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Application CERTIFICATE OF OCCUPANCY ONLY office use Only ^� ��^^ Permit#: (M okl>OL^!� APPLICATION ( I� l.mn Permit Fee:$ ,a(twembun 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8206 or 518-761-8205 www.gueensbury.net **This application is for occupancy only, with no work requiring a building permit** BUSINESS INFORMATION: �,�rr Name of business: Rt)sz//;1 RpyvUUP Business Address (including suite, space, etc.): 21 A)ezll S R� . y Ally wea ns bvr , Detailed explanation of business (attach a separate piece of paper, if necessary): yllcl�5'{�/`' ��i io✓s L.Dvr1+�� o n ***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. p; hr4 pz r Applicant name: Applicant signat Date: 3See 7-_ �Z Property Owner name: t, 41 dl'7 cy/ems Property Owner signature: Date: 3'1�,,6, T u Z / Certificate of Occupancy Only (� Revised December 2020 1'..n,J'(j,.-vn'bun 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 e-h 41C /Ness O c✓�✓�,O- • Applicant: Sri I a� � Zdvm; d- Name(s): I r f1 MY Mailing Address, C/S/Z: 2© Q� cCnS lqh� Qu@�nsGvlt Cell Phone: Land Line: P Email: h4e2-dCM�r ��lMa<<tC0M • er(sl: �M?igei9 al !lM ✓� PSA�/si Co.V6r �i7d n/ df.�LE�/S ontact Names : }N�i� �.�iL� PRCS�i7LpTaFl3oar�l ����r ailing Address) C/S/Z: 2 7 2 0L3ysTl7�� 2c/ LAeE L -ei /2Xy'd ell Phone: -Earizttirre: .S/8 r-�"o M9L - 304P Email: k bA may e rcr?c/ 'i P r, C ONI- • Manager: /oc/tde// 8`d i Contact Name(s): �D�r / �GE�/S Mailing Address, C/S/Z: /5�7 Lo�Aw E Cell Phone: �Land-tiHe: Email: V06Pr%�^OCKcrJe //1y3�C�' �• PropertV Owner(s): Business Name: Contact Name(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Contact Person for Compliance in regards to this project: Cell Phone: L�#w Email: 2i YUbei%f OCKwe/%�Q3����/ F. Certificate of Occupancy Only Revised December 2020 0.fQum.,Lb,,r D E C� E 0 VIE 742 Bay Road,Queensbury,NY 12804 "1 2 6 2021 P:518-761-8206 or 518-761-8205 www.aueensbury.net TOWN OF BUILDING&ECODG SRY EMERGENCY CONTACT I FFORIGIATI "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: U/Y/��ie//may /��1�E2Jf�6/S�C07t/6�E6/�T/D,{/ or GLENS C�G�s Business Location(including suite,space,etc.): �' ueensbuev Xy Business Phone#: ��/�� 3G ' . �-/577 1. Contact name: iCo�i/22 ��'�✓�/� ( G'ftff�.e: ������� 6i2o ElAtZ Main Phone:_( /� )_������� Secondary Phone:—( Coming from what town/village? �9Lf—tiS ��l�S 2. Contact name: /1� V �PR�s iD�ir/T Df aa a vd� Main Phone:_(S/� I_ �76 — �Oil<AS�econdary Phone:_( ) Coming from what town/village? LA,ec L 7/7—XX,41,C TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE P: 51 B-761-8206 F: 518-745-4437 FIR E MARSHA L@QU EENSBURY.N ET FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN Certificate of Occupancy Only Revised June 2017 ftQ 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www,clueensburV.net BUSINESS INFORMATION: Name of business: U1V1-r4 1"?-W owl (/�,QSyG isi CONG�el�c�Tia�r/ o� G<eiY.r `ALG S Address (including suite, space, etc.):_,:�'t hlEE,� Type of business (i.e.: retail, car repair, etc.): Td,*y Please provide an accurate layout of your store 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: /�b t , G C v ale ou.vOS I�a Applicant signature: cec Date: Certificate of Occupancy Only Revised June 2017