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CO-0042-2021 Ww"
E CERTIFICATE 2 np 2N office Use only,
C E Q V L5 AN ICA 1110111
Permit#: U— DU 1 'ZOZ
FED Q i ,�� Permit Fee:$ ) i 0 , �D
Town t�(t cnsbu, 2
742 Bay Road,Queensbury,NY 12804 Invoice#: ✓3
TOWN OF QUEENSBURY
P:518-761-8206 or 518-761-8205 www. ueensMWRMG&CODES
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business:
business Address'(including suite, space, etc.): - V.a-4_-,L:,
Detailed explanation of business (attach a separate piece of paper,'if necessary):
t�lo�n Qr D'�qA
C.,
* *Please provide an accurate layout of your space showing
all walls, exits, stodkrooms, 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:. C��� " P
Applicant signature- Date: I Zz
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Property Owner name: Ktc,, d
Property Owner signature: Date.: r z'��-(
Certificate of Occupancy Only Revised December 2020
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Town of Quccnsbun
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant- �N-If cam
Name(s): ��f�� n � C t z'
Mailing Address, C/S/Z: h,,,,2 ► lS it1 I Z I
Cell Phone: Land Line:
Email: `,' NVJ;�. z4 -a
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
•. Manager:
Contact Name(s): U)pl\1�40
Mailing Address, C/S/Z:
Cell Phone:_( � ) �22 �dD Land Line:
Email:
� • Property.Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_ /e ) 7 9 6S a- I Land Line: _( )
Email:
Contact Person for Compliance in regards to this project: c- ��� � -
Cell Phone: ( Ulv ) C/`�J�� (�OD� Land Line:
Email:
Certificate of Occupancy Only Revised December 2020
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, W 12804
" Hoare of Natural Beauty ... A Good Peace to Line "
PLAN REVIEW
Syndicate East Coast, Inc.
19 Boulevard
CC-0042-2021
2/3/21
The following comments based on review of the submitted plans:
1) Verify Fire Extinguisher locations.
2) Locks & latches shall comply with 2020 NYSFC.
3) Verify CO detection.
4) Verify operation of existing Exit/ emergency lights.
5) Verify aisles & storage.
Deputy Fire Marshal
Gary K. Stillman
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fi r e IN4 a r s h al 's O f f i c e - P h o n e: 518-761-8206 - F a s: 51S-74541437
-flrerruarslral@tir-reerrsbrrrU•raet wit,w.queerasburit.rre:t