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2004-770 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. P20040770 Date Issued: Thursday, October 14, 2004 This is to certify that work requested to be done as shown by Permit Number P20040770 -has been completed. - Tax Map Number. 523400-301-008-0001-016-000-0000 Location: 366 AVIATION Rd ` Owner. KIT ELLEN BURKICH Applicant: NATURAL HEALTH OF QUEENSBURY This structure maybe occupied as a: By Order of Town Board Certificate of Occupancy (COM) TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040770 Application Number: A20040770 Tax Map No: 523400-301-008-0001-016-000-0000 Permission is hereby granted to: NATT TR AL TTF,ALTH OF OT TRFNSBT TRY For property located at: 366 AVIA,TjON 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. f , Twe of Construction Value Owner Address: KIT ELLEN BURKICH 366 AVIATION Rd Certificate of Occupancy(CO1VI) Total Value QUEENSBURY :NY 12804 Contractor or Builder's Name /Address ; [Electrical Inspection Agency Plans&Specifications 2004-770 NATURAL HEALTH OF QUEENSBURY CERTIFICATE OF OCCUPANCY $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, September 30, 2005 (If a longer period is required,an application-for an'extension 1m Ist be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the of Que sbu TAiursday, September 30, 2004 SIGNED BY for the Town of Queensbury. Director of Building&,Co he Enforcement • Town of Queensbury Fire Marshars Office EMERGENCY CONTACT UPDATE LTRS 2000 TO: WARREN COUNTYSHERIFF'S DEPT. FAX: 761-6210 PLEASE PRINT DATE: 7 ,1-71oq BUSINESS NAME: BUSINESS ADDRESS: � Ai o` 4 BUSINESS PHONE: 10 I HOME CONTACT is (67-8)aaa--6 9sS- TOWN RESPONDING FROM: HOME CONTACT 2: �� d Cam a PHONE ��' a�1•-�Qs-6 TOWN RESPONDING FROM: l ys Fall, AJ �- HOME CONTACT 3: Si PHONE �Y - `/ 3;x TOWN RESPONDING FROM: r Fire Marshal Steve Smith, Deputy Fire Marshal Mike Palmer Phone 76I--8205, FAX 745-4437 BP File# New Business Dept. of Community Development CertiflCate Of Town of Queensbury OCCupallcy Permit 742 Bay Road Queensbury,NY 12804 (518) 761-8256 For occupancy only, with no work requiring building permit: no fee required for this permit. CI - SEP 2 9 Z004 O Q TOWN OF OUEENSBDE Name of Business: a a ra NU—� - Address: 3 C C Ayia:hon A . Person in Charge or Manager: M v IA uy.k C,w J u Cr.1W tj r� Business Phone Number: CT-10-76-I6 t 5-0 5 0-T_ Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing store): 4CU,PU0CAre asscwc terms ny Ilea 4er s , Owner of Property: Address: 366 Ayita-6 r 'Rd. Phone Number: 71-9 - It-7 7 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: ofp sonsubp ' this form r Property Tax Map No. Notes/Comments: 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 �� L Received: Permit# fs?U y 7 INSPECTION ON: Name: t�a nc�t. "�r�� AM PM ANYTIME Location: APPROVED N/A YES NO COMMENTS EXIT ACCESS EXIT ENCLOSURE EXIT DISCHARGE MAIN AISLE WIDTH SECONDARY AISLE WIDTH t. EXIT SIGN-NORMAL EXIT SIGN-BATTERY Y�, EMERGENCY LIGHTING FIRE EXTINGUISHER HUNG .�,1 o1 1 C FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER HYDRO FIRE ALARM SYSTEM , C6v'Al 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 f OK THIS DATE " OIC FOR CO NOT OK INSPECTED BY COMDEVIC HRIS J/WORDILETTERS20011FIREMARSHALI NS PECTIONREPORT11022001 WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY �a Town of Queensbury 0 t Fire Marshal's OfficeUu OpPot. 742 Bay Road Queensbury, NY 12804 Phone (518) 761-8205 Fax(518) 745-4437 Fire Marshal's Inspection Report Request SCHEDULE Received: Permit# L INSPECTION O Name: AM PM ANYTIME Location: APPROVED N!A I YES NO COMMENTS EXIT ACCESS EXIT ENCLOSURE EXIT DISCHARGE MAIN AISLE WIDTH i -n a+ rt Q©r SECONDARY AISLE WIDTH '- Ci� ��y 11 EXIT SIGN-NORMAL xJ EXIT SIGN-BATTERY EMERGENCY LIGHTING FIRE EXTINGUISHER HUNG i` FIRE EXTINGUISHER INSPECTION FIRE EXTINGUISHER HYDRO FIRE ALARM SYSTEM FIRE ALARM -FAN SHUTDOWN FIRE SPRINKLER SYSTEM ! l, � �� FIRE SUPPRESSION-KITCHEN ! YUC/"�- 1 17 ►'L b V 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 ILFE CL fNT OK -e \INSPECTED COMDEV/CHRISJNVORD/LETTERS2001/FIREMARSHALINSPECTION PORT11022001 WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY � u h h AQLG J i3 G tN cla ' ' / 20 195 n i� yo ' V, 24' G:P P., `'' o . 191.02' >3 \,WETLANDS A5 PER `- `�'�- /- t : /. / /: %//, MAP - � -% �'' := �/ . �. / /�.� .�. % / /REFERENCE j, 20, UStiED 5' SETBA ' z;Y / CR T t;K FROM POND Al/ NONE I \WETLA S'-A5 ELEV. _ 'J� ' MAP P1rjZ 292.8' REFER ;` t/ INV. 18" C.P.P. ELfV_ = 192.38' � % , :=:.::-�-•;��/ W 12'•�:P:P. PORCH / - t' ��Ja ' ARE / 210 to � ...,•_-- -_ --- � , � � / ' ,205 INV. 22' G.P.P. _ ELEV 1 t ----_. PP♦OPOSED WELL , 92 87' 210 205 00 s,��% .� 100. e 2c ' N , LU 43g.9� AVED w°°Dt° OCT 12, 2004 LANDS N/F OF - POTTER 7o�l L7AirN n .