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CO-0039-2020CERTIFICATE OF OCCUPANCY ONLY|office use only permit,CO~0037-2070 APPLICATION ———___ aeneatoPermitFee:$ 742 Bay Road,Queensbury,NY 12804 neG ir S P:518-761-8206 or 518-761-8205 www.queens i inet[|)JAN 29 2020 | | **This application is for coaner only, CONTACT INFORMATION:~ ©Applicant: Name(s):Deka (Scena Cade Mailing Address,C/S/2:37:8 Cell Phone:_(€45 _)743 “O12 Land Line:_()cll Guaaiaegestoaa alvinacbd Mamail comToeJJ ¢Business Owner(s): COMET NSale RSeeA NT oclow Mailing Address,C/5/2:“mum 576 Buster Acl Queansioucy Wy lago4 Hal bot Cell Phone:(245 _)793-O\%Land Line:_() EmailfecesearolwixwcbaleoyailCow ©Manager: Contact Name(s): Mailing Address,C/S/2: Cell Phone:_US4ahs )Biya zianoue:Land Line:_() Email: +Property Owner(s): Business Name:_Ayyatii Mal Contact Name(s):Compson Fe\vo Mailing Address,C/S/Z:51%Avzdiacs “ich Queensbury bIY 19.GO4 Cell Phone:(Biq_)_BaAb-020 Land Line:_(jeEmail:_C,SrebexOPYc.mil lg.Co Ccerficate of Occupancy Only Revised June 2017 Town of Ques 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. vate:/°Y/A0aD Business Name:_<0 GATONS Business Location (including suite,space,ete):7%Puedior Pach Qeensiesy WY L264 Epece “\4" ausiness Phone #:_B45 -743 -o1d3 1.Contact name:_‘o& Main Phone:(446,)14 3-O\23__;secondary Phone:_|) Coming from what town/village? 2.Contact name: );Secondary Phone:_{) Coming from what town/village? TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICEP:5187618206 F:518-745-4437 FIREMARSHAL@QUEENSBURY, FIRE MARSHAL MIKE PALMER DEPUTY Fi |ARSHAL GARY STILLMAN. Ccerficate of Occupancy Only Revised lune 2017 Town of Qucensbury 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or $18-761-8205 www.queensbury.net BUSINESS INFORMATION: Name of business:2 Sea Address (including suite,space,etc):D1%Au Spelt <oace”4 Type of business (i.e.:retail,car repair,etc.):bala Fits. 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: Sammy Fota Applicant signature:<==(=pateW/29/29 Cerificate of Occupancy Only Revised June 2017 | eco Gorst OseaCee Back coon