2005-575 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
42 Community Development- Building &Codes (518) 761-8256
CE RT I F I CAT E OF OCCUPANCY
Pernut Number. P20050575 Date Issued: Thursday, January 04, 2007
This is to certify that work requested to be done as shown by Permit Number P20050575
has been completed.
Tax Map Number. 523400-302-011-0001-002-000-0000
Location: 643 GLEN St
Owner. T&M JACOBS PROPERTIES LLC
Applicant: T&M JACOBS PROPERTIES LLC
This structure maybe occupied as a:
Certificate of Occupancy(COM) By birder 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, �.Dj W j t
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,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050575 Application Number: A20050575
Tax Map No: 523400-302-011-0001-002-000-0000
Permission is hereby granted to: T&M JACOBS PROPERTIES LLC
For property located at: 643 GLEN 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. Type of Construction Value
Owner Address: T&M JACOBS PROPERTIES LLC
Certificate of Occupancy(COM)
643 GLEN St
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name / Address Electrical Inspection Agency
Plans&Specifications
2005-575 FOOT DYNAMICS
CERTIFICATE OF OCCUPANCY
$50.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, September 02, 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 Q ensb r' ay, ` 02, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
RECI •.'U L 2 5 2005
Town of Queensbury
Fire Marshal's Office
EMERGENCY CONTACT UPDATE
LTRS 2000
TO: WARREN COUNTY SHERIFF'S DEPT. F ,743-2502
PLEASE PRINT
DATE: 2 Z 15
f =
BUSINESS NAME: - C o ",ro I
BUSINESS ADDRESS:
U J�
BUSINESS PHONE: �' J
HOME
CONTACT 1: «(n � PHONE �q
ADDRESS:
G'
HOME �/
CONTACT 2: ��C'T �+ � C, PHONE �y , '2 d / 0
y,�+ �
ADDRESS: 5� �
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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.
Fire Marshal Steve Smith, Deputy Fire Marshal Mike Palmer
Phone 761-8205, FAX 745-4437
BP File#
REED JUL 2 5 2005 �557
New Business
Dept of Community Development Certificate of
Town of Queensbury
742 Bay Road
Queensbury, AT 12804
(518) 761-8256
For occupancy only, with no work requiting building permit: no fee required for this permit.
R
JUL, 2 5 2005
Name of Business: I')V,rq
I uft ✓RY
Address: k\q-"
Person in Charge or Manager: e ffc-, IQ-e
Business Phone Number: S
Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing store):
pedc FC (`I I'Itin I.C-4 C 41--I—a
ti
Owner of Property: rf-j'a C.'In 0
Address:
Phone Number: C
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet ofpaper.
Signature: Date:
rm.
An t0t�iui,4Aisfb
Property Tax Map No.3_0 c 'l J,
Notes/Comments:
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. �7,
Town of Queensbury
742 Bay Road
Queensbury,NY 12804 Scheduled Inspection Date: Time: _
Phone: (518) 761-8206 Business Name:
Fax: (518) 745-4437 Location:
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES: f)V / �� P
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE r
Sign-normal
Sign-battery
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydra extinguisher
FIRE ALARM SYSTEM
Fan Shutdown
Fire Sprinkler System
Fire Suppression-kitchen
Fire Suppression-Gas 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.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign
Emergency Evacuation Plan
o Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupanc:y
o Denied
❑ Call for Recheck
Inspected By:
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