CO-0009-2020 CERTIFICATE OF OCCUPANCY ONLY office Use Only
APPLICATION Permit#: Co' evoy '=
Permit Fee:$ /GO.limn ci Qprcnsbun'
vo
742 Bay Road,Queensbury,NY 12804 Invoice#: ,11,7 Q S
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: ECEOW i 1 I
•ILLLJ0b2o2o 1 .l
• Applicant: E --_ -..=M i
Name(s): M D M 17)H1 f KWnit.-,
Mailing Address, C/S/Z: 67g. ft v cul MAY Road `_- t& S 16,Ua,4 N Y 12 g e t
Cell Phone: ( 5- 1 43 ) 20q -437 S- Land Line: ( )
Email: - iJ-}r&a 2e-vg 6) ( - c
• Business Owner(s):
Contact Name(s): Nip M TI1-1 A
Mailing Address, C/S/Z: 53 g Aviek.Eicv' MOW P,o0J. 841(e°14 N Y 128a
Cell Phone: _( 5- 1 B ) 20 9 - C 3 7 S Land Line: _( )
Email: -74+Erket 2 a 9 0 ff' (- e_'vh
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Property Owner(s):
Business Name: A v i ahol Ma,U
Contact Name(s): CgOY,ero 4 'Fkkell
Mailing Address, C/S/Z: 5-7-g Pr v i c 'i el-) Mck,i( keno( avvi4vr NY f'2.-To t
Cell Phone: (CI d ) 3 9 6- 0 3 6 I Land Line: ( )
Email: eAme1wi1fiSkeh 0 P jParyn1U(m1.
Certificate of Occupancy Only Revised June 2017
Town dQuccn_ ry
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.aueensburv.net
BUSINESS INFORMATION:
Name of business: i.M CMNbY S Ho PPE
Address (including suite, space, etc.): 6-7 g flti 160-1m MoLU 10,c^J SPAS r
aueelSbLo^4 N`( ( 2 Po t)
Type of business (i.e.: retail, car repair, etc.): OAK cl) t' j , (;c
e�- c
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: M 1) M To H A-
Applicant signature: t o TrI
Date: 01 /0C/2_0f 0
Certificate of Occupancy Only Revised June 2017
Town of Oyern. nv
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: (I /C 6/2-0 26
Business Name: r �_A NDY $H 0 PPE-
Business Location (including suite, space, etc.): 77 g Avl46'1 Mc U iZookri
lnl�rsc 5cp ru- ' op-) &ike.elislvu;1 NJ /2VO f
Business Phone#: 5 ig- ZO y- 6 3 �c
1. Contact name: i`1 t) NITD H A
Main Phone:_( 5- I g ) 20 9 - 6 j 7 c ; Secondary Phone:_( l u )(y)Z-c`)/
Coming from what town/village? H 01/446--m
2. Contact name: 5 .r I T k
Main Phone:_( 5 I$ ) y 15 - 31 ; Secondary Phone: ( S 1g ) S 1( - 39 71
Coming from what town/village? 1-1-0 a--'
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 June 2017