applicationCERTIFICATE OF OCCUPANCY ONLY[oficeuse on
APPLICATION Permit C802802oES
Permit Fee:$_}OO 7
Invoice ts 262TownofQueet
742 Bay Road,Queensbury,NY 12804
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):__Keystone Novelties Distributors LLC
Mailing Address,C/S/Z:201 Seymour Street Lancaster PA 17603
Cell Phone:_(4e|__)3A37H44-Land Line:_(_717_)_394-1078
Email:_AMutzabaugh@keystonenovelties.com
°Business Owner(s):
Contact Name(s):_Jack May
Mailing Address,C/S/Z:_201 Seymour Street Lancaster PA 17603
CellPhone:(610)888-5715 Land Line:(_800_)390-0844
Email:_jfmay@keystonenovelties.com
°Manager:
Contact Name(s):__Alex Mutzabaugh
Mailing Address,C/S/Z:_201 Seymour St Lancaster PA 17603
Cell Phone:_{)Land Line:(_717_)_394-1078
Email;amutzabaugh@keystonenovelties.com
°Property Owner(s):
Business Name:__Saratoga Prime Properties,LLC.
Contact Name(s):__Frank J Parillo
Mailing Address,C/S/Z:__215 Ballard Rd Wilton NY 12831
Cell Phone:_()Land Line:(518 _)584-1444
Email:
Contact Person for Building &Code Compliance:_Keith Lambert
Cell Phone:_(_401 )323-7197 Land Line:_()
Email:__klambert@keystonenovelties.com
jECEIVE
IP]|may 28 2029 l
TOWN OF QUEENSBURY
Certificate of Occupancy Only BUILDING &CODfetised vecdmber 2017
Town of Queens
742 Bay Road,Queensbury,NY 12804
P:$18-761-8206 or 518-761-8205 www.queensbury.net
BUSINESS INFORMATIO!
Name of business:Keystone Novelties Distributors,LLC
Address (including suite,space,etc,):_1471 Route 9 Queensbury,NY 12845
Type of business (i.e.:retail,car repair,etc.):_Retail NY legal fireworks sales
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:Keith Lambett
Applicant signature:tl Lew
Date:511G/a030
Cerificate of Occupancy Only Revised December 2017
Town of Q
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:5/18/2020
Business Name:Keystone Novelties Distributors
Business Location (including suite,space,etc.):_1471 Route 9
Queensbury,NY 12845
susness Pronew:___(FO0)310 —OLY
1 contactname:__Chi wash bum
Main Phone:(5 [F%_)41S —O3%0 secondary Phone:_(BX _)390 -O84
Coming from what town/village?
2.contatname:Home of Ree epadioos (hex
Main Phone:(0 _)390—O&44
__;secondary Phone:
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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 December 2027