Application CERTIFICATE OF OCCUPANCY ONLY office Use only
Permit#: CO ' E��Z' 2l02-1
APPLICATION
Permit Fee:$ 11 t)
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8206 or 518-761-8205 www.gueensbury.net
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**This application is for occupancy only, with no work requiring in%P 9" **
BUSINESS INFORMATION: oy
Nameofbusiness: Rco- H' 's Seu trv�Yt��ch+, �S muvC �U,c�
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Buss Address (including suite, space, etc.):
Z Qactk'er Iwoc1 Suitt (3
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Detailed explanation of business (attach a separate piece of paper, if necessary):
Gyy-, a UCLLLi t SF+cTP lush :.h in c"Y�L+tuh 3 e-►ls
no+ c,%S books,P0-+"+f-fn% �p►e-k-A ILt4ts . Itiu cu,� 0. se.w+'� ry��,h,u�
o1cal�.rI sar�tc2 S�+tit�{ rYtach�r:� r{�aitsar,/tce . 4ch cju.�lFtn� I
Stw, y1�c ht✓tA oast 1-0 trtelrvtdVa-ts t in Se*h S. T host- 5 quttr /2tTrts
***PWase provide an accurate layout of your space showing R;60<&NcS y or
Peem 5.iS
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 correctiveaction and a re-inspection.
Applicant name: �-�rtan
Applicant signatu r� f 1 its Date: 4Ua 2. 409A
Property Owner name:
Property Owner signature: Date:
certificate of Occupancy Only Revised December 2020
loran of f 2ucrruhun
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.ciueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Br%" S Path Ebfabruol�
Mailing Address, C/S/Z: 94 Sprir� St• t kFG✓1Svp t I So. Cale.✓1s FIS,kN Iz$v'3
Cell Phone: -W4W-Line: 518 - 307- (v"72q (ftZth) S78- 307-13-77 �Becan�
Email: Irl @ prcrnsSew;nq . cz-Al
• Business Owner(s): J
Contact Name(s): PaFi-i E-St-A bcVok-
Mailing Address, C/S/Z: Sn rr.a a-bov�t
Cell Phone: Lai S�8- 30' f"72'cf
Email:
Manager:
Contact Name(s): Pct-+ti Esr&-becDok
Mailing Address, C/S/Z: S&.m,e_ 4-bvvt
Cell Phone: Laad-Line: C5t8) 3o-7-co?zq
Email:
• Property Owner(s):
Business Name: Y\0.1dc-S PfoPe✓t e-S
Contact Name(s): N11c Koc e,) A-so-n KG d QS
Mailing Address, C/S/Z: R C. dox 2.(v1Z1GtevcrAo-Iel Nl( 12g20
Cell Phone: Land Line: 518-(vS4y— SU41 Cc116ksc n 51g—`iq1 --7o61
Emai1:gUa.n C g'S ct.1l MtrhaGl �18- �gb-zlo0
YA.«tas Properties, CoM
Contact Person for Compliance in regards to this project: PaA+i slat�r�o1�_
Cell Phone: Land Line: Glib - 30'7-cvZ2.9
Email: l,n�p &) PQ+hS6Gklfn3,Lavv%.
Certificate of Occupancy Only Revised December 2020
G inn M(�ntrnshun'
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or518-761-8205 www.oueensburV.net
EMERGENCY CONTACT INFORMATION
"THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR
BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND
AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
GAINING ENTRY TO YOUR BUILDING."
PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN
DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL.
Date:
Business Name: R[1_tt'S St,� Y ' IGC( CLltt p5 { MUv-C.
Business Location (including suite,space,etc.): I (c0 016ka- J-r ICOaJ Si-11 C [�
OVGGlSbL" , 112gbL�
Business Phone 0:
1. Business contact name: Pa++. ESi-t'6ruotk- / g2lGY1 Est b �
Main Phone: ; Secondary Phone: S I$ 3c"1 -Io_7 Z-`i 518- 30-1 t 3 _7 1
Coming from what town/village? Cfi-y of 6111{x6FZ�Us
2. Business contact name:
Main Phone: ; Secondary Phone:
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 5 18-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised December 2020
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AUG 0 2 2021 302.7-1-44 CO-0572-2021
Patti's Sewing Machines & More
TOWN OF QUEENSBURY 160 Quaker Rd, Ste B
BUILDING&CODES Certificate of Occupancy
302.7-1-44 CO-0572-2021
Patti's Sewing Machines & More
160 Quaker Rd, Ste B
Certificate of Occupancy
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