CO-0801-2021 CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit#: CO -ObOI -U 21
iTbomof C�eacenabua}
Permit Fee:$ 1
742 Bay Road,Queensbury,NY 12804 Invoice#: e)
P:518-761-8206 or 518-761-8205 www.gueensbury.net
"This application is for occupancy only, with no work requirira a building permit" .
BUSINESS INFORMATION: D C. rr1E
Name of business: SC-F_V ? ° �,A-5 OCT 28 2o2j
Business Address (including suite, space, etc.): T
`` I� v OF QUCC�vSBURY
14� o S �'4- 9, U>� 3, ya�2 6-7 9-6fe, !v t. Z 'y - BUILDING& CODES
Detailed explanation of business (attach a separate piece of paper,.if necessary):
C",L S, OLS ew'j Wma gre 5 5e s
***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: P—nc Cruz.
Applicant signature: Date: /U 2g 4/
Property Owner name:
Property Owner signature: Date: L,-7 &
Certificate of occupancy Only Revised December 2020
l
Town of t}irrns'my
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.aueensbury.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 bFF-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: C teeP f �ra S
Business Location (including suite,space,etc.):
Business Phone#:
1. Business contact name: CC-Cru r--
Main PFione:L�tlsJ Secondary Phone:
Coming from what town/village? Clip f'r r
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
Toism of Qiiwcnibuq
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
CONTACT INFORMATIOWPLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): r�rc� e!'u v , aSao � �"��e y t2gG�
Mailing Address, C/S/Z: �(� /l�f�+.w10� /�'UL `
Cell Phone: Land Line:. C�'/�� �3�- &26 3 Jw6) 113 - ago
Email: �rtL®5� cv�G1Ir�S, c�r/1
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z: J�"""'
Cell Phone: Land Line:
Email:
Manager:
Contact Name(s):
Mailing Address, C/S/Z: 5ao;(12-
Cell Phone: Land Line:
Email:
• Property Owner(s):
Business Name: 5nkpnvs I LLL
Contact Name(s): ZCW L �Aooa — C�@®f `� i0gq/ —
Mailing Address, C/S/Z: Iq 54.E �\ � z_ I y�3
Cell Phone: Land Line: ��((: C3' (�3' �'�°� �°"d `l�/ J
Email: t®Gre LO pro I. C'ff"
Contact Person for Compliance in regards to this project: 5avne e,g G(neV�
Cell Phone: Land Line:
Email:
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
Sleep and Spas
1476 Route 9, Suite 4
CO-0801-2021
11/3/2021
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
• Verify clearances to electrical service panels
• CO detection is required, if source is present
• Provide key for Knox Box
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
firemarshaftueensbunt net - WWW.queensbury.net
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288.12-1-17 CO.0801-2021
Sleep and Spas
1476 State Rte 9, space 4
Certificate of Occupancy Only