application RX Date/Time 06/24/2020 13:15 P,002
From:Daniel Dawson Fax:18656918509 To: Fax:(518)745-4474 Page:2 of 6 06124/2020 1:14 PM
CERTIFICATE OF OCCUPANCY ONLY Office Use Only
yii� --
A r33 —aalO
Permit CO�
tIOO' Permit i•ee:y
T6cf7�Of{�tM.'CYSS)till'
��__l L 15 invoice#;
742 Bay Road,Queensbury,NY 12804 D
P:518-761-8206 or 518-761-8205 www. u��y s r .t u L `t 2020
TOWN OF QUEENSBURY
**This application is for occ BUILDING-ol uwtn So vork-re uirin a buildingpermit**
pP P� 1i:' 9 g
CONTACT INFORMATION:
• Applicant:
Name(s): Craig Migawa, Caleb Stone
Mailing Address, C/S/Z: 3275 Newport Highway, Suite 5 Sevierville,TN 37876
Cell Phone: ( ) _ Land Line: ( 865 ) 429-4277
Email: daniel@culpepper-cpa.com
• Business Owner(s):
Contact Name(s): Craig Migawa
Mailing Address, C/S/Z: 3275 Newport Highway,Suite 5 Sevierville,TN 37876
Cell Phone:_( ) Land Line: _( 865 ) 429-4277
Email: kimd@)repperpalace.com
• Manager:
Contact Name(s): Caleb Stone
Mailing Address, C/S/Z: 3275 Newport Highway, Stifle 5 Sevierville,TN 37876
Cell Phone:_( ) Land Line: _( 865 ) 429-4277
Email: calebs(Elpepperpalace.com
• Property Owner(s):
Riisinpss Name. Lake George Northway. LLC
Contact Name(s):_
Mailing Address, C/S/Z: 2700 Westchester Ave, Suite 407 Purchase, NY 10577
Cell Phone: _( ) Land Line: _( 914 ) 253-6500
Email:
Contact Person for Building&Code Compliance: Caleb Stone
Cell Phone: ( ) Land Line: I 865 ) 429-4277
Email: calebsPpepperpalace.com
Certificate of Occupancy Only Revised December 2017
RX Date/Time 06/24/2020 13:15 P.003
From:Daniel Dawson Fax:18656918509 To: Fax:(518)745-4474 Page:3 of 6 06/24/2020 1:14 PM
Ak&Na*k
1:004,;1V:
•-•
takkodiii;:';
742.8ay.Road,Queensbury,NY:12804
12;.518-761-8206 or 518-761-8205 www.nueensburv.net
BUSINESS INFORMATION:.
Name of business: Pepper Palace Inc..
Address (including sulte,.space, etc.):- 1424 State Route 9,Sulte 14
Lake George,:NVI2845
Type-of business retail,.carrepair-,etc:): Retail
Please provide:an accurate layout of your storeSholkiing:all walls, exits, stockrooms, rest
rooms, counters and fixtures on aseparate sheet of paper„
. IMPORANIT:The business:ommeris respOnSibleforkeeping exits clearand maintaining exit
.;am. ml man im liali e r-. 1 1. r. _ -
re.quireannktal inspections byan:outside contractor anal thecorres.pondingdocumentation
must be provided Town ofo.i.e.ensbury Fire Marshal's-offipe.. Fire extinguishing sotems.
found in-kitchens and gas stations req.UirerSerni-annUal inspections. Any violations noted
during an inspection.require immediate correetive action and a re-inspection.
„ . .
. .
Applicant name: (W.1.5 iciatda,
Applicant Signature: .
bate: tafaq449:0a4 .
CertifIcate.of Occupancy Only Revised.December 2017
RX Date/Time 06/24/2020 13:15 P.004
From:Daniel Dawson Fax:18656918509 To: Fax:(518)745-4474 Page:4 of 6 06/24/2020 1:14 PM
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: 6/24/20
Business Name: Pepper Palace Inc.
Business Location(including suite,space,etc.): 1424 State Route 9,Suite 14
Lake George, NY 12845
Business Phone#: 865-429-4277
1. Contact name: Craig Migawa
Main Phone:_( 865 ) 429-4277 ;Secondary Phone:_( )
Coming from what town/village? Lake George
2. Contact name: Caleb Stone
Main Phone:_( 865 ) 429-4277 ;Secondary Phone:_( )_
Coming from what town/village? Lake George
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 2017