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2010-466 TOWN OFQ UEENSBURY if#0 742 Bay Road, NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF OCCUPANCY Permit Number: P20100466 Date Issued: Thursday, December 29, 2011 This is to certify that work requested to be done as shown by Permit Number P20100466 has been completed. Location: 3 OGDEN Rd Tax Map Number: 523400-308-015-0001-055-000-0000 Owner: NYSARC INC. WARREN & WASHINGTON COUN Applicant: NYSARC, INC. WARREN WASHINGTON CO'S CHAPTER This structure may be oc*11414klaWASHINGTON ARC Certificate of Occupancy(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 Planning Board Director of Building&Code nforcement or Zoning Board of Appeals. TOWN OF QUEENSBURY ET 4y 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20100466 Application Number. A20100466 Tax Map No: 523400-308-015-0001-055-000-0000 Permission is hereby granted to: WARREN WASHINGTON ARC NYSARC, INC. WARREN WASHINGTON CO'S C For property located at: 3 OGDEN 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: NYSARC, INC. WARREN WASHI 375 BAY Rd Suite 200 Certificate of Occupancy(COM) QUEENSBURY,NY 12804-0000 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency Plans &Specifications 2010-466 C/O only- Warren Washington ARC $0.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday, October 01, 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 Town bu ; Fr'•• y LS 5 er 01,2010 4 -4 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement EZ- - Community Development Office Town of Queensbury• 742 Bay Road • Queensbury, New York •1 1111 Marilyn Ryha, Executive Director•David Natin, Director of Building&Codes Craig Brown,Zoning Administrator•Michael J.Palmer,Fire Marshal TOWN OUEENSBURY e�a14.Du_ .CORES NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT APPLICATION TAX MAP # BLDG. PERMIT FILE# / 6 apple bie Name of Business: (rt2Avre„r 6hat.11, •k A ee_. Address 3 01denr 12r,�►J- ileec,✓s6 r�y' N.31, of Business: 3 !S -61:ty R.da Svt''- aOD QJecws6rar�,/N QUESTEMAIL cIONSode?s CALL 761- eensb8256 r l aC7.aaurv.net or Manager: / VISIT OUR WEBSITE FOR MORE Person in ChargeA 9 /CAN"to.,> I- L e C1�11 nLe�.nn ��cam. INFORMATION w.aueensburv.net Business Phone Number: 51 i- t)I13'LI0/c(1 Type of Business: k J.* Se„, e 1 UArre V VA1�•��^0,1 4 kC- Owner of Property: Phone Number(s):578-7`13-Y2o'/ SIT bet-0 IN N Home Cell Owners Address:dr)c RAI 1?, J Sse.. :tc C ev. r,16tH L /1/41. )2,o'1 Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, 11 counters and fixture layout on a separate sheet of paper. Signature: -.6 / � Date: 9-Z0 -/U // Of person submitting this form Notes/Comments: *Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit /0 --467k EMERGENCY CONTACT UPDATE TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502 PLEASE PRINT DATE: Cr a0 -eplQ I a BUSINESS NAME: w (.) A R Q ' ei,er) Road Iac,ceo� C�,t f n 9 BUSINESS ADDRESS: _ ! !";,���, BUSINESS PHONE: S I - 53 -Liao HOME CONTACT 1: Wick h PHONE 4s%-01(1 ADDRESS: I 141 c,..12_ & &c%J h/'.4) /&k (� HOME J CONTACT 2: eal vN, 041e y PHONE 2 2.3- 06 t/5 ADDRESS: r.,�. ;✓ l - Ed L✓ r✓✓ 'a ' r 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 QUEENSBURY FIRE MARSHAL'S OFFICE P h o n e: 518-761-8206 • F a x: 518-745-4437 firenaarshal@queensbury.uet • www.queensbury.net (2 - / -l� 5-Tait)S j /( c) Inspection Form Town of Queensbury Fire Marshal C)Periodic Inspection Date: Time: 742 Bay Road,Queensbury NY 12804 o Re-Inspection /() 4' 7 518 761 8206/518761 8205 CO Inspection - ) Permit#: Fire Marshals Representative _MJ Palmer Business Name: KI Location: 3 0(RC.0 , -- Pei GK Stillman Contact: 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 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 TRUSS ID SIGNAGE FC 505.3 EMERGENCY LIGHTING: Interior FC 1006.3&FC1029.8 //j7 Exterior FC 1006.3P441-1M-t0 Clearance to Electrical FC 605.3 Electric Wiring Enclosed/Labeled FC 605.3.1 Combustibles in Equipment Rooms FC315.2.3 F.D.Signage- FC 510 // /2eV '144, No Smoking Signs FC 310.3 Storage FC 315.2 ��Q/'i YJ � ✓f�k4i4 �'J J 11&.:i1i4I 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" 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 DATE: OK NC HVAC Shutdown Sprinkler System Annual Sprinkler FDC Kitchen Suppression Semi Annual -4 J 6jI Fuel Island Suppression Semi Annual ,p /; � /12/1 Hood Cleaning 3-6-Annual / f `if iCl� ���/ LL Knox Box:installed/checked FC506 / " Permit, if required will be issued after 00/y Operatingq Completion of Inspection TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 IF0,001, Community Development-Building&Codes (518) 761-8256 Inspections per Permit Permit# P20100466 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 09/21/2010 Miscellaneous Certificate of Occupancy(COM) JENNIFER HENDERSON Staff Misc 2010-466 PERMIT ENTERED 12/16/2011 Status Inspection Certificate of Occupancy(COM) JENNIFER HENDERSON Staff Misc 2010-466 MADE OUT STATUS INSPECTION SLIP Inspection for Permit to Occupy Fire Marshal's Office Request Rec'd Permit No. w lU - 1"t Co V Town of Queensbury 742 Bay Road Q la'i''k O Queensbury,NY 12804 Scheduled Inspection Date: Time: Phone: (518)761-8206 Business Name: `Jl'Ut}(2 .-- Fax: (518) 745-4437 Location: _Qj -1:Z'0-A 0 Type of Inspection N/A Yes No EXITS: Exit Access UL Exit Enclosure CiL COMMENTS Exit Discharge Lit AISLES: MaiAisle Width aL Y � ..*06 cp,....ct c. Secondary Aisle Width EXIT SI -nor (= Sign-normal f& 01 4 }- Sign-battery { ' ' l EVAC signs in rooms v....-- TRUSS TRUSS ID SIGNAGE `^ ,/ EMERGENCY LIGHTING - DC FIRE EXTINGUISHER: Hung Inspection of extinguisher 4--i FIRE ALARM SYSTEM Fan Shutdown '— Fire Sprinkler System (FDC) `- Fire Suppression-kitchen '— Fire Suppression-Gas Islan ...- Generator ....- Hood Hood Installation Elevator — Interior Finishes Storage - g; Compressed Gas v _ Clearance to Sprinklers Clearance to Electrical V Electric Wiring Enclosed/Labeled w�, Combustible Waste 0 -,) Vehicle Impact Protection --- Knox Box — F.D.Signage-Utility Rooms .- No Smoking Signs l Maximum Occupancy Sign , n& ) , Emergency Evacuation Plan '--. Approved (If no other approvals appy,the B 8.C Office vv�ll issue t' ertificat .f Occupancy) o Denied / call for Recheck Inspected By: �� L:\FireMarshal\FM Forms Masters\permitto occupyform.doc