2010-418 TOWN OFQ UEENSBURY
wwo742 Bay RoadQueensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100418 Date Issued: Thursday, September 09, 2010
This is to certify that work requested to be done as shown by Permit Number P20100418
has been completed.
Location: 123 DIXON Rd
Tax Map Number: 523400-302-014-0002-027-000-0000
Owner. BAYVIEW PROJECTS LLC
Applicant: ADIRONDACK CROSSROADS COUNSELING PLLC
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 441,5t
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&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
ellionmiPk
` 742 Bay Road,Queensbury NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100418 Application Number. A20100418
Tax Map No: 523400-302-014-0002-027-000-0000
Permission is hereby granted to: ADIRONDACK CROSSROADS COUNSELING PL
For property located at: 123 DIXON 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: BAYVIEW PROJECTS LLC
123 DIXON Rd Certificate of Occupancy(COM)
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2010-418
Adirondack Cross Roads Counseling PLLC - CO only
$0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, September 03, 2011
(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 To eensb 4 rrDated at the To eensb , r r,d • .tember 03, 2010
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
41.1 Town of Queensbury • 742 Bay/ Road • Queensbury, New York •12804
Marilyn Ryba, Executive Director•David Hatin, Director of Building&Codes
Craig Brown, Zoning Administrator•Michael J. Palmer, Fire Marshal
NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT
APPLICATION
TAX MAP # a,-)2744 - "2 7 BLDG. PERMIT FILE# /0-4/if applica `�
Name of Business: i1' ' ' "c k G✓�O S S Rocas 69(414“414\7 PLL C
Address /2 t Xo j✓1IS lA
of Business: l (�( '/u QUESTIONS? CALL 7614256 OR
EMAIL codes(a7queensbury.net
E
Person in Charge or Manager: I Sc "' ��` VISIT OUR INFORMATION
TE R MOR
www.queensbury.net
Business Phone Number: 7'Qv' 258 S'
Type of Business: PS j t nip 1 on L S +
8 Gc 4,v,p u7 fvoj eAj (1-C
�a wag tr //� . 7`V 3 C55 7W $ 72
Owner of Property: y ' l Phone Number(s).
Hone Cell
Owners
Address: 0-3 boY`D vi Rd
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet of paper.
4'• iq
Signature: ( 16Jcl-e---44'4-VDate: v • I v
Of person submitt this fort)
Notes/Comments:
*Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. �-4'`
Town of Queensbury
742 Bay Road _
Queensbury,NY 12804 Scheduled Inspection Dote: (?/ /'10 72lime: �t .)5
Phone: (518)761-8206 Business Name: 44( ��nj
Fax: (518)745-4437 Location: /205 ®7p
Type of Inspection N/A Yes No
EXITS:
Exit Enclosure v COMMENTS
Exit Discharge ✓
AISLES:
Main Aisle Width t/7
Secondary Aisle Width ✓
EXIT SIGNAGE
Sign-normal
Sign-battery ,/'
EVAC signs in rooms
TRUSS ID SIGNAGE V.
EMERGENCY LIGHTING i/
FIRE EXTINGUISHER:
Hung I/'
Inspection of extinguisher 1/
FIRE ALARM SYSTEM I/'
Fan Shutdown i '
Fire Sprinkler System (fDC) //'
Fire Suppression-kitchen I/'
Fire Suppression-Gas Islan v•
Generator ✓
Hood Installation r/
Elevator
60
Interior Finishes ✓/
Storage ,/'
Compressed Gas
Clearanceal -• t-
to Sprinklers
Clearance to Electrical ✓
Electric Wiring Enclosed/Labeled
Combustible Waste 1� f
Vehicle Impact Protection
Knox Box ✓
F.D.Signage-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign /
Emergency Evacuation PlanV/
Approved (If no other approvals apply,the B&C Office will issue the - «."e of Occupancy)
o Denied /call for Recheck /
lnsp- ed B i ' : —
L:\FireMarshai\FM Forms Masters\pernitto occupyform doc
inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. /6-0e
Town of Queensbury
742 Bay Road v,1
Queensbury,NY 12804 Scheduled Inspection Date: 9/2-J/ Time: /1/5,77
Phone: (518) 761-8206 Business Name: 79‘li2 dd#gck f t d� . lnl
Fax: (518)745-4437 Location: 123 00A/ ?
Type of Inspection N/A Yes No
EXITS:
Exit Access ✓'
Exit Enclosure COMMENTS
Exit Discharge
AISLES:
Main Aisle Width i, /7
Secondary Aisle Wiidth
EXIT SIGNAGE
Sign-normal NV'_ V--
Sign-battery
EVAC signs in rooms � /
TRUSS ID SIGNAGE V
EMERGENCY LIGHTING Jc
FIRE EXTINGUISHER:
Hung 1.71
Inspection of extinguisher r/
FIRE ALARM SYSTEM ►.,'
Fan Shutdown I,'
Fire Sprinkler System (FDC) 1
Fire Suppression-kitchen V
Fire Suppression-Gas Islan ✓'
Generator ✓.
Hood Installation V
Elevator V
Interior Finishes
Storage V
Compressed Gas V .
Clearance to Sprinklers V
Clearance to Electrical e v
Electric Wiring Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection
Knox Box !/
F.D.Signage-Utility Rooms
, No Smokin�Sgns
Maximum Occupancy Sign
Emergency Evacuation Planif
a Approved (If no other approvals apply,the B&C Office wi issue the Certificate of Occupancy)
Denied / call for Recheck _
frior_
Imp- •e B .
L:\FireMarshal\FM Forms Masters\permitto occupyfo.m.doc
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TOWN OF OUEENSBURY
FIRE 1VIARSHAL'S
REVIEWED BY C9 KSOFFICE .
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