application Office Use Only
Town of Queensbury Fire Marshal
Received:
ESTABLISHMENT OF A NEW BUSINESS Tax Map ID:
CERTIFICATE OF OCCUPANCY PERMIT APPLICATION Permit No.: J 1 D
P ' ee:
*Note: This application is for occupancy t.
/cupancy only,with no work requiring a building permit
Name of Business /\ � �N1i' ATp.nyl Ui✓ �i- ILjNC
Address
Type of Business N C
Manager I gkA 11
OR
Person in charge
Business Phone No.
Property Owner
co u N Ta 16-L)00p M6v
Address
Phone ��
✓Provide an accurate layout of your store showing all walls,exits,stockrooms,rest rooms, counters,and,fixture layout on a.
separate sheet of paper: .
Print Name:_- i./(�� .,���>:LAN� �
Signature: �G—
Date: ">> ( Z ZI .. .
MInn
Notes f Comments:
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D.
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IMPORTANT: 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 Fire Marshal's office. fire.extinguishing systems found in kitchens and gas.stations require,
semi-annual inspections. Any violations noted during an inspection,require immediatecorrectiye action.
CONTACT NUMBERS:
Director,Building and Codes-761-8253_ Zoning Administrator-76 1-8218 Zoning-761-8238
Fire Marshal-761-8206. Planning=761-8220
Town of Queensbury Fire Marshal=New Business Permit 518-761-8206
EMERGENCY CONTACT UPDATE
TO:. . Warren.County Sheriff's Department. .
1. ' This form is.used to-assist Emergency SeNice-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:
I Please be advised that failure to respond to assist emergency-service-personnel may.result in damage to your
building to facilitate entry by police and/or fire personnel.
PLEASE PRINT
DATE:
BUSINESS NAME: 2(Mf( QaiLrNy
BUSINESS ADDRESS: T �u i j U zee f
BUSINESS PHONE: S /.
Y�'
CONTACT 1:. iL ` HOME PHONE:.
ADDRESS.
IUS )v 1 ZOC)L,
CONTACT 2: lb(C 0 HOME PHONE
ADDRESS:
Town of Queensbury Fire Marshal—New Business Permit: -518-761-8206