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application CERTIFICATE OF OCCUPANCY ONLY Office Use Only . Cc ersb5- 20 WSJ Permit#: .�--- APPLICATION /-- r Torn orCZrccnsbun Permit Fee:$(00 742.Bay Road,Queensbury,NY 12804 Invoice#: 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: o Applicant: Name(s): voo 17. 05`t(A E • Mailing Address, C/S/Z: LIZ f"o6--T +� +Ft(( - ► AoREA ) iZ J 8 Cell Phone: ( S73 ) (oB3 -2"quuo -_ Land Line: ( S' 3 ) eZSE Email: r 1`7 O SIVJANO62 4-(M it , w( o Business Owner(s): Contact Name(s): 146V/( . LI SA OAP i (& Mailing Address, C/S/Z: eiN ' 1-D I�0 r Ul/IUC CAI/ ) 2c2)S Cell Phone: ( / ) (A; --2'0(, Land Line: _( SrP) ) 7/3— 82S-3 Email: VOSt 1 P Ccwv►n a Manager: Contact Name(s): Kai/0V ©S AI g— Mailing Address, C/S/Z: z(2 re-42._T C Cell Phone:_(57e ) (v9,'3 —7c/f)c, Land Line: _( (;—'i3 ) 7 3 Email: //b051-(. 't76(Z i. &—MAI lan o Property Owners): Business Name:_ ,KUR. .C/1y r')/ fcraucT/detl C b •iA/L Contact Name(s): a (--N T.74V0I Soh/ Mailing Address, C/S/Z: 7cO 'P1-LL44Rt> Cell Phone:_( STA ) fQS— o' , Land Line: _( S t ). 8 o - F, Email: 3c vi�Sv..^ 6 C+ct (t:n vvt Contact Person for Building& Code Compliance: 5 v i 6 A-5 44ot Cell Phone: ( ) Land Line: ( ) Email: 7777 l.1 j i AUG % B 2020 ‘.1:j ';OWN OF OUEE SauRY Certificate of Occupancy Only BUILDING w. COP.cc �_..� Revised December 2017 / GL ca E Ye F + } Tow ofCZcroncb!iry {° ' 742 Bay Road,Queensbury,NY 12804 AUG 19 2O2D P:518-761-8206 or 518-761-8205 www.queensbury.net _ t TOWN OF 1sBulLr BUSINESS INFORMATION: Name of business: ?ctc 1-'���C S Address (including suite, space, etc.): 3 v A-Y �. c)1v� r cBu 10( [ 4id Type of business (i.e.: retail, car repair, etc.): (- y Wt IA/As'-f c S / fie 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: eVi ‘J , . Applicant signature: Date: g 19- Certificate of Occupancy Only Revised December 2017 Q-/ AUG f192n2B Town of-CZcrcrnstn,ri TOWN OF QUEENSBURY BUILDING&CODES 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- (9 ✓20 Business Name: ? y�� '�i -- ATk- E ,c C / 'l—/l./L Business ocation(including suite,space,etc.): 23 U A ( pD 6 seo U! AP( rzec)if Business Phone#: 1 g — 6 v✓- 210 6 1. Contact name: K`"f Ai OSt (? Main Phone:_(5(Q ) (0(?) —29hG ;Secondary Phone:_( S/Q ) 7d13— Zs 3 Coming from what town/village? .[V l(')R.CA-tJ 2. Contact name: Lr c A 5 1 KAIV91!2 Main Phone:_(c7 ) 7 qt./- (Q h l ;Secondary Phone:_(S/(3 ) 793-- (82�..? Coming from what town/village? tub e_e At} TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE P:518-761-8206 F: 5 1 8 745-4437 FIREMARSHAL@OUEENSBURY.NET FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN Certificate of Occupancy Only Revised December 2017