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CO-0891-2021 CERTIFICATE OF OCCUPANCY ONLY Office Use Only r ' APPLICATION Permit#: C o-- ob!) 2D 21 Town cjfCLecnsbury Permit Fee:$ 1 742 Bay Road,Queensbury,NY 12804 Invoice#: P:518-761-8206 or 518-761-8205 www.Queensbury.net **This application is for occupancy only, with no work requiring a building permit** BUSINESS INFORMATION: Name of business: LR�� 0967 0VT�-�`T Business Address (including suite, space, etc.): DEC 21 2021 d 7-4 5rPr!!C 5 ING& COD � 1--11K G C,7E50GZc-)iz� PJ Y I Z8 Ll b� TO u OF QUEE BUILDESRY Detailed explanation of business (attach a separate piece of paper, if necessary Rr5'rA-1 L S Pt l3�7 LJ tN G 1- 5 P I RctS, ***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: ZA-cf4A-K o R Applicant signature: Date: I Property Owner name: '!1J koop . Property Owner signature: Date: Certificate of Occupancy Only Revised December 2020 Toxin of CZerrcnsbury 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): ZA.c..r, I"�©oiz� 11 11 v y ti ' Mailing Address, C/S/Z: q LFF�1y Palo 2C�F- Cell Phone: Land Line: CA' SI 5- 6 93 ova Email: 2 Moo P-ML 8 0.0). cam • Business Owner(s): Contact Name(s): Z AC_V_ Ao0 V-E— I Z�ys Mailing Address, C/S/Z: I -t9J STD `��T� 9 Cell Phone: Land Line: �Lc� 5/q- &93-6)79b Email: TMt,6P-r L-9 0taJ- ccrnl • Manager: Contact Name(s): SA-A' A5 A16 V E Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Property Owner(s): Business Name: T t5 4--V�'-D 1 ��i C-:P-i>[z SQ L Contact Name(s): Vp Roov—a Mailing Address, C/S/Z: / �qs y � �j ��c LQv� �►S��R� � � '� I �/ Z�d Cell Phone: 1--time: 6-N - :Pg6 - 33, Email: rip , 4c)OeV Sao cow Contact Person for Compliance in regards to this project: 2V—' Cell Phone: L-E� g - -p Fao Email: Z_adoO��L® 0.61. C'G7✓7 Certificate of Occupancy Only Revised December 2020 Tmsm of(L-cnsbuay 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: J2� i:F f Zf Business Name: �,�kC C—Z I` � W►tjL Col 1-11�� LL Business Location(including suite,space,etc.): ours C1, L 44-1 Co o 2(--7R d) Y /Z Z6— Business Phone#: 1. Business contact name: ZA-- I-t- Awv-'E Main Phone: ;Secondary Phone: Coming from what town/village? 2. Business contact name: Main Phone: ;Secondary Phone: 6-1q" Coming from what town/village? " QU���➢5�U12-"i TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE P: 518-761-8206 F: 518-745-4437 FI REMARSHAL@QUEENSBURY.N ET FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILL—MAN Certificate of Occupancy Only Revised December 2020 288.12-1-17 CO-0891-2021 Lake George Wine Outlet LLC 1476 State Rte 9, space 4 Certificate of Occupancy SHE ---- -- :;.----- -- - --- - ----------VIN - ----"--- --- ------- E - .:.. _ ? o m i a C4 - y C _ a.._- .._...... ro _ A- G V ® II' Cm ® m A @ a ®- , TA or, M J/4 NMI SO= F fll <�42 _ y - QD CD VC+ NtJN r t NN C ®� .-- ` r .c A-" off°° CA �,RNM I MOM � A-2 AHLI I ro DATA '-- -- ---- --"„------ Arf(R E0. EO 7 - � 9NI1113NS-- ,; r __._.�i�--��-,�� �' _.9NIA'13NS-;�-- ; � 4N _8il AM A-?2 2' Z �a� fifflNG (1)G7Sr A A�f9 (9)uT s. • N ELD (\4 AffA 70 BAIA R4IX 70 DATA MY �.(a "t 01.0)7 � A�.iS az AEA" a 2._ i ,- A-B (;1 POWER PLAN n a o i cr n T9'AFF.._:b-' l 1 rma vn•„txr m sac] oN{alin3 mneSN33no:iO NMol v6Z L Z 330 FIRE MARSHAL'S OFFICE Town of Queensbury 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauti ... A Good Place to Live " PLAN REVIEW LG Wine Outlet 1476 Route 9, Suite 4 CO-0891-2021 12/21/2021 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 ■ Fas: 518-745-4437 -firemarshal@queensbun/net - www.queensburt .net