CO-0156-2021 � CERTIFICATE OF OCCUPANCY ONLY Office Use Only
Permit#:
APPLICATION
r
' Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: OrD 2,1
P:518-761-8206 or 518-761-8205 Www.Queensbu_Ir API
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION:
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Name of business: -` Vxwr 1m -FXeR vvo��
Business Address (including suite, space, etc.): �� 2[��1
1HFM
14 q-110 shy 2A2Q I S S_ 2J� TOWN OF QUEENSBURY
BUILDING&CODES
Detailed explanation of business (attach a separate piece of paper, if necessary):
***Please provide an accurate layout of your space 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: t4ve-C,�NT
Applicant signature: Date:
Property Owner name: r--A)
Property Owner signature: Date: 3-7 zV-LO Z J
Certificate of Occupancy Only Revised December 2020
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www, uetns6_,no
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): P/yj A.I-ry wt FIR-67W v P-91' Ei}5TL—��✓2EG o.r/ s-
Mailing Address, C/S/Z: 2 yyf /3 Earn o�T''��/� a/ovwyS7-0WXJ ors-,o
Cell Phone: 'one: 5-/9- a 477 - o y 2-df-
Email: k/5gA*-ra0® F'ii/Z�wo� k5,cowt
Business Owner(s): i..�aJrzKS'
Contact Name(s): III&e,FjaT 5z,,Aa 3a jp a�grvrar� FiQ�
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Mailing Address, C/S/Z: 2 v!vr'
Cell Phone: Lax4-1:4ne:
Email:
0 Manager:
Contact Name(s): .Jo^4&✓ -m yEiZS
Mailing Address, C/S/Z: 30 o?,9-y
Cell Phone: Land Line: s'! P•-
Email: 7-�j,2p ® 0-/Rr l;W-f 9,C DOI
• Property Owner(s):
Business Name: E A ,�- fl•T �NTc�P.e�sFr
Contact Name(s): Zqc, oo ax �s�yiey�aiFoy
Mailing Address, C/S/Z: i 47& 67Wi1t-'-,e0 Ny-E 9
Cell Phone: Land Line: 3-1?-&3- o 7 a o
Email: 2 itpo�e&L®goc.. C0-01
Contact Person for Compliance in regards to this project: /IAIe- 7— Szj*A o
Cell Phone: Land Line: 2,u7 -o 1Vz y-
Email:
certificate of occupancy Only Revised December 2020
1
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742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www•elueensbury 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:
Business Name: pteijri'rex4 /Pee' !N G
Business Location (including suite,space,etc.):
OLA VKN y 5u iTe 3
Business Phone#:
1. Business contact name: _jD1 / V Al L/ep- S
Main Phone: ; Secondary Phone: S1 �'�t� " ¢�ye,- 1- 79Z -1092-9
Coming from what town/village? F O f-T
2. Business contact name: (/j1d6 e�af Sigh v
Main Phone: ;Secondary Phone: 5- & - Z 4
Coming from what town/village? C'4/P_D
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
`SIRE RSUALO—Q . SDURYNET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of occupancy Only Revised December 2020
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Phantom Fireworks
1476 Route 9
CO-0156-2021
3/29/2021
The following comments are based on review of drawings:
• Verify function of exit and emergency lighting
• Verify paths of egress
• Verify storage
• CO detection required
• Locks and latches shall be compliant w/ Chapter 10 IFC
• Verify Fire extinguisher types and locations
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office - Phone: 518-761-8206 Fax: 518-745-4437
-flremarshal@queensburj.net - ZV7M.queensbunl.net
Queensbury Building and Zoning
We will be opening up in the Old DKNY site suite 3 to sell state legal Fireworks for the 4"of July season
We will open on the 4th of June thru the 4th of July the first two weeks we will be only open on the
weekends dates of June 4,5,6,and 11,12,13 and then continues from the 18th on to the 41h of July.We
will operate totally in the guide line of state 1124 fire codes on operating days our hours will be 10-9
daily
Thank You
Vincent S abo
I
W E
MAR 2 5 221
TOWN OF QUEENSBURY
BUILDING&CODES
288.12-117 CO-0156-2021
Phantom Fireworks
1476 State Rte 9, Suite 3
Certificate of Occupancy
DocuSign Envelope ID:AF60E52F-9072-4417-8FEl-064339lF60CE
PIIANTom RREWORKs
TEMPORARY LEASE AGREEMENT
THIS FIREWORKS STAND/TENT AND LEASE AGREEMENT is made between
Property Owner(herein referred to as the"Landlord"),whose address is:
Landlord: Ed & Ed.T Enterprises Phone Number: 5186830720
Email: zmoorel @aol .com
Address: 1476 State Route Nine Queensbury NY 128 4Contact. ZacK Moore
Federal Tax ID or SSN: 141696687 Check Payable:Ed & Ed.T Enterprises LLC
Site Information
Property Name:Log i am outl et Mal 1 Phone Number: 5187921483
Email:zmoo rel @aol.com
Address: 1476 State Route 9 Contact: Zack Moore
and,PHANTOM FIREWORKS EASTERN REGION,LLC dba Phantom Fireworks(herein referred to as the"Tenant"),
whose address is:2445 Belmont Avenue,Youngstown,Ohio 44505-2405,330-746-1064.
LEASE OF PROPERTY. Landlord leases to Tenant the location space on property described.above, detailed on
attached EXHIBIT A,which is made a part hereof. The lot,parking lot or common area is owned and/or controlled by the
Landlord, who warrants and certifies it has full right and authority to lease the location space to the Tenant. The location
space is to be used for housing a temporary sales facility from which the sale of state-legal I AG (Class C) consumer
fireworks and novelty items will be conducted in accordance with applicable law. Landlord specifically gives permission
and the exclusive right to Tenant to locate a temporary stand,kiosk or tent and storage container on the location space to be
used for the purposes stated herein. Landlord will permit no other sales of 1 AG consumer fireworks on any of the property
not occupied by Tenant.
TERM. The term is for the lease period May 28,2021 through ]ul y 13,2021 If the Property is
sold to another party at least 90 days prior to the beginning of the lease period,this lease can be voided. Landlord must
provide written notice on or before 90 days prior to the beginning of the lease period and all prepaid deposits and/or rent
must be returned within 10 days of termination of this lease. This lease cannot be voided due to the property being sold to
another consumer fireworks vendor.
f
RENT. Tenant agrees to pay rent to the Landlord in the amount of$ 21oo.no for the location space on the
property named above and detailed on Exhibit A,which includes electricity and a space for a storage unit,which amount
shall be paid in full a week prior to the commencement date of the lease term. Additionally,Tenant agrees to pay to
Landlord10 %of all sales made on the property over$21000.00 (excluding sales tax),which amount shall be paid on
or before September 15 following the lease period.
TENANT'S PROPERTY. Tenant assumes the risk of its personal property on the location space of the leased
property.
OPERATORS. Landlord acknowledges that Tenant may sublet the sale of the fireworks to independent operators
and approves of all such arrangements, and Tenant is not relieved from its obligations hereunder. However in the event
Tenant is not able to secure an independent operator for the property, Tenant may terminate this lease with at least TEN
(10)days written notice to Landlord,and Landlord shall refund to Tenant all prepaid rent amounts.
INSURANCE. Tenant shall provide liability insurance covering the Tenant's use and occupancy of the location
space,including product liability,bodily injury,personal injury and property damage coverage,on an occurrence basis,with
coverage in the aggregate amount of TEN MILLION DOLLARS($10,000,000.00). Landlord shall be named as"additional
insured"under the insurance"as Landlord's interest may appear." Prior to occupancy,Tenant shall provide Landlord with a
Certificate of Insurance evidencing the required insurance. Landlord is not required to hold similar policies of insurance,
and Tenant's insurance shall be primary for the term of this lease relative to the location space.
f�< =9` State of New York
s � Office of Fire Prevention and Control
1220 Washington Avenue, Bldg 7A
Albany, NY 12226
Phone#: (518) 474-6746
Fax#: (518) 474-3240
SPARKLING DEVICE
CERTIFICATE OF REGISTRATION
Permit Number : 21-000050
Location of Activity: Phantom Fireworks Eastern Region, LLC
1476 State Route 9, Lake George, NY, 12845
Phone: (330)746-1064
Type of Activity: Certificate of Registration-Sparkling Devices - Specialty Retailer
Date of Activity: 02/17121
Expiration Date: 01102/22
The above applicant is hereby granted pennission to conduct the above described activity in accordance with
provision of the 9 NYCRR 225 and the Fire Code of New York State. Approval is contingent on payment of Fee of
$2500.00 and adherence the following conditions:
It is the Applicant's responsibility to comply with other applicable health, police,building or constriction
requirements for such matters as electrical, plumbing or mechanical activities.
0211712I
Date Benjamin S.Keller
Chief, Fire and Life Safety Branch
THIS CERTIFICATE MUST BE CONSPICUOUSLY POSTED
AT THE SITE FOR THE DURATION OF THE ACTIVITY,
FAILURE TO COMPLY WITH THE FIRE CODE
REQUIREMENTS OR ANY CONDITION SET FORTH
ABOVE IS CAUSE FOR REVOCATION OF THIS CERTIFICATE
DocuSign Envelope ID:AF60E52F-9072-4417-8FE1-064339IF60CE
INDEMNITY. Tenant shall indemnify,defend,and hold the Landlord harmless from any claims in connection
with any injury or damage caused to any person or property arising out of Tenant's use or occupancy of the leased location
space. Tenant shall not indemnify or be liable to Landlord for the negligent acts of Landlord,its employees or agents.
SURRENDER OF PROPERTIES & RIGHTS. Tenant agrees to surrender possession of the properly to the
Landlord upon termination of this agreement in as good condition and repair as the same shall be on the date Tenant first
occupied the property hereunder -- ORDINARY WEAR AND TEAR EXCEPTED. The Tenant shall make any and all
repairs necessary to restore any portion of the property where such restoration is necessitated by the Tenant's use of the
location space on the property. Tenant agrees to keep the location space clean and free from garbage and trash during the
term of this lease and remove all property owned by Tenant prior to surrendering occupancy.
OPTION. If Tenant has met all of its obligations hereunder,Tenant shall have the option to lease the premises for
the same purpose for the next fireworks selling season by giving notice to the Landlord.
CHANGE IN LAW. In the event that the sale of consumer fireworks is prohibited for any portion of the term by
any level of judicial,legislative or executive law,order,rule or regulation,this lease shall,upon notice from the Tenant,
terminate,whereupon any advanced rental payment shall be returned to the Tenant on a pro rata basis(number of days of
term occupied)and the Tenant shall be relieved from any further liability hereunder.
PERMITTING. This agreement is contingent upon Tenant securing,at its cost and expense, all required local and
state licenses and permits to sell 1.4g(Class C)consumer fireworks at the location space on the property. If Tenant cannot
secure such licenses and permits prior to commencement of the lease period, any pre-paid amounts shall be refunded and
this agreement shall be null and void.
PROPERTY/SALE OF PROPERTY. If the property is inaccessible or unusable due to construction or the like,or
if Landlord attempts to move the location space on the property,this lease is subject to revision on terms acceptable to
Tenant. If Landlord sells the property to a third party buyer,Landlord shall have the right to terminate this lease upon 90
days'notice to Tenant or transfer this lease to the buyer. Upon termination hereunder,Landlord shall refund to Tenant all
rental payments made to date. Landlord shall not sell the property to another fireworks seller or to a third party with the
intent of defeating Tenant's right to sell fireworks on the location space in favor of any other fireworks vendor.
ATTORNEY'S FEES. In any action or proceeding to enforce,interpret or declare rights under this agreement,the
prevailing party shall be entitled to its reasonable attorney fees,costs and litigation expenses.
ENTIRE AGREEMENT. This agreement and any incorporated exhibits or attachments contain the entire
agreement between the parties and cannot be modified in any manner other than by an agreement in writing signed by the
parties with the same formalities attendant to the execution of this agreement. Each understanding, term and provision of
this agreement shall be construed to be a promise,covenant and condition.This agreement supersedes any previously signed
agreement between the parties.
PROVISIONS BINDING. The agreements herein shall be binding upon and inure to the benefit of the parties,
their heirs,executors,administrators,personal representatives,successors and assigns.
IN WITNESS WHEREOF,the Landlord and Tenant have executed this agreement,each party acknowledging
receipt of an executed copy hereof.
Zack Moore PHANTOM FIREWORKS EASTERN REGION,
Name of Landlord Entity—"Landlord" LLC—"Tenant"
g bv: Vaebsrywo-'d$k:
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By: � .,, By:
Name: 2 �e�aaa2s::. Name:vi n
Title: Manager Title: Regional Mgr
Date:9/29/2020 Date:9/30/2020
Revised 3/8/18
2
DocuSign Envelope ID:AF60E52F-9072-4417-8FE1-064339lF60CE
i
Phantom Fireworks Eastern Region, LLC
2445 Belmont Ave Youngstown, Ohio 44505
330-746-1064
PROPERTY PERMISSION FORM
The undersigned, owner and/or controlling party, of the property listed below hereby
grants permission to Phantom Fireworks Eastern Region, LLC to use the property for
the temporary sale of fireworks at the following location:
Name: Ed & Ed T Enterprises Parcel No: 51171
Address:1476 state Route 9
City: Lake George ST:ny Zip:12845 County: warren
This Temporary Use Permission Form is for the purposes of obtaining state and local
licenses, permits, and other uses pertinent to the retail sale of Class C state approved
fireworks at the location for the 2021 season.
DoCu519Kedby:
ii
Sign a Ure227=58 444.28...
lack Moore
Name- Please Print— Property Owner/Controller of Property
Ed & Ed.T Enterprises Managing Partner
Company/Title
9/29/2020
®ate