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
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 28,2012
(If a'longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Thursday,July 28,2011
SIGNED f for the Town of Queensbury.
llI rector o Bui
l g&.ode Enforcement
E ERGENCYCONTA T UPDATE
T W UNTY SKERWF'S DEPT. 743-2502-
PWASE PRINT
'71=11
DOE:
Comprehensive Neuropsychol4wi Services,_PLLC
BUSINESS NAME-
123 quaker Road,Suite 10.5,Queensbury,NY 12804
BUSINESS ADDRESS:
(5t8)458,2314
BUSINESS PHONE:
Dr_RiChatd DursM (518),812�193
'CONTACT., l: HOME PHONE
7 Loran Drive,Queenstwry,NY 42804
ADDRESS:
Dr,'bft Ufrak (5 I8)256-3�6D
CONTACT 2: _ -- HOME PHONE
490 Westem Ave,Albany,NY 12203
This form is us®d to ossist Emergency Service personnel who may be called to your
business after hours. Please be sure that-the persons WOW on this form will be willing
and avallabie'to respond during Off-hours lo assist Police and/or Fire porsonnel in,
gpaining entry to your building.
PLEASE SE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERIACE PERSONNEL
MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACiUTA fE ENTRY BY POLICE AND/OR FIRE
PERSONNEL.
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--� Community Development
Town of Queens0bry-i 742"eey Road-' Gtueonsbun, New York -12804
David hlaTin, Director or8oading&codes an,^.. �"f,r,`
Craig grown,Zoning Adm i
inistrator•Michael J.Palmbr, Fire Ad M
ESTABLL4itEHE'NT OF A MEW BUS/NES.S
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION
*Noie. This itpplicattbO is far oaeup$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.
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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,
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(\�• .• Rofolam.. �� J•
LWe re renting tf i sa lt, 2•room suite.uite#1
it'has,a cot mon
bathroom:
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-07/25/2011 15:07 5183738817 KAREN M GAZDA PAGE 03
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Zo DATE MUED FOR
09.09.08 IURISDicr ON REVIEW