2011-571 itraki TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20110571 Date Issued: Monday, December 12, 2011
This is to certify that work requested to be done as shown by Permit Number P20110571
has been completed.
Location: 375 BAY Rd
Tax Map Number: 523400-296-019-0001-032-000-0000
Owner: PROVIDENT BAY ROAD, LLC
Applicant: ADIRONDACK ADVANCE IMAGING, LLC
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
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owner of the responsibility for compliance with Site Plan,Variance, or �;� V -
other issues and conditions as a result of approvals by the Planning Board Director of Building&Code Enforcement
or Zoning Board of Appeals.
TOWN OF QUEENSBURY
eaki
Fow 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110571 Application Number: A20110571
Tax Map No: 523400-296-019-0001-032-000-0000
Permission is hereby granted to: ADIRONDACK ADVANCE IMAGING, LLC
For property located at 375 BAY 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: PROVIDENT BAY ROAD, LLC
353 BROADWAY, 2ND FLR Certificate of Occupancy(COM)
SARATOGA SPRINGS,NY 12866-( Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
BP 2011-571 Adirondack Advance Imaging
C/O Only - Suite 101 Contact Person: Michael Way
$50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 16,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of sbury; r1 Wednesday,November 16,2011
SIGNED BY / it` for the Town of Queensbury.
Director of Building&Code nfor + ent
E i a a
Community Development Office �1 ,
Town of Queensbury• 742 Bay Road• Queensbury, New York -92804
David Hatin, Director of Building& Codes ( ' ., I . , .�
Craig Brown,Zoning Administrator• Michael J. Palmer, Fire Marshal DE `�' � .�f`�-� f�� ���'�'�
b
ESTABLISHMENT OFA NEW B SV 1 2011 ,
CERTIFICATE OF OCCUPANCY PERMIT A '; �� iv; S:URY
BUILDING& CODES
*Note: This application is for occupancy only, with no work requiring a bulkftng pernd
TAX MAP# ( 61(°,1'9--(-);L_ BLDG. PERMIT FILE# f l. .3 7I
If applicable
Name of Business: Pi 131.R NW\ck 1\c ce, LmA&t,' f, LL�
of Bress �� --e,1 GAO �T�01 �1 'IVS bue �� �ol t �
of Business: (> QUESTIONS? CALL 761-8256 OR
EMAIL codesaqueensburv.net
VISIT OUR WEBSITE FOR MORE
I�1Person in Charge or Manager: 1 1 t C '\l\� I \AA y INFORMATION
c� '+ c� www.eueensburv.net
Business Phone Number: 5) O- 0-Q I' Q 81
�n
,p Adirondack Advance BP 2011-571
Type of Business: M R:1 So ITC.- Imaging, LLC (MRI Suite)
375 Bay Road, Suite 101
0/0 only
Owner of Property:QROUt OtNI be.w.lisptincAriGk Phone Number(s): Si 8-(61L. '4 o
#♦ernei NC$ Cell
Owners Address: 353 'AQ i)1A)A1 Sp&INI7S N.'J. ) 3G6
Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
Signature: A/WDate: I1/15/lf
Of person submitting this fo
Notes/Comments:
EMERGENCY CONTA T UPDATE
Please print clearly
IRECEOWE
11, iNCV 1 2011
DATE: 1 IN I I t .�,
TQWN of wUEENSBURY
BUILDING &CODES
BUSINESS NAME: AQiRoriOAGkiqoiMNCe1111/4Gi(A, C.Zr✓
BUSINESS ADDRESS: 3 75- y ! AO Sk)WTC )0i, ()uewNSboRy, N.V/dot
BUSINESS PHONE: 18 " 409- 3 ( t
�n� WA/
PHONE 1:
CONTACT 1: 1l 11(, fps\ PHONE 2:5%-.3,7-7018
TOWN/VILLAGE RESPONDING FROM: Qeibu
uic
PHONE 1:
CONTACT 2: Ke l c Lr rAIWCAIC. PHONE 2:5-f£i-3“0-06)Oi
TOWN/VILLAGE RESPONDING FROM: A R TOGA S PR i Cs
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 PERSONNEL.
TOWN OF QUEENSB1JRY FIRE MARSHAL'S OFFICE
I'h o n e: 518-761-8206 • F a x: 518-745-4437
firemarshal@queensbury.net • www.queensbury.net
Fire Marshal Michael I Palmer Deputy Fire Marshal Gary Stillman
Inspection Form
Town of Queensbury Fire Marshal o Periodic Inspection Date: /2/e// Time: /4'.11)
742 Bay Road,Queensbury NY 12804 c,Re-Inspection /
518 761 82 6/518 761 8205 - C16 Inspection Permit#: //-57 7/
Fire Ma ais Representative IIy-
J Palmer Business Name: dt ,7d r,I_ ,/E 21
Location: 3 2$ /c 1 /
�GK Stillman Contact: i ,ei _ 11/ 7
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 / NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024&FC1029
Locks and latches FC1008& FC1029.2 f
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 f
Inspection of extinguisher FC 906
EVAC Plan FC 404.6
TRUSS ID SIGNAGE FC 505.3
EMERGENCY LIGHTING:
Interior FC 1006.3&FC1029.8 -'
Exterior FC 1006.3 _-/"
Clearance to Electrical FC 605.3 f
Electric Wiring Enclosed/Labeled FC 605.3.1 ,./
Combustibles in Equipment Rooms FC315.2.3 ./
F.D.Signage- FC 510
No Smoking Signs FC 310.3
Storage FC 315.2 -----"-
Compressed
Compressed Gas FC 3003
Vehicle impact Protection FC 312.1
Interior Finishes FC 803-804
Smoke Detectors FC 907
CO detectors FC 610 / ,._�
Clearance to Sprinkler/Ceiling FC 315.2.1
18" / 24" / ! I 11W
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 . . REINSPECTION DUE APPROXIMATEL
Vacant Buildings FC 311 / 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 111;1 122 DATE: OK NC
HVAC Shutdown
Sprinkler System Annual 0 it
Sprinkler FDC
Kitchen Suppression Semi Annual
Fuel Island Suppression Semi Annual
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
Inspection Form
Town of Queensbury Fire Marshal o Periodic inspection Date: :///q// Time: /6/104JM
742 Bay Road,Queensbury NY 128044"S'Re-inspection
518 761 8206/518 761 8205 CO Inspection Permit#: ,ZO//— 51/
Fire Marshals Representative
—MJ Palmer Business Name: „�.- 9�k dt ��� ��n 1°
location: 3 75 tt 20462. .9 /a/
X GK Stillman Contact: /ri.h,id Lrlay
Type of Inspection N/A Yes No
EXITS: Exit Access FC 1014&FC1029 / NOTES
Exit Enclosure FC 1020&FC1029
Exit Discharge FC 1024&FC1029 /r
Locks and latches FC1008& FC1029.2 ..000°-
Sign:Normal FC 1011 &FC1029 ,/'.
Sign:backup FC 1011.5.3&FC1029.7.5 .00°.°
AISLES:
Main Aisle Width FC 1024/1025&FC1029.11 .00"."-.
t,
Secondary Aisle Width FC 1025&FC1029.11 ,..0°.°,..0°.° y`7`/
it)/)� 5 T .05 A15405-SC'te
FIRE EXTINGUISHER: Hung FC 906 >‹.
Inspection of extinguisher FC 906 ,.i"''*4
. )
EVAC Plan FC 404.6 .....-•"°.
TRUSS ID SiGNAGE FC 505.3 -,�•''.
EMERGENCY LIGHTING: 1
Interior FC 1006.3&FC7029.8
Exterior FC 1006.3
Clearance to Electrical FC 605.3 `
Electric Wiring Enclosed/Labeled FC 605.3.1 a 1
Combustibles in Equipment Rooms FC315,.2.3 ,,//. d % I
F.D.Signage- FC 510 /1^
No Smoking Signs FC 310.3 ...�'"
Storage FC 315.2 .00°7° t.
Compressed Gas FC 3003 1�
Vehicle Impact Protection FC 312.1 ..0."°.-
Interior Finishes FC 803-804 J''
Smoke Detectors FC 907 _,! ,
CO detectors FC 610 r..•"^'"� j
Clearance to Sprinkler/Ceiling FC 315.2.1
I/ /
18" / 24" ( , (Loy\' ir.A. es IN N
EVAC SIGNS IN Rooms FC 404.6(R1 &R2) ' r- F'' be- h I C..411.1►1
Fuel Pump Warning Signs FC2205.6 ,, y
Fuel Station Emer Procedures FC2204.3.5 0:-..-0-- M / A •RA-I az AA,
Exterior Storage FC 315.3 %,,,,,,,00".
REINSPECTION DUE APPROXIMATELY
Vacant Buildings FC 311 „/r
21 DAYS
SYSTEMS: FC 901.6 Imp 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 .4121,
Sprinkler FDC
Kitchen Suppression Semi Annual
Fuel island Suppression Semi Annual
Hood Cleaning 3-6-Annual
Knox Box:installed/checked FC506
Operating Permit, if required will be issued after
Completion of Inspection
tb It Adirondack Advance BP 2011-571 / iI--
Imaging,
a ip LLC (MRI Suite) 11 'vL 1
375 Bay201
Road Suite 101
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