CO-000620-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000620-2016 Date Issued: Monday, January 23, 2017
This is to certify that work requested to be done as shown by Permit Number CO-000620-2016
has been completed.
Tax Map Number: 296.13-1-68
Location: 974 State Rte 9
Owner: Jason Southwood
Applicant: Ray Roberts
This structure may be occupied as a:C/O only,Suite B
Tenant: Columbia Cabinets LLC By Order of Town Board
TOWN OFF QUEENj4A
SSBURY
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CO-000620-2016
Tax Map No: 296.13-1-68
Permission is hereby granted to: Columbia Cabinets LLC
For property located at: 974 State Rte 9
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
Tvce of Construction
Owner Name: Jason Southwood Certificate of occupancy $0.00
Owner Address: PO Box 226 Total Value $0.00
Cleverdale,NY 12820
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
C/O only,Suite B
Tenant:Columbia Cabinets LLC
$50.00 PERMIT FEE PAID-TIBS PERMIT EXPIRES: Wednesday,September 20,2017
(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 ofens n uesd y 'e mber 20,2016
SIGNED BY: �rfF({// for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Fire Marshal
Received:
ESTABLISHMENT OF A NEW BUSINESS Tax Map ID:
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: CZ " (¢20-2-t to
Permit Fee: "t V-%U w , lo 6V
'Note: This application is for occupancy only,,with no work requiring a building permit.
Name of Business
Address �y7 AQ1e /t/t
Type of Business / ( fw ✓/ C 4;nP r J TU/e-
Manager
Manager Ru.� �oGir.1i
OR
Person in charge
Business Phone No. /k' - d91—//700 // /
Property Owner myi In/,7ad c�,&y/ ..�dLriz�i ��Gvnec/
Address / 0 Ao c o�d,L y (_14A,^e� c iq b.. AIV ly4"
Phone _g-/fir - Lyd - A) 7d
✓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: J�71/o �7 Z-Q✓
Signature:
Date:
Notes I Comments:
IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire
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: G
BUSINESS NAME: ��_9
BUSINESS ADDRESS:( ? /0"K 9, /VV MATO �
BUSINESS PHONE: J_/00 U
PHONE 1:
CONTACT 1: PHONE 2: - 1 ?— uc
TOWN/VILLAGE RESPONDING FROM: '�� Tei A
PHONE 1:
CONTACT 2: PHONE 2:
TOWN/VILLAGE RESPONDING FROM: 4 ci 4�,4n
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
fireviarshalQqtieensbunt net • 1MV70.queensburnImet
Fire Marshal Michael J Palmer Deputy Fire Marshal Gan,/ K Stillman
296.13-1-68 CO-000620-2016
Columbia Cabinets LLC
974 State Rte. 9
C/O only
IWI 92' /
�IWindow Window
^ L�
2 R
3
C 0
J
g
a
o
v J m w
i ; F
R
-
�
_ 6
0
'o
\
0
0 o u
eN N
Hallway
DOOR a
- 4 23, 1M.- /— / 43QYi —/ / 30' (--30' 36' /
1B2{ 36' JS' X30'—!
- 300• -
/-
Lake George Showroom
_ I
All dimensions size Jesignmions e1/1 This is an ori,i ,d Jesign vnd muse IDcsigneJ:8/31/2016
given are sobjcc.�o vcri(wlim=nn LV�omu J nm be released ar copied unless Primed:9/9/2016
job siic and vdpu ln....1 m 0i job Vph.ble @e has been paid or Job r —
ondhions. ordernmeea.
Lake George All Drawing k:1 I No Scale.