2010-331 TOWN OFQ UEENSBURY
742 BayRoadQueensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100331 Date Issued: Friday, November 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20100331
has been completed.
Location: 9 CAREY Rd
Tax Map Number: 523400-308-016-0002-002-003-0000
Owner: HUDSON HEADWATERS HEALTH NETWORK
Apxl1lclan�Number. HUDSON HEADWATERS HEALTH
Owner. HUDSON HEADWATERS HEALTH
This structure may be occupied as a:
Commercial Alteration 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&Code E orvement
Planning Board or Zoning Board of Appeals.
��` TOWN OF QUEENSBURY
`0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100331 Application Number. A20100331
Tax Map No: 523400-308-016-0002-002-003-0000
Permission is hereby granted to: HUDSON HEADWATERS HEALTH
For property located at: 9 CAREY 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: HUDSON HEADWATERS HEALT
1 BROAD ST. PLAZA Commercial Alteration $35,000.00
GLENS FALLS,NY 12804-0000 Total Value $35,000.00
Contractor or Builder's Name/Address Electrical Inspection Agency
THE MC CORMICK GROUP
743-9300
1582 STATE ROUTE 9
FORT EDWARD,NY 12828-0000
Plans &Specifications
2010-331
1500 sq ft commercial alteration
$180.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 15,2011
(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 o eens u/i : July 15,2010
SIGNED BY ` �' \ for the Town of Queensbury.
Director of Building&Code Enforcement
.--- . -",,,,0,0
OFFICE USE ONLY f� ``� /
TA MAPXO�" ,1- Z -z �3 'ERMITNO. /(,� cJJ 1 '
FEES: PERMIT •„.! i R :ATI* ENGINEERING
if �� /eo (If applicable)
PRINCIPAL ST”UCTURE: APPLICATION FOR ZONING APPROVAL & BUILDING
PERMIT
A PERMIT MUST BE OBTAINED BEFORE BEGINNING CONSTRUCTION. APPLICATION IS SUBJECT TO REVIEW
BEFORE ISSUANCE OF�fA'VALID PERMIT FOR CONSTRUCTION.
APPLICANT/BUILDER: Iif_ ogm,a G .vap OWNER: tuDSoi ,g VYAirg5
ADDRESS: 15 t2. .1Z-r. 9 Fc RT EDWN2i> W, ADDRESS: ( CPizY V-t)ils1J
PHONE NOS. C'l ))- 171-13 ,ciS vv. PHONE NOS. 5 if 'lei c' trQ
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE:Tim alc,Lvarn,a PHONE: r71-13• (30-o
LOCATION OF PROPERTY:9 C is 12..Y 14.V kb) ►.l%g09 ,
HAS THERE BEEN A SITE PLAN REVIEW;VARIANCE OR SUBDIVISION APPROVALYES, 0 NO
IF SO, INDICATE APPLICATION NO.AND DATE OF APPROVAL:
PLEASE INDICATE MEASUREMENTS AS REQUIRED BELOW:
CHECK ALL THAT p a o (-
APPLY TO YOUR Z H w O cr) C� w "" w
PROJECT _1 W
O Q O O O ~ =
w � � � � W Q OOU
Z < Q - u) Nco Ou I U.- a = ors
SINGLE FAMILY
TWO-FAMILY
MULTI-FAMILY
(NO.of UNITS )
TOWNHOUSE
BUSINESS OFFICE X i 5 D 0 1/ c D 0
RETAIL-
MERCANTILE
FACTORY OR
INDUSTRIAL
ATTACHED
GARAGE(1,2,3)
OTHER
1
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
Revised 4/14/2010
IF COMMERCIAL OR INDUSTRIAL-NAME OF BUSINESS: Lb„„,„_,E.}.„ �EL�H � it1k
ESTIMATED CONSTRUCTION COST: S S,oa-t) FUEL TYPE: C7h S
HEAT TYPE: fb D Avg.. *HOW MANY FIREPLACE(S):Nth AND/OR WOODSTOVES(S): 'N E
ZONING CATEGORY: ARE THERE WETLANDS ON THIS SITE? c7
IS THIS A HISTORIC SITE? Nt
PROPOSED USE OF BUILDING OR ADDITION: CZ)FF.)ct � {
ARE THERE STRUCTURES NOT SHOWN ON PLOT PLAN? 1,.)-(7
ARE THERE EASEMENTS ON PROPERTY?
*Please complete a separate Application for"Fuel Burning Appliances&Chimneys"available in our office
I acknowledge no construction activities shall be commenced prior to issuance of a valid
permit. I certify that the application, plans, and supporting materials are a true and
complete statement/description of the work proposed, that all work will be performed in
accordance with the NY State Building Codes, local building laws and ordinances, and in
conformance with local zoning regulations. I acknowledge that prior to occupying the
facilities proposed, I or my agents will obtain a certificate of occupancy. I 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 a certificate of occupancy.
I have read and agree to the above.
Signe g I 71264-211. �
Director of Building & Codes: 761-8256 (for questions regarding Building Permits, construction codes
or septic systems)
Zoning Administrator: 761-8218 (for questions regarding required permits, the permit process,
application requirements or to schedule an appointment)
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
inspection for Permit to Occupy
Fire Marshal's Office Request Recd Permit No. 10 " 8
Town of Queensbury
742 Bay Road —
Queensbury,
Queensbury.NY 12804 Scheduled Inspection Date: I 1 Time: ti
Phone: (518) 761-8206 Business Name:
Fax: (518)74,5-4437 Location: 4-hti D
Type of Inspection N/A Yes j No
EXITS:
Exit Access
Exit Enclosure F� ;",.4• `" J_!r- .�+.
Exit Discharge
AISLES:
Main Aisle Width
Secondary Aisle WidthPi A
H N it31
EXIT SIGNAGE ^--
Sign-normal Ars bl+Irshat
Sign-battery ((,,,..
EVAC signs in rooms
TRUSS ID SIGNAGE
CL
EMERGENCY LUGIMNGIN
FIRE EXTINGUISHER: 71‘,1\(\f" :...‘
Hung 1 4
Inspection of extinguisher 0►h y (j L dal
119\1411
FIRE ALARM SYSTEM Q 110 0(L
Fan Shutdown
Fire Sprinkler System (FDC) 91 l() o� ^-
Fire Suppression-kitchen
Fire Suppression-Gas Islam
Generator
Hood Installation
Elevator
Interior Finishes }8•• t r,, r
Storage 1 `. Pit et
Compressed Gas
Clearance to Sprinklers
Clearance to Electrical A 'U
Electric Wiring Enclosed/Labeled
Combustible Waste
Vehicle Impact Protection �--p- fShal
Knox Box
F.D.Signage-Utility Rooms w,,.-_ T jT A
No Smoking Signs
Maximum Occupancy Sign /`
Emergency Evacuation Plan
Approved (If no other approvals apply,the B 8,c office will issue -••to of Occupancy)
`d Denied call for Recheck
Inspected By: .
L:\FireMarshal\FM Forms Masters\permitto occupyfomi.cfoc
-/camr,c;P -
inspection for Permit to Occupy
Fire Marshal's Office Request Recd_ Permit No. /0- `S3 /
Town of Queensbury
742 Bay Road j
Queensbury,NY 12804 Scheduled Inspection Date: T- 1 2-J (7 Time: JO.IO
Phone: (518)761.8206 Business Name: / 10 , ' CL- -r-3
Fax: (518)745-4437 Location: &t re--.7 ,�1
Type of Inspection WA Yes No
EXITS:
Exit Access ✓'
Exit Enclosure 1/, COMMENTS
Exit Discharge I/
AISLES:
Main Aisle Width r4
Secondary Aisle Width r/
EXIT SIGNAGE
Sign-normal
Sign-battery 1 -
EVAC signs in rooms `
TRUSS ID SIGNAGE 1/
EMERGENCY UGHTING
FIRE uuEnTINGUISHER:ung -7- ,4Q s1I MIA /RC A l/o6
Inspection of extinguisher J t -
HRE ALARM SYSTEM I I CXt u P' *- kik 4-4,01
Fan Shutdown `
Fre Sprinkler System (FDC) t. __._g_ Y' `W�(,1 N039 13 14( 1`T'c
1
Fre Suppression-kitchen
Fre Suppression-Gas Islan ✓'
Generator V'
Hood Installation ‘/'
Elevator 1../-
Interior
../Interior Finishes )/
Storage 1.
Compressed Gas 1/'
Clearance/ arto Sprinklers /fes
Clearance to Electrical /g/� fIL�_f'Electric Wiring Enclosed/Labeled j) --
IVYL ,—.VGr 1 J
Combustible Waste T/
Vehicle Impact Protection
Knox Box
F.D.Signage-Utility Rooms / i/
' No Smoking Signs
Maximum Occupancy Sign V
Emergency Evacuation Plan
❑ oved (If no other approvals apply,the B&C Office wiY issue the Certificate of Occupancy)
Denied / call for Recheck
inspect4w.Lr____::: : ____
L .
L:\FreMarshd\FM Forms Masters\pemiitto occupyfonn.doc
tiNk.
Commercial Final Inspection Report •
Office No.: (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pT#_. Depart: am/pm
742 Bay Road, Q nsbury, NY 12804 Inspector's Initials: -D
NAME: r GaG is l L PERMIT#: / ç )3
-g,33,/
r _ DATE:
COMMENTS:
Y N NA
Chimney/"B"Vent/Direct Vent Location
Plumbing Vent Through Roof 6"/Roof Complete
Exterior Finish/Grade Complete 6'in 10'or Equivalent
Interior 1 Exterior Guardrails 42 in. Platform/Decks
Interior I Exterior Banisters 4 in. Spacing Platform I Decks
Stair Handrail 34 in.—38 in./Step Risers 7"/Treads 11"
Vestibules For Exit doors>3000 sq.ft.
All Doors 36 in.w/Lever Handles/Panic Hardware, if required
Exits At Grade Or Platform 36(w)x 44"(1)/Canopy or Equiv.
Gas Valve Shut-off Exposed&Regulator(18")Above Grade
Floor Bathroom Watertight/Other Floors Okay
Relief Valve,Heat Trap/Water Temp.110 Degrees Maximum
Boiler/Furnace Enclosure 1 hr.or Fire Extinguishing System
Fresh Air Supply for Occupancy/Ventilation Combustion
Low Water Shut Off For Boilers
Gas Furnace Shut Off Within 30 ft.or Within Line Of Site
Oil Furnace Shut Off at Entrance to Furnace Area
Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/4 doors
> 10%> 1000 sq.ft.
' Hour Corridor Doors&Closers
Firewalls/Fire Separation,2 Hour, 3 Hour Complete 1 Fire
Dampers/Fire Doors
Ceiling Fire Stopping, 3,000 sq.ft.Wood Frame
Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24"
Smoke Vents Or Fan, if required
Elevator Operation and Signage/Shaft Sealed
Handicapped Bathroom Grab Bars/Sinks/Toilets
Handicapped Bath/Parking Lot Signage
Public Toilet Room Handicapped Accessible
Handicapped Service Counters,34 in., Checkout 36"
Handicapped Ramp/Handrails Continuous/12 in.Beyond[Both
des]
Active Listening System and Signage Assembly Space
Final Electrical/Flex Gas Piping Bonded
Site Plan/Variance required
Final Survey, New Structure/Flood Plain certification,if req.
As-built Septic System Layout Required or On File
Building Number or Tenant Address on Building or Driveway 4'
Water Fountain or Cooler
Building Access All Sides by 20'/Driveable Surface 20'wide / 6
Okay To Issue Temp. or Permanent C/O
Okay To Issue C/C ifrht< '4 f 1i'1• ipra ei
/ ,e /ij aa`'"' ""
L:U3uilding&Codes Forms\Building&CodesUnspection Fonns%Commercial Anal Inspection Reportdoc Revised Jarliary 7,2008
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No..Mil
..I ...� . s•� Cert. N 1014 3 Cut-in Card No
.j�
Owner /I–Ai
Location C 121r�L.,4-' 6/«gam.'
Installation Consisting of v� .caw" rcf} I? £ez6719 .2 (r./....-�,% -�,R
�2e2 /' ' L /72 '/b-219C�A. j/moi
Installed By ,/� /7( /)� ,/1/� � Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be .romptly made for inspection.
Inspectors of this Company shall have the privilege of makin: ins.-ctions at any time, and if its
rules are violated,the Company shall have the right to ev this e+ 'Cate.
Date Q'`z-/p INSPECTOR
Member N.F.P.A.,I.A.E.I.
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Based on our;Io',4,..: X kt' :A it(;?r.t OM pllance
with our coalmen- .,1'1;-,,,!. '•,, oe Conetrued as
indicating the plans aou JpecifiCatione ate in
full compliance with the Building Cadet of
New York State.
09-08-2010 09:50 FCSI 518-747-2518 PAGE1
FIRE CONTROL SYSTEMS INC.
104 REYNOLDS RD., FORT EDWARD, NY 12828 P (518) 747-2567 FAX 747-2518
www.firecontrolsystemsinc.com email: info@fcs88.com
9/8/2010
Mr. Michael Palmer
Fire Marshall
Town of Queensbury
742 Bay Rd.
Queensbury, NY 12804
Re: Hudson Headwaters
Office Space
Queensbury, NY
Dear Michael:
The alteration of the above buildings fire sprinkler system for an office fit-up has been completed.
The system is on and operational and to the best of my knowledge, the system conforms to the NFPA
13 Standard. If you require anything further please give me a call.
Sincerely,
.* ZegvieigeZmv`c-C
Richard E. Boucher
Sec-Treasurer
Cc: TMG
SEP-9-,2O1Li O8: 16A FROM:NEN YORK FIRE & SECLI 5187925199 TO:7454137 P.
,
PROTECTION SYSTEM
NEW YORK FIRE&SEA i1RITY INSPECTION REPORT
4 Glens Falls Technical Pf k
Glens Fails,NY 12801-3>-.2 DATE O 0i WO ORDEREDflv
(518)7Oo fl C1 �!/ic
ORDER TAKENV PHONE
Fax(518)792,5199
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INSTALLATION DATE LAST INSPECTION
INVOICE DATE JOB PHONE
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INSPECTION 42 EDUIPMENT61ANUF
INFORMATION d v 0 C� it I. t—Cof ! IO
SY. ALLER
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Fixed Heat i , `' 'fix{Imo -
- Photoelectric ,.Ly �c :- _ �- S
rOF
for _ /A‘„ .4ti,°.a1—
Ducl - -- MAr< E PROGRAM BY
Ma me i 0 a A(0-.AeC l/1
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Markus / ' _ tJU; UP TO GATE ❑ /
Yea ❑No
F
Q., Cross Zane
, Single Zone
-E, Contacts
•` Motions - -
l
CONTROL PANEL AGENT TANK COMMUNICATIONS.DEVICES
Water Flow . , - „
Law Air A, •.Voltage Weight A.C.Voltage
Six-slider Temper
C .with Load Last Hydro D.C.Voltage
r
C .without Load Gauge Pressure D.C.without Load
Air Hard. —•
i. • Serial#
o s. .
Door Relieves
'V Duct Damper ..._
Equipment -_.1
di AZ,AC.Voltage
1 D.C.Voltage
E' Battery r • l j 1� �rasstCrTf /�.` p le �r c /'- /)�tr+/7.es t� Icts.
DateCaon CircuitJ
yz AWN*cazwt
}.. Remote Adlva/ion
Audible Devices I'_ Visual Devices
Pro.Dlsdargs
': Sfgns Al Needed
Selector Valves _ `-.
. Piping
Nozzles :4 :. `:
Tanks
Jf • Gauges INSPECTOR
Piston Acflvela _ s�-
- I hereby acknowledge the sagarectory completion SYSTEM FUNCTIONAL
r..7 or the obove descrwed wvr%.
Manual'Retards - . .
s lime DoLlv 0 SYSTEM NON-FUNCTIONAL
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Remote Malian Trans.
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