CO-0841-2021 CERTIFICATE OF OCCUPANCY ONLY office use only
Permit
APPLICATION #: � + d�t,1• 24Z1 .
''- Permit Fee:$
Town of QuccnsWuay
742 Bay Road,Queensbury,NY 12804 Invoice#:
f 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:
Name of business: ,�,j-��-}��hw�c✓� a��
BusineessfAddress (including suite, space, etc.):
Detailed explanation of business (attach a separate piece of paper, if necessar 2 Q
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***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: JvKo HLe("S
Applicant signature: / Date:
Property Owner name: OYD I�GL� P am t �— an
Property Owner signature: — Date:
Certificate of Occupancy Only Revised December 2020
7oKr of QKens�un°
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.aueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):Jv Kn fft,y 6
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email: Jl7� � �a-'�-�f'�Gl.�.� ,L(�'►^
• Business Owner(s1:
-Contact Name(s): 66LY"
Mailing Address, C/S/Z: S
Cell Phone: Land Line:
Email:
• Manager:
Contact Name(s): &UL,4,
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email: �>Ci�
• Property Owner(s): � \ �� Al"C—O ,LLC
Business Name: Q�� A
Contact Name(s): Tut
Mailing Address, C/S/Z:. ac.Q.Q_ ry
Cell Phone: Land Line: zst%' f �
Email:
Contact Person for Compliance in regards to this f�roject:
Cell Phone: Land Line: ��- � '' d' U 4
Email: �UKr\ e.� 1—�kGt_.�� E eC�Y�
Certificate of occupancy Only Revised December 2020
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Tour of Qacensbury
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: /1, n
Business Name: h'-�r (n/�jt� 64—k
Business Location (including suite,space,etc.): A U L4,+ aate- Lt2, 1
Business Phone#: dSI p-42A-
1. Business contact name: jl� n elf S
Main Phone: ;Secondary Phone:
Coming from what town/village? �- 6G�/lG�
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: 5 18-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised December 2020
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Ent One Rentals
578 Aviation Road
CO- 0841-2021
11/24/2021
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
Verify paths of egress
• Verify clearances to electrical service panels
• CO detection is required, if source is present
• Knox Box key is required, if not present
_7
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
{iremarshal@queensburif.net www.queensburil.net
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Entertainment One Rentals
578 Aviation Rd, Space 42
o Certificate of Occupancy Only