application CERTIFICATE OF OCCUPANCY ONLY Office Use Only
Permit#: CO —Z:01,al --213
'` APPLICATION
!own i Qu rn,turE
Permit Fee:$ IOiS`�
742 Bay Road,Queensbury,NY 12804
Invoice#: I L.�
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: 5ECEUVE
11 MAR o52019
• Applicant:
Name(s): Andrea Jentz TOWNeOF QUEENSBURYY
L1iwDP &CODES
Mailing Address, C/S/Z: 21333 Haggerty Rd. Suite 100,Novi Mt'48375
Cell Phone: ( ) Land Line: ( 248 ) 675.1992
Email: Ajentz@learningcaregroup.com
• Business Owner(s):
Contact Name(s): Childtime T.earning Centers, Inc
Mailing Address, C/S/Z: 21333 Haggerty Rd. Suite 100,Novi MI.48375
Cell Phone: _( ) Land Line: _( 248 ) 675.1992
Email: Ajent7@learningraregroup enm
• Manager:
Contact Name(s): Jennifer Cameron
Mailing Address, C/S/Z: 28 Vly Road Albany,NY. 12205
Cell Phone: _( 518 ) 203.9246 Land Line: _( 518 ) 869.1720
Email: Jcameron@learningcaregroup.com
• Property Owner(s):
Business Name: NCA of QU Real Estate Holdings,LLC
Contact Name(s): William Johnson
Mailing Address, C/S/Z: 106 Reynolds Road,Ft. Edward,NY 12828
Cell Phone: _( ) Land Line: _( 518 ) 225.3567
Email: N/A
Certificate of Occupancy Only Revised June 2017
Town ot'Ogeenchun
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
BUSINESS INFORMATION:
Name of business: Childtime Learning Centers,Inc.
Address (including suite, space, etc.): 6 Willowbrook Road
Queensbury,NY. 12804
Type of business (i.e.: retail, car repair, etc.): childcare facility
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: Andrea Jentz
Applicant signature:
Date: 07/25/0019
Certificate of Occupancy Only Revised June 2017
rown deQueen,bui
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.
Date: 02/25/2019
Business Name: Childtime Learning Centers,Inc.
Business Location (including suite, space, etc.): 6 Willowbrook Road
Queensbury,NY. 12804
Business Phone#: 518.798.8111
1. Contact name: Jennifer Cameron
Main Phone:_( 518 ) 869.1720 ; Secondary Phone:_( 518 )203.9246
Coming from what town/village? Albany
2. Contact name: Nicole Patrone
Main Phone:_( 914 ) 747.3027 ;Secondary Phone:_( 860 )839.0825
Coming from what town/village? Albany
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised June 2017