CO-0835-2021 7
CERTIFICATE OF OCCUPANCY ONLY Office use oniv
1 Q
APPLICATION Permit#:CO-oI - Zd 2-1
Trnm of CLecns6un-
Permit Fee:$ l i o
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"
CONTACT INFORMATION:
• Applicant:
licant:
Name(s): J o-7 �
Mailing Address,.C/S/Z: [.- W
Cell Phone: ) o Land Line:
Email: &,M
• Business Owner(s):
Contact Name(s): C
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Property.Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
D ECE'DVE
NOV 19 2021
TOWN OF QUEENSBURY
BUILDING&CODES
Certificate of Occupancy Only Revised June 2017
a�
�54 '
Tots of Fjticenstiury
742 Bay Road,Queensbury;NY 12804
P:SIS-761-8206 or S18-761-820S www.ciueensbury.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:Al
Business Name: & C2
Business Location(including suite,space,etc.): ' lX �V C
Business Phone#:
1. Contact name: I�► y
Main Phone:_ ;1<� �,�;Secondary Phone:_( )
Coming from what town/village? C/
2. Contact.name: tA,6L 'VVV ���
Ai
Main Phone:_(1hh /�72� �OLI I ;Secondary Phone:_( )
Coming from what town/village? 0
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 June 2017
Tottin of Queen
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.ciueensbury.net
BUSINESS INFORMATION:
Name of business:. VI 7
Address (including suite, space, etc.): v
Type of business (i.e.: retail, car repair, etc.): -W 1 M L
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:
Applicant signature:
Date:
Certificate of Occupancy Only Revised June 2017
288.-1-58 CO-0835-2021
Q Plain Jane's
D 1471 State Rte 9, Space 10
Certificate of Occupancy K
. TOWS O�G�CpDEs
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Imagery @2021 Maxar Technologies,New York GIS,Map data @2021
D .ECEOVE
t
ENOV 2 .2021
TOWN OF QUEENSBURY
BUILDING &CODES
https://www.google.com/maps/@43.3678438,73.6972182,203m/data=13ml!le3 1/1
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Plain Jane's
1476 Route 9, Suite 10
C0=0835-2021
11/22/2021
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
firemarshal@queensbunt.net - www.queensburj.net