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CO-000740-2017 � I TOWN OFQ UEENSBURY 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development-Building& Codes (518)761-8256 CERTIFICATE OF OCCUPANCY Permit Number: CO-000740-2017 Date Issued: Tuesday, December 5, 2017 This is to certify that work requested to be done as shown by Permit Number CO-000740-2017 has been completed. Tax Map Number: 288.12-1-22 Location: 1444 State Rte 9 Owner: Moose on the Loose Deli, Adirondack Factory Outlet Applicant: Moose on the Loose Deli This structure may be occupied as a:C/O Only Tenant:Moose on the Loose Deli LLC By Order of Town Board (formerly Sammy D's) 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 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-000740-2017 Tax Map No: 288.12-1-22 Permission is hereby granted to: Moose on the Loose Deli For property located at: 1444 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 Tvne of Construction Owner Name: Erin Hunnewell Certificate of occupancy $0.00 Owner Address: 11 MIDNIGHT DR SOUTH Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications C/O Only Tenant:Moose on the Loose Deli LLC (formerly Sammy D's) $50.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 30,2018 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the piration date.) Dated at the To f QueeT4r ovember 30,2017 SIGNED BY: for the Town of Queensbury. Director of Building&Code Enforcement CERTIFICATE OF OCCUPANCY ONLY Office Use Only APPLICATION Permit#:Co - 2-CV lown<d QExun'buto Permit Fee:$ C30 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8206 or 518-761-8205 www.gueensbury.net "This application is for occupancy only, with no work requiring a building permit" CONTACT INFORMATION: • Applicant: Name(s): 41od Gr 7%. I-avSE DC� L LC- Mailing Address, C/S/Z: Al t j Al/ >1Ti�- Cell Phone: (57�> Land Line: f s<a ) 291 —ff 7-1 Email: PfA4 5-e cys • Business Owner(s): Contact Name(s): c,2t (/✓�G /L �6 C rb�J / �„�gc�2�� Mailing Address, C/S/Z: 1111ii-: D,2 n Cell Phone: _ {(y; _) —%5 y Land,Line: Email: d cad50- ; • Manager: Contact Name(s): C`7 bC weC-1GGw Mailing Address, C/S/Z: tj jlkta' Cell Phone: -(,51') ) 53y,- 9 Land Line: _( ) Email: yjZ3 4- l�Lcu--- • Pro ert Owner (s): Business Name: Contact Name(s): �J Mailing Address, C/S/Z: l e t2 Cell Phone: _(5f L 7 3 Land Line: _( ) Email: Laz_k.6 h 15 Certificate of Occupancy Only Revised June 2017 fewu ut(jtx'rrn!4dar 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.gueensbury.net BUSINESS INFORMATION: I / Name of business: at')�- C_ Address (including suite, space, etc.): 5 C rL ,i2� c. t�' S Al A c -K-) Type of business (i.e.: retail, car repair, etc.): Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms, counters and fixtures on a separate sheet of paper. IMPORANT: 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 Town of Queensbury 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 and a re-inspection. Applicant name: L VW e6 N Applicant signature: ��-- Date: u 136 LI Certificate of Occupancy Only Revised June 2017 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.gueensbury.net EMERGENCY CONTACT INFORMATION "THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN GAINING ENTRY TO YOUR BUILDING." PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL. Date: t ( / Business Name: Business Location (including suite, space, etc.): y L0� Business Phone#: l 1. Contact name: C_ Main Phone:_( 6lf� Q 3'14—fC,9Cj y ; Secondary Phone:_( Y /� l Coming from what town/village? IDUR.. 'K 2. Contact name: �f'1 Main Phone:_( /� ) d �2 ; Secondary Phone:_(�l�)-N lL 7/ Coming from what town/village? '_..P_P,l't- �/— TOWN OF QUEEN SBURYFIRE MARSHAL'S OFFICE P: 51 8 761 -8 2 06 F: 51 8 745-4437 f it emar shal Cada ueensbur y.net Fir a Mar shal Mike Pal mer Deput y Fir a Mar shal Gar y St it I man Certificate of Occupancy Only Revised June 2017 r CEOWE NOV 3 0 2017 TOWN OF QUEENSBURY BUILDING&CO ES Co - qzlo- Zo Nrl FAAZ�� 5 11L � D [ CEO Nov 3 0 2017 TOBUNLD GU&CODES Y D�w ovt r t,oy� Piv V �12-,n f