator, Code Compliance, and Structural Plan review.
The Building and Codes Office will allow commencement of your proposed project only after
Issuance of your permit.
Declaration: Please sign below after you have carefully read the statement:
To the best of my knowledge, the statements contained in the application, together with the plans and
specifications submitted, are a true and complete statement of all proposed work to be done on the described
premises and that all provisions of the Building Codes, the Zoning Ordinance, and all other laws pertaining to the
proposed work shall be complied with,whether specified or noted,and that such work is authorized by the owner.
Further, it is understood that I/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued, as requested by the Zoning Administrator or Director of Iding and Codes, an As Survey by a
licensed surveyor, drawn to scale, showing actual location of all onstruction.
Date: Z% Applicant/Builder Signature:
'he application of dated is hereby approved and
)ermission granted for the construction, reconstruction or alteration of a building/and or accessory structure as set
orth above.
Date: Authorized Signature:
:\Sue Hemingway\Building.Permit.FORMS\Principal Structure Permit Application.doc V:12/14/04
JWQueensbury Building & Code Enforcement - Resid tial al Inspect'c�rl
Office No.(518)761-8256 Arrive: pm art: am/
Date Inspection request received: Inspector's Initi �//
NAME: -PP ize"-A-6 RJ)IIIT#:
LOCATION: 1-7 &A1 b &I &-t' E: 5'!3&Sz-
TYPE OF STRUCTURE:
Comments
Y N N/A
Chimney Ht./"B"Vent/Direct Vent Location
Fresh Air Intake
3 inch Plumb Vent through roof minimum 6"
Roof Complete/Exterior Finish Complete
Guard 30 in.or more @ stairs,decks,patios
Guard at stairwell at 34 in. or more
Guard at deck,porches 36 in.or more
Exterior Finish Complete
Interior/Exterior Railings 34 in.to 38 in.
Platform at all exterior doors
Interior Handrails stairs 2 or more risers
Enclosed Stairs Sheetrock Underside minimum %"
Gypsum
Grade away from foundation 6 in.with 10 ft.
Handrail Termination at Newell Post or Wall
6 inch clearance to sill plate
Gas Valve shut-off exposed/regulator 18"above grade
Gas Furnace shut-off within 30 ft. or within line of site
Oil Furnace shut-off at entrance to furnace area
Furnace/Hot Water Heater operating
Low water shut-off boiler
Relief Valves installed/Heat Trap/Water Temp 110
Interior privacy/trim/doors/main entrance 36 in.
Bathroom/Kitchen watertight
Safety glazing/Window in stairwells safety glazing
Interior Smoke Detectors:
Every level: / Every Bedroom:
Outside every bedroom area:
Inter Connected: / Battery backup:
Carbon Monoxide Detector
Bathroom Fans, if no window
Plumbing fixtures
Foundation insulation
Floor truss,draft stopping finished basement 1,000 sf
Emergency egress below grade
Basement stairs closed rise>4 inches
Garage Floor Pitched
Garage fireproofing/'/4 hour fire door/door closer
Duct work Sealed properly
Gas Logs in Sealed or Glass Enclosure
Attic access 30 in.x 22 in x 30 in.(ht.)In accessible area
Crawl Spaces 18"x 24"access, 1 s . ft.-150 s . ft.vents
Building No./Address visible from road
Final Electrical
Site Plan /Variance required
Final Survey Plot Plan
As Built Septic System/Sewer Dept. Inspection Sticker
Flood Plain Certification, ' e it
Okay to issue C/C or / em orar / rmanent
L:\PamW\Building&Codes\Inspection Forms\Res, Final Insp. form 2.docLast printed 2/12/04
Town of Queensbury
Fire Marshal's Office
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspection Report
Request 1-0
CHEDULE
Received: Permit# — � NSPECTION ON:
�,� �\ i
Name: Dpp� e "\ta",� � AM PM ANYTIME
Location: Ma
A PROVED
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE V _
EXIT DISCHARGE _ t ���
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH �` ��
EXIT SIGN-NORMAL ' �� 4rti
EXIT SIGN-BATTERY _ K
EMERGENCY LIGHTING k
FIRE EXTINGUISHER HUNG
FIRE EXTINGUISHER
INSPECTION
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN
FIRE SPRINKLER SYSTEM V
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS X,
ISLAND
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE _
COMPRESSED GAS
CLEARANCE TO SPRINKLERS
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION
FIRE LANE
F.D.SiGNAGE-UTILITY ROOMS
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN
II
OK THIS DATE t FOR CO NOT OK
INSPECTED BY
COMDEV/C HRISJ/WORD/LETTERS2001/FIREMARSHALINS PECTIONRE PORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
Commercial Final Inspection Re WC�
Co Report p p
Office No.: (518) 761-8256 Date Inspection re st ree
Queensbury Building&Code Enforcement Arrive: p Depart: t4ggjxl�
742 Bay Road,Queensbury,NTY 12804 Inspector's Initi
NAME: . PERMIT#-
LOCATION: J DATE:
COMMENTS:
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish Grade Complete 6"in 10' or Equivalent
Interior/Exterior Guardrails 42 in. Platform/Decks
Interior/Exterior Ballisters 4 in. Spacing Platform/Decks ►J�
Stair Handrail 34 in.—38 in./Ste Risers 7"/Treads 11"
Vestibules For Exit doors>3000 s . ft. P1_� �
All Doors 36 in.w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36 (w)x 44"(1)/Canopy or Equiv. — F FLjP_
Gas Valve Shut-off Exposed&Regulator 18" Above Grade
Floor Bathroom Watertight/Other Floors Okay (��
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System — In
Fresh Air Supply for Occupancy/Ventilation Combustion �G-
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft. or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area _ -Td
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/z doors
> 10%> 1000 s . ft.
3/a Hour Corridor Doors&Closers
Firewalls/Fire Separation, 2 Hour, 3 Hour Complete/Fire
Dampers/Fire Doors ��-
Ceiling Fire Stopping, 3,000 s . ft. Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24" 1 I
Smoke Vents Or Fan,if required �� L
Elevator Operation and Si a e/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets �� �PS�
Handicapped Bath/Parking Lot Si na e
Public Toilet Room Handicapped Accessible
Handicapped Service Counters, 34 in., Checkout 36"
Handicapped Ram /Handrails Continuous/12 in. Beyond
Active Listening System and Signage Assembly Space
Final Electrical
Site Plan/Variance required
Final Survey,New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway
Water Fountain or Cooler
Building Access All Sides by 20' /Driveable Surface 20' wide
Okay To Issue Temp. or Permanent C/O
Okay To Issue C/C
Last printed 6/3/2003 9:27 AML:\PamW\Building&Codes\Commercial Final Inspection Report.doc
Framing / Firestopping Inspection Report
Office No. (518) 761-8256 Date Inspection reque ece' e .
Queensbury Building& Code Enforcement Arrivek art: ar r
742 Bay Road, Queensbury, NY 12804 Inspector's Initials:
NAME: f J _ PERMIT#: o
LOCATION: INSPECT ON: -
TYPE OF STRUC RE:
L
o Y N lvia COMMENTS
raming
Jack Studs/Headers
Bracing/Bridging
Joist hangers
Jack Posts/Main Beams
Exterior sheeting nailed properly
12"O.C.
Headroom 6 ft. 8 in.
Stairwells 36 in. or more r
Headroom 6 ft. 8 in. T�
Notches/Holes/Bearing Walls ��( - n '.Skjk�
Metal Strapping for Notches Top Plate
1 %s w) 16 gauge(8) 16D nails each side
Draft stopping 1,000 sq. ft. floor trusses
Anchor Bolts 6 ft.or less on center
Ice and snow shield 24 inches from wall
Fire separation 1,2, 3 hour
Fire wall 2, 3,4 hour
Firestopping
Penetration sealed
16 inch insulation in cavity min.
Garage Fire Separation
House side % inch or 5/8 inch Type X
Garage side 5/8 inch Type X
! Ceiling/wall
Windows Habitable Space/Bedrooms
24 in. (H)
20 in. (W) `
5.7 sf above/below grade f
5.0 sf grade
L:\SueHemingway\Quilding.Codes.inspection.FORMS\Framing Firestopping Inspection Repomdoc January 28,2003
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TOWN OF QUEENSBURY BUILDING DE NT
& CODE Based on oUr limited examina i •
compliance with our comments sh , ,
:Y -- - not be construed as indicating fh r _y - t
-•--- ' �. plans andspecifications are in fu `
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compliance with;the Building,Code
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