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2011-359 TOWN OFQ UEENSBURY IFVO742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20110359 Date Issued: Friday, July 29, 2011 This is to certify that work requested to be done as shown by Permit Number P20110359 has been completed. Location: 123 QUAKER Rd Tax Map Number: 523400-296-019-0001-002-000-0000 Owner: MRK COMMUNITY COLLEGE HOUSING, LLC Applicant: COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICE 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 (Th4a 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&CWEn b cement Planning Board or Zoning Board of Appeals. 1 TOWN Q OF' UEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building & Codes (518) 761-8256 CERTIFICATE OF , OCCUPANCY , . Permit Number: P20110359 Date Issued: Friday, July 299 2011 Thi&is to certify that work requested to be done.as shown by Permit Number P20110359 has been completed. Location: 123 QUAKER Rd- Tax Map Number: 523400=296-019-0001-002-000-0000 Owner: MRK COMMUNITY COLLEGE HOUSING, LLC Applicant: - COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICE Thin structure may be occupied as a: Certificate of Occupaucy(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&C of ement 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: P20110359 Application Number: A20110359 Tax Map No: 523400-296-019-0001-002=000-0000 Permission is hereby granted to: COMPREHENSIVE NEUROPSYCHOLOGICAL SEI 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. Type of Construction Value Owner Address: MRK COMMUNITY COLLEGE HOl 6 CHELSEA Pl Certificate of Occupancy(COM) CLIFTON PARK,NY, 12065-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-359 CO only- COMPREHENSIVE NEUROPSYCHOLOGICAL SERVICES $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 28,2012 (If a'longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Queensbury; Thursday,July 28,2011 SIGNED f for the Town of Queensbury. llI rector o Bui l g&.ode Enforcement E ERGENCYCONTA T UPDATE T W UNTY SKERWF'S DEPT. 743-2502- PWASE PRINT '71=11 DOE: Comprehensive Neuropsychol4wi Services,_PLLC BUSINESS NAME- 123 quaker Road,Suite 10.5,Queensbury,NY 12804 BUSINESS ADDRESS: (5t8)458,2314 BUSINESS PHONE: Dr_RiChatd DursM (518),812�193 'CONTACT., l: HOME PHONE 7 Loran Drive,Queenstwry,NY 42804 ADDRESS: Dr,'bft Ufrak (5 I8)256-3�6D CONTACT 2: _ -- HOME PHONE 490 Westem Ave,Albany,NY 12203 This form is us®d to ossist Emergency Service personnel who may be called to your business after hours. Please be sure that-the persons WOW on this form will be willing and avallabie'to respond during Off-hours lo assist Police and/or Fire porsonnel in, gpaining entry to your building. PLEASE SE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERIACE PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACiUTA fE ENTRY BY POLICE AND/OR FIRE PERSONNEL. b0 39Vd bQZdJ -W N3dVA :LT888l.88T5 01:91 TIOZ/5Z/L0 --� Community Development Town of Queens0bry-i 742"eey Road-' Gtueonsbun, New York -12804 David hlaTin, Director or8oading&codes an,^.. �"f,r,` Craig grown,Zoning Adm i inistrator•Michael J.Palmbr, Fire Ad M ESTABLL4itEHE'NT OF A MEW BUS/NES.S CERTIFICATE OF OCCUPANCY PERMIT APPLICATION *Noie. This itpplicattbO is far oaeup$Oy only.with no wogs eabilina a building permit- 296.19-1 2 NOTAPPLICABL.E -TAX MAP# BLDG. PERMIT FILE# . ap s Comprehensive NSeutoPsYchobgical 8erviewj, PLLC Name of Business. Address. 123 Quaker"Road".Suite 105,Queensbury.NY 12804 �sCALL :a2as OR Buslness: QUESTIONS? ca __— ,,..� EMA L—ca_dlggsumnsbruev.net Maria Lifiak.PhD vheht OUR wLoStrh:MR MORE Person in Charge or M$nager. hNF<"ATION www.auwn�b�rY.net (519).458-23?4 Business Phone Plumber z Nb=PsYtho gical Assessment.Cognitive Rehabilitation,snd.Mentvl Nsvlxh Services. Typo of Business: — �---- ---------- MRK Real Property,LLC" (518)3T3-4810 Owner of Property,_ -- Phone Numbegs): home :.eG Owners Address: 6 Chelsea Place Clifton Park,NY 12065 Provide an aCCufate layout of your store showing all walls, exits, stockrooms. rest rooms, -counters aneffixture layout on a separate sheet of paper. Statur _ ?12212G71 _ Date: Of Verson sisbai4hin9 this tom, Notes 1 Comments: We are hoP►V for an August 1st,2011 occupancy=MWCernent date.M undetsland if this is not fessible given the shlon nooco. E0 39Vd tlQZdJ ,W N321ti>f . . LT8$8L88T5 01:5T TTOZ/5Z/Le Inspection Form Town of Queensbury Fire Marshal (_0 Periodic Inspection Date: ¢� Time: 742 Bay Road,Queensbury NY 12804 o Re-Inspection G[, 518 7618206/518 7618205 c CO Inspection Permit#: `--�f Fire Marshals Representative MJ Palmer Business.Name: ep �. tea e ►ul�� It^��f S Location: u3 �i�rgt��. ! ' GK Stillman Contact: Type of Inspection N/A Yes- No EXITS: Exit Access. FC 1014&FC1029 Exit Enclosure FC 1020&FC1029 NOTES Exit Discharge FC 1024&FC1029 "r Locks and latches FC1008& FC1029.2 Sign:Normal FC 1011 &FC1029 Sign:backup FC 1011.5.3&FC1029.7.5 AISLES: Main Aisle Width FC 1024/1025&FC1029.11 Secondary Aisle Width FC 1025&FC1029.11 ✓` FIRE EXTINGUISHER: Hung FC 906 Inspection of extinguisher FC'906 EVAC Plan FC 404.6 IN t P 6 L TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTING: Interior FC 1006.3&FC1029.8 Exterior FC 1006.3 Clearance to Electrical FC 605.3 .. Electric Wiring Enclosed/Labeled FC 605.3.1 Combustibles In Equipment Rooms FC315.2.3 F.D.Si na e- FC 510 No Smoking Signs FC 310.3 Storage FC 315.2 ,d Compressed Gas FC 3003 Vehicle Impact Protection FC 312.1 d Interior Finishes FC 803-804 Smoke Detectors FC 907 CO detectors FC 610 f Clearance to Sprinkler/Ceiling FC 315.2.1 18" / 24" / EVAC SIGNS IN Rooms FC 404.6 R1 &R2 Fuel Pump Warning Signs FC2205.6 Fuel Station Emer Procedures FC2204.3.5 Exterior Storage FC 315.3 / REINSPECTIONDUE APPROXIMATELY Vacant Buildings FC 311 l � 21 DAYS SYSTEMS: FC 901.6 Insp OK NC DATE: OK NC Date Generator Annual DATE: OK NC Hood Installation Elevator Semi Annual FIRE ALARM Annual DATE. OK NC HVAC Shutdown Sprinkler System Annual ....r-. Sprinkler FDc Fire Marlins_pec]vt Cwplfite Kitchen Suppression Semi Annual OK to 16SUe Certificate of Occupancy Fuel Island Suppression Semi Annual Hood Cleaning 3-6-Annual 1r3 � Knox Box:installed/checked FC506 JUL 28 Operating Permit, if required will be issued after Fine Warshd Completion of Inspection TMofQueensbury VIE, .Fj_ (\�• .• Rofolam.. �� J• LWe re renting tf i sa lt, 2•room suite.uite#1 it'has,a cot mon bathroom: � G•-__, _O �6Q r p�D�Sti . • 3 !• � i Z9 3Wd tl.QZd9 W N3NV>f LIBBELE819. Z T T8Z -07/25/2011 15:07 5183738817 KAREN M GAZDA PAGE 03 IF I I�• I ' I I r a t , ti Y i ILA :0 �1 • �l 1�. _ �_ 07/25/2011 15:07 5183738817 KAREN M GAZDA PAGE 02 i r F•—, L� •I L ��Ooo P eyAM yN f� � � 123 QUAKER ROAD m mm O - QUEENSBURY,NY 12MM Zo DATE MUED FOR 09.09.08 IURISDicr ON REVIEW