2005-927 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: P20050927 Date Issued: Thursday, December 15, 2005
This is to certify that work requested to be done as shown by Permit Number P20050927
has been completed.
Tax Map Number: 523400-308-015-0001-008-000-0000
Location: 133 PITCHER Rd
Owner: CELINA BUTLER
Applicant: WOODLAND PASS DELI & GROCERY
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 the
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 Enforcemen
Planning Board or Zoning Board of Appeals.
u y
TOWN OF QUEENSBURY
LIJ 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050927 Application Number: A20050927
Tax Map No: 523400-308-015--0001-008-000-0000
Permission is hereby granted to: WOODTAND PASS DELI& GROCERY
For property located at: 133 PITCHER 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. Type of Construction Value
Owner Address: CELINA BUTLER
87 PITCHER Rd Certificate of Occupancy(CO1VI)
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-927 WOODLAND PASS DELI AND GROCERY
CERTIFICATE OF OCCPANCY
$50.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, December 06, 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 th f Que bu T :esday, December 06, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Co e Enforcement
BP File#
Dept of Community Development ---- �C C to
Town ofQueensbury
742 Bay Road
Queensbwy,NY 12804
(518) 761-8256
For occupancy only,with no work requiring buildingpermit. no fee required for this permit
Name ofBusiness: o-nk&kS pa ss &M ejn
Address: 133 P;�z , kJ AJ V IQ90q' .
Person in Charge or Manager.- „&3 n i a � z•e a Ad v.-f&n �e -
Business Phone Number: _6;i S- 193 0!f 8
Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing story;'
Owner-ofProperty: Cy c11z &Aie Y -
Address: .. . ._ :7_.
Phone Number-.-.
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: —At- Date. /,z L� 03
of pff=submitting this fon
2005-927
WOODLAND PASS DELI & GROCERY
� 13 PITCHER ROAD
CERTIFICATE OF OCCUPANCY
Property Tax Map No. / / TAX ID 305.15-1-8
Notes/Comments:
Town of Queensbury
Fire Marshal's Office
.! EMERGENCY CONTACT UPDATE
LTRS 2000
TO: WARREN COUNTY SHERUTS DEPT. FAX: '743-25U2
PLEASE PRINT
DATE: /--L0,;_ 143
BUSINESS NAME: . l� lJ �i �►
BUSINESS ADDRESS:'_ 1`33
BUSINESS PHONE: S J 8 7 91 - 9 S
HOME
CONTACT 1: (,IO4`ev' —PHONE ,
ADDRESS: 9 0 L Ax �A (It n sl rn�u7 t/
��:�. HOME
CONTACT 2 . _.., �h n i� .. �. _._._:.:.PgONF -...79a `fo��g :-.•. ...
ADDRESS: 'D
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
----PERL.
Fire Marshal Steve Smith,Deputy Fire Marshal Mike Palmer
Phone 761-8205, FAX 745-4437
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. 6_ /Z7
Town of Queensbury /
742 Bay RoadI y) Time:
Queensbury,NY 12804 Scheduled Inspection Date:
Phone: (518) 761-8206 Business Name: tll� WJWd ;/ 55 C�ev'z /
Fax: (518) 745-4437 Location: 3 he',— 12- I
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sign-normal
Sign-battery
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydro 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 Smokinq Si ns
Maximum Occupancy Sign
Emer enc,.Evacuation Plan
/04� Approvecl (If no other approvals apply,the B&C Office will issue th �Tertificate of Occupancy)
❑ Denied
❑ Call for Recheck
Inspected By: I _
L�' U
L:\Sue Hemingway\Fire Marshals Office Inpsection 08.17.2005.doc
Inspection for Permit t® Occupy
Fire Marshal's Office Request Rec'd /=�" �'!U�' Permit No.
Town of Queensbury / f
742 Bay RoadU`j f ��
Queensbury,NY 12804 Scheduled Inspection Date: (+ Time: - �
Phone: (518_7.6.6820 Business Name: lao-4����
Fax: ' 18) 745-4437 Location:
3
C--
Type of Inspection N/A Yes No
EXITS:
Exit Access COMMENTS
Exit Enclosure
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle Width "
EXIT SIGNAGE
Sign-normal �C
Sign-battery ��.
TRUSS ID SIGNAGE X
EMERGENCY LIGHTING N/ , � t h,� � ) �";A k
FIRE EXTINGUISHER:
Hun
Inspection of extinguisher
Hydro extinguisher
FIRE ALARM SYSTEM T'
Fan Shutdown
Fire Sprinkler System .3C _
Fire Suppression-kitchen 4.
Fire Suppression-Gas Island
Hood Installation Q,
Interior Finishes
Storage
Compressed Gas X
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 k
Maximum Occupancy Sign
Emergency Evacuation Plan /
❑ Approved (If no other approvals apply,the B&C Office will issue the Certificat of Occupancy)
-q Denied r
❑ Call for Recheck
Inspected By:
L:\Sue Hemingway\Fire Marshals Office Inppection 08.17.2005.doc
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