CO-0728-2021 • ,--� Office Use Only
CERTIFICATE OF OCCUPANCY ONLY
APPLICATION Permit#:
"I"UN7]of(Zrccnstiury
Permit Fee:$ �QG Oa
742 Bay Road,Queensbury,NY 12804 Invoice#: 40_5 t0
P:518-761-8206 or 518-761-8265 www.gueensbury.net
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION:
Name of business: L i 4k. I-lcrl=vr Gor-k Coy-Fey"A
Business Address (including suite, space, etc.): t�LJZ o9pe-e C?teh sl'
(�)� ry 13N I u04
Detailed explanation of business (attach a separate piece of paper, if necFTOWN
(�'� p�
OCT 0 4 2021
***Please provide an accurate Layout of your space showing OF QUEENSSURY
LDING& CODES
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:
Applicant signature: Date: Z�
Property Owner name:
Property Owner signature: % Date: �I
G� -
Certificate of Occupancy Only Revised December 2020
f
Torn of Qareenslrurr'
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
• Applicant:
Name(s): -"bh ] �►�G �,.T IZB�IS�
Mailing Address, C/S/Z: `{ 0 Zox &65"
Cell Phone: Land Line:
Email: 5r6- U2%-- 36d2
• Business Owner(s):
Contact Name(s): Jon Txx-Ai-- yJy )Z�ky�
Mailing Address, C/S/Z: }?o Zox
Cell Phone: Land Line:
Email: L S)£S-4 2£s' 3502-
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Property Owner(s):
Business Name: Tim q4GS.'
Contact Name(s): ---Zo hk\-
Mailing Address, C/S/Z:
�ne� Land Line:
Email: "`. r-"'/�kb`�t�'GtG�vt
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
Certificate of Occupancy Only Revised December 2020
Town of CjgccnS
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.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: 9 7 )
Business Name: L! � Coynpcv)y
Business Location (including suite,space,etc.): &y3 (Q" S q v-ekWS bLArl
U' `$
Business Phone#: JoI8- 35oa
1. Business contact name: -,)Oy-. 'enTAl?,
Main Phone: ;Secondary Phone:
Coming from what town/village?
2. Business contact name:
Main Phone: ;Secondary Phone:
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised December 2020
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Little Harbor Boat Co
643 Glen Street
CO-0728-2021
10/5/2021
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• Location of exit/Emergency lighting appear adequate. Function test will be
required
• Lock/ latches shall comply with Chapter 10 of 2020 IFC.
• Verify paths of egress
• Verify storage , including flammable and combustible materials
• Verify clearances to electrical service panels
• CO detection is required, if source is present
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
,fcremarshal@queensbun'.net - zvzvzv.queensbunl net
D y�
ILI
302.11-1-2 CO-0728-2021
Little Harbor Boat Co
643 Glen St
Certificate of Occupancy Only
ai-i:=-, c.•=ys �F3 7 '." _ ss� c E C-I17-•H S U R M h RSAL ZS:TA'TE T
.FF6 2 3-2017
• � / G � � •f1(,Zrfc �;`rur'E` _ .: Cam; •_ ._ _ -._
302.11-1-2 CO-0728-2021
D E C E U V E `'� Little Harbor Boat Co
' 643 Glen St
APR C 4 2017 Certificate of Occupancy Only
COMAAi t iOF QUEENSBURv