2005-583 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number. P20050583 Date Issued: Friday, August 26, 2005
This is to certify that work requested to be done as shown by Permit Number P20050583
has been completed.
Tax Map Number: 523400-296-019-0001-002-000-0000
Location: 123 QUAKER Rd
Owner. FIRST NIAGARA BANK
Applicant: LEXINGTON CENTER DB/A HOME BASE OF GLENS FALLS
This structure maybe occupied as a:
Commercial Alteration By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the (�2)j W 00t
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,Queensbury,ICY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050583 Application Number: A20050583
Tax Map No: 523400-296-019-0001-002-000-0000
Permission is hereby granted to: LEXINGTON CENTER DB/A HOME BASE OF GL
For property located at: 123 QUAKER 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: FIRST NIAGARA BANK Commercial Alteration $20,000.00
ATTN: REAL ESTATE MGR/FACIL Total Value
P.O. BOX 514 $20,000.00
LOCKPORT, NY 14095-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-583 LEXINGTON CENTER DB/A HOME BASE OF GLENS FALLS (SURVIVORS OF
TRAUMATIC BRAIN DAMAGE
COMMERCIAL INTERIOR ALTERATION
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, July 29, 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 11�T-Ozly Q s ,July 29, 2005
o Queensbury.
SIGNED BY for the Town of Q ry.
Director of Building&Code Enforcement
Permit No R =
Building&Codes Office-Department of Community Development-Town of Queensbury Fee Paid :
742 Bay Road,Queensbury,NY 12804
Dave Hatin,Director s;Qdes@aueensbury.net Recreation Fee �
Phone: (518) 761-8256 FAX: (518) 745-4437 J
Principal Structure Building Permit A li o f nf, r s
Application & Plans sub-ect to review before issuance of a valid Permit p•r 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/Bb*cter t G r' l 'd1 S Address: Owner:
t�7 Address:
Home Phone: 3 6 c ' Home Phone: c,�c
Email Address: Email Address:
Cell Phone: Cell Phone: - 7
FAX Phone: FAX Phone:
Person responsible for supervision of work with respect to building and codes compliance:
Name: ��� n
Address:
Phone 3U7-
Location of proposed
Cconstruction: Lot No. Legal Address: jcz 3 � r
Tax Map Number: La� Subdivision Name:
Estimated Cost of Construction: $ a� o/ mo
Proposed construction is for: _Residential Use _Commercial Use G�
Name of Business: �' n �E��� h Cti. - 1,,., :sc C C`7
If proposed construction is an addition,what will use of new addition be? i49 C - 75' -v' v`'-S
New Addition Alteration Proposed Construction Id Floor 2nd floor Other Total Proposed
structure (Occupancy Type) Sq.Ft. sq.ft. Sq.Ft. Square feet Height
Ft.&in.
Single-Family Dwelling
Two-Family Dwelling
Townhouse
Multifamily Dwelling
Number of Units:
Office
Mercantile
Manufacturin
Other:
Attached Garage 1, 2, 3
Type of Heating System: Electric, Oil, Gas, Wood, Forced Hot Air, Baseboard, Other:
Is a fireplace and/or woodstove being installed, please refer to a separate application. —Yes —No
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 ;ff O ancy or tificate of Compliance
being issued, as requested by the Zoning Administrator or Director uil g and des, an As-Built Survey by a
licensed surveyor, drawn to scale, showing actual location of all ew tr cti
Date: 1 414 Applicant/Builder Signature:
The application of dated is hereby approved and
permission granted for the construction, reconstruction or alteration of a building/and or accessory structure as set
forth above.
y Date: Authorized Signature:
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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 SCHEDULE �v
Received: Permit# INSPECTION ON: air
Name: (� v M PM ANYTIME
Location: JL
APPROVED
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE
EXIT DISCHARGE _
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH n
EXIT SIGN-NORMAL (LJ�4 �r, -� (a o-,C t i
EXIT SIGN-BATTERY
EMERGENCY LIGHTING
FIRE EXTINGUISHER HUNG
FIRE EXTINGUISHER
INSPECTION
FIRE EXTINGUISHER HYDRO �vy\
FIRE ALARM SYSTEM
FIRE ALARM -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.SIGNAGE-UTILITY ROOMS
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN
OK THIS DATE FOR NOT OK
INSPECTED BY
COMDEV/CHRISJIWORDILETTERS2001IF IREMARSHAUNSPECTIONREPORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
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 SCHEDULE
Received: Permit# INSPECTION ON: _
Name: PM ANYTIME
Location: V
APPROVED
N lA YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE D r
EXIT DISCHARGE
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH �>�1 `t w f
EXIT SIGN-NORMAL
EXIT SIGN-BATTERY ���
EMERGENCY LIGHTING _
FIRE EXTINGUISHER HUNG
FIRE EXTINGUISHER cos`�
INSPECTION aC �!
cp
FIRE EXTINGUISHER HYDRO P�
FIRE ALARM SYSTEM
FIRE ALARM -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.SIGNAGE-UTILITY ROOMS
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN_.,_.
OK THIS DATE OK CO ( —OT OK
I
COMDEVICHRISJIWORDILETTERS2001IF IREMARSHALINSPECTIONREPORT 11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
Commercial Final Inspection Report
Office No.: (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: ►Jt-J am/p Depart: am/pm
742 Bay Road, Queensbury,NY 12804 Inspector's Initials: - 1 f
NAME: �r ' C —�'" PERMIT#:
LOCATION: JX3 �Y DATE:
Pt
0MMENTS:
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
Stair Handrail 34 in.—38 in./Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 s . ft.
All Doors 36 in.w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36(w)x 44"(1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator 18" Above Grade
Floor Bathroom Watertight/Other Floors Oka
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hi% or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
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
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/z doors
> 10%> 1000 s . ft.
3/4 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"
Smoke Vents Or Fan,if required
Elevator Operation and Si a e/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
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 VZ
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
Commercial Final Inspection Report
Office No.: (518) 761-8256 Date Inspe on request received: !fo U�
Queensbury Building&Code Enforcement Arrive: am/pm Dep rt: am/pm
742 Bay Road, Queensbu�ray,NY 12804 Inspector's Initials:
NAME:v�L� !.� Ci Son. ^ _ �/=PERMIT#: �C-.3
LOCATION: () /a 3 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
Stair Handrail 34 in.=38 in./Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 s . ft.
All Doors 36 in. w/Lever Handles/Panic Hardware,if required
Exits At Grade Or Platform 36 (w)x 44"(1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator 18" Above Grade
Floor Bathroom Watertight/Other Floors Oka
Relief Valve,Heat Trap/Water Temp. 110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
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
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 %2 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"
Smoke Vents Or Fan, if required
Elevator Operation and Si a e/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
—711
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 reg.
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 CIO
Okay To Issue C/C
Last printed 6/3/2003 9:27 AML:\PamW\Building&Codes\Commercial Final Inspection Report.doc
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Town of Queensbury y
Fire Marshal's Office X 0`
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-44 77
Fire Marshal's Inspection Report
Request C SCHEDULE J r�
Received: Permit# J INSPECTION ON: �� / J
Name: LL>m, ► C-t t52 1 AM 'PM ANYTIME
Location: 2�3
APPROVED
N/A YES NO COMMENTS
EXIT ACCESS
EXIT ENCLOSURE sl S I�r �c�
EXIT DISCHARGE �l
MAIN AISLE WIDTH
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL Grt E- `-3. i S Lu 'S 0
EXIT SIGN-BATTERY
EMERGENCY LIGHTING _ t 1� f c,r r Sic. t,,
FIRE EXTINGUISHER HUNG `— �1 n 1
FIRE EXTINGUISHER ,/ \
INSPECTION
FIRE EXTINGUISHER HYDRO
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION-KITCHEN �--1
FIRE SUPPRESSION—GAS jV�\h'c,*'
ISLAND
HOOD INSTALLATION _
INTERIOR FINISHES
STORAGE
COMPRESSED GAS
CLEARANCE TO SPRINKLERS D 1 C,t P
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE_
VEHICLE IMPACT PROTECTION
FIRE LANECt
F.D.SIGNAGE-UTILITY ROOMS ,< / 1 �
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN_
EMERGENCY EVAC PLAN
I
OK THIS DATE OR CO NOT OK
INSPECTED BY
COMDEVICHRISJIW ORDILETTERS20011FtREMARS HALINS PECTIONREPORT 11022001
WHITE—BUILDING DEPARTMENT COPY YELLOW—OCCUPANT COPY
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