CC-0006-2023 k Office Use Only
ADDITION/ALTERATION PERMIT Permit#:CC, - 000 Lo 2�
Town ofQueensbury APPLICATION Permit Fee:$ zn
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensburV.net Invoice#:
Flood Zone? Y N Reviewed By:
Project Location: �S� U",e, (�-=r\e�
Tax Map ID #: � Z.. -- "'�J` .Z Subdivision Name:
1k
PROJECT INFORMATION: < D [(�
JAN 0 41023
TYPE: El Residential Commercial, Proposed Usk
COSBESRY
BUILDINGG&& COp
❑ Single-Family ❑ Two-Family ❑ Multi-Family(#of units_) o #�c�
❑ Business Office ❑ Retail ❑ Industrial/Warehouse ❑ Garage (#of cars )
❑ Other(describe )
ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE:
1st floor: 1st floor:
2nd floor: 2nd floor:
3rd floor: 3rd floor:
Basement(habitable space): Basement (habitable space):
Total sq ft: Total sq ft:
Scope of work to be done: A l A�e_�'A�c�.'S
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Addition/Alteration Application Revised June 2022
ADDITIONAL PROJECT INFORMATION:
1. Estimated Cost of Construction: $ 5J)IZZC)
2. Source of Heat (circle one): 'Gas ❑ Oil ❑ Propane ❑ Solar ❑ Other:
Fireplaces/inserts need a separate Fuel Burning Appliances & Chimney Application
3. Are there any structures not shown on the plot plan? ❑ YES 'C�NO Explain:
4. Are there any easements on the property? ❑ YES P�'N 0
SITE INFORMATION:
• Is this a corner lot? ❑ YES W NO
• Will the grade be changed as a result of the construction? ❑ YES 'N--N'O
• What is the water source? ,PUBLIC ❑ PRIVATE WELL
• What type of wastewater system is on the parcel? I,5EWER ❑ PRIVATE SEPTIC
DECLARATION:
1. I acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be
completed within a 12 month period.Any changes to the approved plans prior to/during construction will require
the submittal of amended plans, additional reviews and re-approval.
2. If,for any reason,the building permit application is withdrawn,30%of the fee is retained by the Town of
Queensbury.After 1 year from the initial application date, 100%of the fee is retained.
3. Ifthework is not completed by the 1 year expiration date the permit may be renewed, subject to fees
and department approval.
4. 1 certify that the application, plans and supporting materials are atrue and a complete statement and/or description
of the work proposed,that all work will be performed in accordance with the NYS Building Codes, local building laws
and ordinances, and in conformance with local zoning regulations.
5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of
occupancy.
6. 1 also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of certificate of occupancy.
1 have read and agree to the above /
i
PRINT NAME: /
l
SIGNATURE: DATE: /
Addition/Alteration Application Revised June 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z:
Cell Phone: LanJ Line: �)
Email: \`� P.r�) � w � r CCU✓—
• Primar Owners :
Name(s): I ��. �S G � L,,(_
Mailing Address, C/S/Z:
Cell Phone:�_) Land Line: � )
Email:
ArCheck if all work will be performed by property owner only
• Contractor(s): (List all additional contractors on the back of this form)
Contact Name(s): '\
Contractor Trade: JTIU -
Mailing Address, C/S/Z: �`�v� ���
Cell Phone: Land Line: �)
Email:
"Workers' Comp documentation must be submitted with this application"
• Arch itect(s)/Engineer(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line: J )
Email:
Contact Person for Compliance in regards to this project:
Cell Phone:��`'�) � Z—`7 g� Land Line: ( }
Email:_
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Addition/Alteration Application Revised June 2022
FIRE MARSHAL'S OFFICE
Tozvn of Queensbunj
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Smoothie King
756 Upper Glen
CC-0006-2023
1/9/2023
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• Verify paths of egress
• Verify storage
• CO detection is required
• Locks /Latches to comply with Chapter 10 of IFC
• Function test of exit and emergency lighting
• NFPA13 letter of compliance required if any heads are relocated
• NFPA 72 inspection and testing report required for the fire alarm system
• Provide keys for Knox Box
• Need details related to use and ownership of the new corridor. As a
minimum, emergency lighting will be required throughout
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office - P h o n d: 518-761-8206 ■ Fax: 518-745-4437
flremarshal@queensbtirj.net - 7MMqueensbumnet
NEW YO.RK pepartmerit
sTATE OF..
OPPORTUNITY. of Health
KATHY HOCHUL, DAMES V. McDONALD, M.D.,M.P.H. MEGAN E. BALDWIN
Governor Acting Commissioner Acting Executive Deputy Commissioner
February 28, 2023
Jonathan Trager
9 Bowman St. �1AR 0 3 7® ,
Saratoga Springs,
ngs, NY 12866
Re: Smoothie King(Proposed) TOWN OF QUEENSBURYBUILDING& CODES
�— --Facility-Code:-56=BF55--- - --- - ----- - - _ -
Queensbury(T), Warren County
Cam— Ood 6 -?-C 2_-,�
Dear Mr. Trager:
This office is in receipt of an Application for a Permit to Operate (DOH-3915), Notice of Intent to
Construct, Enlarge or Convert a Facility (DOH-154), kitchen floor plans, and numerous ancillary
documents regarding the conversion of Smoothie. King (formerly 16 Handles) to be located at
756 Upper Glen St., Suite 18, Queensbury (T), received February 13, 2023. In reviewing your
submission,we find your proposal to be in substantial compliance with the New York State
Sanitary Code (NYSSC), with the following conditions, and pending the satisfactory
completion of a pre-operational inspection by a representative of this office:
• There Was no seating capacity listed on the permit application. Once seating capacity
has been determined by the local Code Enforcement Official, please provide this number
to the Glens Falls District Office.
• All food that requires washing, straining, or will be thawed under running drained water
must be done in a separate designated food preparation sink or in one of the bays of the
3-compartment sink conditional that the sink.bay is thoroughly cleaned and sanitized in
between use. Mounting of chemical and soap dispensers above sink bays where food
prep will occur is prohibited.
• All ice wells, ice machines, and food preparation sinks must be equipped with an indirect
drain to waste, preferably an air gap. _
-- Use of a reduced oxygen packaging machine (vacuum sealer) at the facility to package
food product and Sous Vide cooking is prohibited without approval from the Glens Falls
District Office.
• As a reminder, minimum 4" baseboard coving must be installed at all floor and wall
junctures in food storage and food preparation areas to facilitate easy cleaning. The
coving must be smooth, easily cleanable, and non-porous.
• Please note that mechanical ventilation or an openable window to the outside must be
installed in all restrooms. Restroom doors must self-close and latch.
• Please note that no person is to work in a food service establishment in a capacity which
can result in contamination of food or food contact surfaces with disease-causing
organisms; while infected with or carrier of disease-causing organisms capable of
transmission by food; or, while afflicted with a boil or infected wound. As such, this office
suggests that you establish and adhere to a protocol that addresses the treatment of
infected wounds, the screening and exclusion of staff from food handling based on
Empire State Plaza,Corning Tower,Albany,NY 12237 1 health.ny.gov
d.
illness or symptoms, and the reporting of all allegations of patron illness (that which may
be food borne) to this office with 24 hours. It is strongly recommended that your protocol
require the exclusion of ill food workers exhibiting gastrointestinal illness for at least 48
hours after the cessation of illness symptoms. These'procedures, along with satisfactory
hand washing, and prevention of bare hand contact with ready to eat foods, constitute
the most significant barriers to the potential spread of illness at a food service
establishment.
• Basic CPR equipment must be maintained at the facility. A brochure detailing your
requirements has been included for your review.
• Finally, you must obtain a Certificate of Occupancy (C/O), Certificate of Compliance
(C/C), or something in writing from your local code enforcement official stating a C/O or
C/C was not required to be issued. Once obtained, please forward a copy to this office
for filing.
As a reminder, section 14-1.190(a) of the New York State Sanitary Code (NYSSC) requires
y: you to ob.taino(valid Mrmit to Operate prior to operating your facility. Please contact me
of(518) 793=3893 to schedule a pre-operational inspection.
Sincerely,
Corey Lorenzo
Principal Sanitarian
NYSDOH —Glens Falls District Office
77 Mohican St.
Glens Falls, NY 12801
(518) 793-3893
Encl: CPR Brochure
cc: Ms, Rebecca Bussert, GFDO
-- Queensbury-(7)-Code Enforcement
File
THE INSPECTOR
5390 State Route 11,Burke,NY 12917
1-800-487-0535 www.theelectricalinspector.corm
Date:May 8,2023 Application No. On File:175621
THIS CERTIFIES THAT Smoothie King
Only the electrical equipment as described below and introduced by the applicant named on the above application number in the premises of:
756 Glen Street Town of Queensbury Contractor: DM Electric of Dutchess,LLC
In the following location: Basement I"Floor X 2nd Floor No.of Apt Garage Attic Outside Commercial X Residence
Was examined on 5/3/23 and found to be in co m liance with the requirements of the National Electric Code.
GFCI Fixture Outlets Receptacles Switches Fixtures Ranges Cookin Decks Ovens Dish Washers Exhaust Fans Smoke/Heat
Incandescent Fluorescent Other Amt. K.W. Amt. K.W. Amt. K.W. Amt. K.W. Amt. I K.W. Detectors
23 64 10 5 64 1
LED
ers Furnace Motors Dimmers Water Heaters Unit Heaters Multi Outlet Sys. Electric Heaters
Amt. K.W. Oil H.P. Gas H.P. Amt. Watt Electric Oil Gas I Amt. Rating No.of Feet Amt. K.w. Amt. K.W. I Amt. K.W. I Amt. K.W.
Transformers Alarm Systems Special eceptacle Panels Motors Signs Track Lighting Dis osal
Amt. KVA AN I PS Det. I Panel Amt. K.W. Amt. No.of circuits Rating Amt. H.P. Amt. No.of Lamps No.of Heads Amt. I H.P.
1 28 100
1 12 200
Service Disconnect Equipment Service
Amt. I Amp. I Tye Meter 1 Phase 1 Phase 3 Phase 3 Phase No.of CC. AWG. No.of AWG.of No.of AWG of
2W 3W 3W 4W Cond./phase CC.cond. Neutrals Neutrals HI-Les III-Leas
Other Apparatus
2 Emergency lights Feed to sign
2 Exit/Emergency 1 Time clock
1 Gas RTU
14 GFI20 amp breakers
� x
Manager
This certificate must not he altered in any manner;return to the office of THE INSPECTOR if incorrect. Inspector's credentials can he verified.