2007-100~~~
RE~~~~~
EMERGENCY CONTACT
G
U 'r~+„'~~~®~v.5t5l.~RY
CC~E
TO: WARREN COUNTY SHERIFF'S DEPT. FAX: 743-2502
PLEASE PRINT
DATE: __i I Z ~~ °~
BUSINESS NAME:
~N
BUSINESS ADDRESS: ~ I~ G ~ e,nw.~.~c/L ~ve.,
BUSINESS PHONf: J / ~ - 1 ~ ~ ' 32,31
I~LC
-19 6 - X1323 ~.N~
HOME
CONTACT 1: ~.+-~ /~-~ len PHONE 193 ' ~~q3 C,c,~
ADDRESS:
l1 7f
~- / HOME ~
CONTACT 2: ~~`. J~~4~-~•a•. C. (~eeiScr PHONE 32~-'~J~ 6 L~-
ADDRESS: ;5 6 ~
k-. TIC(.
/ ZB~~I
This form is used to assist Emergency Service personnel who may be called to
your business after hours. Please be sure that the persons listed on this form will
be willing and available to respond during off-hours to assist Police and/or Fire
personnel in gaining entry to your building.
PLEASE BE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERVICE
PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACILITATE ENTRY BY
POLICE ANDJOR FIRE PERSONNEL.
_. _. _ _.
TOWN OF QLIEENSBURY FIRE MARSHAL'S OFFICE
Phone: 518-761-8206 Fax: 518-745-4437
.~iremarshalC~3c~ueensburu.net www.c~ueensburu.net
Inspection for Permit to Occupy
Fire Marshal's ~fflCe Requsst Recd Permit No. U ~~ ~ ~
Town of Queensbury _„
742 Bay Road t ~ l ~ "~ Q
Queensbury, NY 12804 Scheduled Inspection Date: / ~ ` Time:
Phone: (518} 761-8206 Business Name: ~ C ~` "" Pn'~ ~-~' ~
Fax: (518) 745-4437 Location: f~r-w~ Jam,.
T e of Ins action N/A Yes No
EXITS:
Exit Access
Exit Enclosure
Exit Dischar e
EVAC Plan
AISLES:
Main Aisle Width
Secondar Aisle Width
EXIT SIGNAGE
Si n -normal
Si n -batter
EVAC si ns in rooms
TRUSS ID SIGNAGE
EMERGENCY LIGHTING
FIRE EXTINGUISHER:
Hun V
Ins action of extin uisher
H dro extin uisher
FIRE ALARM SYSTEM p/'
Fan Shutdown v
Fire S rinkler S stem ~/
Fire Su ression -kitchen v
Fire Su ression -Gas Island
Hood Installation
Interior Finishes f/
Stora e
Com ressed Gas
Clearance to S rinklers
Clearance to Electrical ~/
Electric Wirin Enclosed
Combustible Waste
Vehicle im act Protection ,/'
Fire Lane ,,.-
F.D. Si na e - Utilit Rooms l
No Smokin Si ns f
Maximum Occu anc 5i n
Emer anc Evacuation Plan
COMMENTS
~ Fire Marshal Inspeclaon Complete
i OK to Issue Certificate of Occupancy
ApR 0 6 2D07
s%''_~a~4pproved pf no other approvals apply, the 8 & C Office will issue the C 'ficate of Occupancy)
^ Denied
^ Cail for Recheck
Inspected y:
L:\FireMarshal\insptopermitto occupyform.doc
~ I
5~_ Community Development Office ~ ;
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 ' ,~
~ ,
Marilyn Ryba, Executive Director • David Hatin, Director of Building £~ Codes ;
Craig Brown, Zoning Administrator • Michael j. Palmer, Fire Marshal ~ ~ F' i r ` ~ ~
~ '
TOG~TIQt1~= ~~~c~vo~sc.1~1~----=
NEW BUSINESS CERTIFICATE OF OCCI,IPA~~~~~MIT
APPLICATION
~~- - lG~
TAX MAP # 5 ~~`~~'-~`i~-cj9-~~~-~,.zy-~,.~:i~;~ BLDG. PERMIT FILE#
If applicable
Name of Business: ~~ vu~t ,L ., ;~~,` ~,~ } (~(,,(,
Address c /
of Business: ~o G~/fir-'zrJ~y~ /fir ~ ~y£€avSb~a--
Person in Charge or Manager: !mac- . , ~~,~~-L.~,.~ C ~Q„r p"~
Business Phone Number:.. ~ I!`~ ° ~T9 !~ -`323 ~
Type of Business:
GIUESTIONS? CALL 761=8256 OR
EMAIL codes~aueensburv.net
VISIT OUR WEBSITE FOR MORE
INFORMATION
www.gueensburv.net
Owner of Property: ~OM !~a ~~•v Phone Number(s): ~9~"Lf 32~ }~',/ - ya 9j
Home
Owners _
Address: l U ~/dNE~/A // ~ rr ,c,
Celi
Please provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and~re layout on a separate sheet of paper.
Jy - ~~
Notes /Comments:
*Note: This application is for occupancy only, with no work requiring a building permit. No fee required for this permit