CO-0459-2020 CERTIFICATE OF OCCUPANCY ONLY Office Use Only
Permit#: CO D VVIII ' 2-0213
,4: APPLICATION
Town ofCuccnsbunyL\
Permit Fee:$ 100
742 Bay Road,Queensbury,NY 12804 Invoice#: 2/8(Q,
P:518-761-8206 or 518-761-8205 www.queensburv.net
**This application is for occupancy only, with no work requiring a building permit**
CONTACT INFORMATION:
•
• Applicant:
Name(s): Li SQ, LibrI S - Sp;(i 1+Qtt ,tfll
Mailing Address, C/S/Z:(3 rn t c.heuJ ID SC LrieCf ady '/ I roD06
Cell Phone: cS l 9 ) SSs 41 D Land Line: ( )
Email:s d l S+- 2O 00 Sp11' - in a I I()Wei • et Or1)
• Business Owner(s): \
Contact Name(s): S P 1n t' `t��� r)
Mailing Address C/S/Z: (Q 8`ate Blade—LJL Wbr'L PilCis 1 h,Qurbbl Y N3 (.P S3L
Cell Phone: ( 0 ) 6 L4 1D Land Line: ( )
Email: M Ikr, 1 y s rS pI1'I, i—h a i • Cow,
• Manager: J L
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( 515 ) gc()- 3 (21 b.2— Land Line: _( )
Email:
• Property Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z: AUG 10 2020
Cell Phone:_( ) Land Line: _(
Email: , TOWN OF QUEENSBURY
BUILDING& UQOES
Contact Person for Building & Code Compliance: IN1 , 9I i(' h�
Cell Phone: ( ) Land Line: ( )
Email:
Certificate of Occupancy Only Revised December 2017
Town of CMrernsbu►v
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
BUSINESS INFORMATION:
Name of business: SIiy 1--- t4a.1
5
Address (including suite, space, etc.): 01:RA-u (& - R 0 c d
a v-tms b u r KN c a T oL4
. • 1
Type of business i.e.: retail, car repair, etc.): rd t \r) Cd 10-WW) Nrt,
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: LI L LMS
Applicant signature: u4&i'j?
Date: ' 6 - 6 2-0
Certificate of Occupancy Only Revised December 2017
Town of CZccnsbuwy
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.aueensbury.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: -1-l.9 - aO
Business Name: S r
B&LLVS (DUf3
ess Location (including suite,space,etc. : 57 ,c v 1 'e rj ZO4c/)
11) 9 / a goLi
Business Phone#: 1 -0 O 5 433a
1. Contact nam iDOCiC,I 9 o 1 OA
Main Phone:_(')53( ) / v `' ( (e3 Secondary Phone:_(
Coming from what town/village? G IPn f(_S-t I'
2. Contact name: jj JQ )11 6itS
Main Phone:_(5 l' ) 5 K51416 L Seconds Phone:_(
Coming from what town/village? SCh hr aO
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