CO-0400-2018TOWN 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-0400-2018 Date Issued: Tuesday, July 3, 2018
This is to certify that work requested to be done as shown by Permit Number CO-0400-2018
has been completed.
Tax Map Number: 296.17-1-42
Location:919 State Rte 9
Owner: Adirondack Carwash
Applicant: Adirondack Carwash
This structure may be occupied as a: Certificate of Occupancy Only
fireworks sales) By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the J 4 4/P*tpropertyowneroftheresponsibilityforcompliancewithSitePlan,
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.
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TOWN OF QUEENSBURYyr
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742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
A Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: CO-0400-2018
Tax Map No: 296.17-1-42
Permission is hereby granted to:
For property located at:919 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
Type of Construction
Owner Name: Mike Seale Certificate of occupancy 0.00
Owner Address:Total Value 0.00
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Certificate of Occupancy Only
fireworks sales)
100.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, June 26,2019
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 6,2018
SIGNED BY:for the Town of Queensbury.
Director of Building&Code Enforcement
CERTIFICATE OF OCCUPANCY ONLY office use Only
Permit#: CD"O4. 0—2'Q`QJ
f APPLICATION
Permit Fee:$ 10 a
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): mom-c
Mailing Address, C/S/Z: VUM _TT QtNffALU Nf' MSO
Cell Phone: ( )_ 6/— Land Line: 71/_ C"430
Email:
Business Owners :
Contact Name(s): Inf- /
Mailing-Address, C/S/Z: t
T C-UA J .1-4LU
Cell Phone:_ 1>0 3bt - Land Line: _( ' ° ` S 711-0 0
Email:
Manager:
Contact Name(s): 1"*,f(d-W( JI-4-V
Mailing Address, C/S/Z: W? && GUA4J- fAi(j /Vr 19SCI
Cell Phone:_ Land Line: _( K f-P43P
Email: OiAA
Property Owners
Business Name: i/0/V
Contact Name(s):
Mailing Address, C/S/Z: U./f J VL
Cell Phone: _(Land Line:
Email:
Contact Person for Building & Code Compliance: JOV
Cell Phone: ( 5A ) 36-(--)-2d,4 Land Line: 913 ) A/ -0430
Email: "iJ ..A1}"V6L"j (2
Certificate of Occupancy Only Revised December 2017
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742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 virww.rxueensbury.ne
BUSINESS INFORMATION:
Name of business: IAh117 I)At Wag
Address (including suite, space, etc.):
y(.fjv) J,'
Type of business (i.e.: retai,l, 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
Applicant signature:
Date: b-5 r
Certificate of Occupancy Only Revised December 2017
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742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.ctueensbury.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: 61'V
Business Name:
Q , w(.lkf AAA t
rt fit {Business Location(including suite,space,etc.): S'`r 1' /+ I
Business Phone#:
1. Contact name:_
Main Phone:_( Secondary Phone:_( 13 ) _50 -9)
Coming from what town/village?_yy'— . y
2. Contact name:
Main Phone:_( Secondary Phone:_(_)
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@OUEENSHURY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised December 2017