CO-0418-2021 CERTIFICATE OF OCCUPANCY ONLY office Use only
APPLICATION Permit#:_LO - bulb• 2:0/2,1
Permit Fee:$ l)tj
742 Bay Road,Queensbury,NY 12804 Invoice M
P:518-761-8206 or 518-761-8205
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:Name of business: ` � 'u-U
toy GJb+
Business Address (including suite, space, etc.):rj���1lL.� � NCI
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Detailed explanation of business (attach a separate piece of paper, if necessary):
* * *Please provide an accurate layout of your space showing
all walls, eats, stockrooms, rest rooms, counters and factures
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 corre _ 6 _ t
must be provided to the Town of Queensbury Fire Marshal's off
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found in kitchens and gas stations require semi-annual inspection . violations note
during an inspection require immediate corrective action and a re i c _�
TOWN OF QUEENSBURY
C Applicant name: BUILDING& CODES
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Applicant signature: Date: r Z
Property Owner name:
Property Owner signature: Date: f
1
Certificate of Occupancy Only Revised December 2320
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s)• iv► N,v%A-4o+
Mailing Address, C/S/Z: �p "Fs� 1� o� ) Lam-►-�
Cell Phone: (�l } b�'�-P =�� �� _Land Line:
Email: r1 eA I CgD�J� M �' � ►
o Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Manager:
Contact Name(s): r
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
o Property Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
Contact Person for Co pliance in regards to this project: I'�oN4.,3 A 40A 'L�- -
Cell Phone: (�j t ) ) Land Line: Li)
Email: JLQ 1 ('[� )�hl� d Gt�t14
Certificate of Occupancy Only Revised December 2020
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205
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: f ko-- �
Business Location (including suite,space,etc.):
Business Phone#: sy� C1�`- L4 'O
1. Business contact name: ��—
Main Phone:_( . \ ) l�i bl�L�;Secondary Phone:_( )
Coming from what town/village?
2. Business contact name: 1(�1j/�Q,�,wgY
Main Phone:_ ' I�- ) (O 1 1�v Secondary Phone:_( )
Coming from what town/village?J C r
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745.4437
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised December 2020
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
All Things Home
1476 State Route 9
CC-0418-2021
6/2/21
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Fire extinguisher locations & inspection.
2) Locks / latches shall comply with 2020 NYSFC.
3) Verify operation of existing exit / emergency lights.
4) Verify Knox Box key, or provide new key.
5) Verify aisles & storage.
6) CO de ection required, verify existing.
De y Fire Marshal
Gary K. Stillman
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fi r e M a r s h a l 's Off i c e - P h o n e: 518-761-8206 - F a x: 518-745-4437
iremarshal@queensburu.net - www.queensbury.net