CO-000614-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Q—t Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000614-2016 Date Issued: Monday, October 3, 2016
This is to certify that work requested to be done as shown by Permit Number CO-000614-2016
has been completed.
Tax Map Number: 303.20-2-34
Location: 19 BOULEVARD
Owner: Nicholas Daigle
Applicant: The Karate Center
This structure may be occupied as a: CO only for THE KARATE CENTER
By Order of Town Board
TOWN
'OFFQQUEENSBURY
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 Enforcement
Planning Board or Zoning Board of Appeals.
Office Use Only
Town of Queensbury Fire Marshal
Received:
ESTABLISHMENT OF A NEW BUSINESS Tax Map ID: 03, Z U -
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: CC)- 0(� I�( Zo (�
Permit Fee: �G• ��
'Note: This application is for occupancy only,with no work requiring a building permit.
Name of Business '�� ( r, ' n�e�
Address h.. C J� r
Type of Business Ad, rum "J
Manager
OR
Person in charge // SEP
Business Phone No.
Property Owner :� z
,
AddressI fine
Phone
,-'Provide an accurate layout of your store showing all walls,exits,stockrooms,rest rooms,counters,and fixture layout on a
separate sheet of paper.
Print Name:
Signature:
Date: Z hi,
Notes I Comments:
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IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fin:
extinguishers,fire sprinkler systems,and fire alarm systems require annual inspections by an outside contractor and the corresponding
documentation must be provided to the Fire Marshal's office. Fire extinguishing systems found in kitchens and gas stations require
semi-annual Inspections. Any violations noted during an inspection,require immediate corrective action.
CONTACT NUMBERS:
Director,Building and Codes-761-8253 Zoning Administrator-761-8218 Zoning-761-8238
Fire Marshal-761-8206 Planning-761-8220
Town of Queensbury Fire Marshal—New Business Permit 518-761-8206
EMERGENCY CONTACT UPDATE
Please print clearly
DATE: I 1 Z
/1 �
BUSINESS NAME: yAc4e 6,14/
BUSINESS ADDRESS: f f?dv l e✓IIdT� ✓e .
BUSINESS PHONE: 7'12_1
6t <5 PHONE 1: 321 ' 3$2
P—VC(CONTACT 1: PHONE 2:
TOWN/VILLAGE RESPONDING FROM: aPn S T ! I S
PHONE 1: �e� 3 '0<) 7
CONTACT 2: r� I l c�2CC�1« PHONE 2:
TOWN/VILLAGE RESPONDING FROM: C, IeA5 r #5
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
Phone: 518-761-8206 • Fax: 518-745-4437
firemarshal fteensbunImet • zuzuzu.queensbun/.net
Fire Marshal Michael J Palmer Deputy Fire Marshal Gary K Stillman
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