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CERTIFICATE OF OCCUPANCY ONLY|office use only APPLICATION Parmer O78Hes“TNS Permit Fee:$__100 ~ Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoice #:_222 P:518-761-8206 or 518-761-8205 www.queensbury.net **This application is for occupancy only,with no work requiring a building permit** CONTACT INFORMATION: ©Applicant: Name(s):___Kimberlee Tooker Mailing Address,C/S/2;___7s L-uzewe Rd Queensbury WY Cell Phone:_(5i8 )__307-585 Land Line:_() Email: ¢Business Owner(s):_. Contact Name(s):___Kimberlee Tooker Tabatha Jarvis Mailing Address,C/S/2:Luzeyne Rd Gueensbury Cell Phone:_(5/§)30]7=57 Land Line:_() Email: «Manager Contact Name(: Malling Address,C/S/Z:TPeElWe Cell Phone:_()landline:(|)PVE E IlEmail:ny a [ 1 NOV CS Cus Y *PropertyOwner(s):TOWNOFQUEENSBURY Business Name:[__BUILDING &CODES Contact Name(s):___An dy—Lucci Mailing Address,C/S/Z:___* Cell Phone:_(_5/¥)Be\Ok Land Line:_() Email: Contact Person for Building &Code Compliance: Cell Phone:_()Land Line: Email: Certieate of Occupancy Only Revised December 2017 Town of Queensbury 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.queensbury.net BUSINESS INFORMATION: Name of business:Little Rascals Family Daycare Center,Dix. Address (including suite,space,ete.):_7 Auzevne Rd,@ weensbury, Type of business (i.e.:retail,car repair,etc.):_Dayc ar 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:_Kimbewke Tpolzer Applicant signature:erhaben WSU :US \\r Certificate of Occupancy Only Revised December 2017 Tenn of Queensbury 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.queensbury.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. pate:__Lif}A1/4 ousnessname:Little Rascdle Family Daycare Center ,Tne Business Location (including suite,space,etc.):_~[zeme 2 d Queensloury,NY (ago Business Phone#:__518 ~3O07-457H or _518-307 -5857(For Now) 1.Contactname:__[dbatha Javvi Main Phone:_(_5))307-45 7 __;Secondary Phone: Coming from what town/village? 2.contact name:__Kimberlee.looker Main Phone:_(5/8)3O7-5857_;Secondary Phone:_((__). Coming from what town/village? TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICEP:518761-8206 F:518745-4437 FIREMARSHAL @QUEENSBURY.NET FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN. Certificate of Occupancy Only Revised December 2017