CO-0105-2022 CERTIFICATE OF OCCUPANCY ONLY office Use only
APPLI Permit#: GP D 105-- 2944-1
DToism of(,vembury emit Fee:$_ 11 -
742 Bay Road,Queensbury,NY 12804 M l�f oice#:
P:518-761-8206 or 518-761-8205 www. uee s etAR , E61��
TOWN OF QUEENSSURy
BUILDING Q CO
"This application is for occupancy on equiring a building permit"
BUSINESS INFORMATION:
Name of business: ( eo& -�C_k Ccx,nNr_, CkA
business Address (including suite,.space, etc.): tk\ ZnjrA ccA fA-
�JQen���sv� hA
Detailed explanation of. business (attach a separate piece of paper, if necessary):
* * *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:
Applicant signature: Date: '27
Property Owner name:
Property Owner signature: Date:
Certificate of Occupancy Only Revised February 2022
To»n of Quccnsbun
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): CIr ---' �,rP
Mailing Address, C/S/Z:
Cell Phone: ( S"Jb Land Line: ( - —)
Email: C �k cAP,N%. Ccx2C ,,���h. •
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Manner:
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:
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
Certificate of Occupancy Only Revised February 2022
1
Town of Quccnsbuq
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: '2
Business Name: (Azj�s
Business Location (including suite,space,etc.): Z P)L r'A Dona
Business Phone#: 511,%
1. Business contact name: cfw. Cf� f�2.f1
Main Phone:_(FSLOr-, ) '��'L— \\�� ;Secondary Phorie:_( )
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 TYSON CONVERSE
Certificate of occupancy Only Revised February 2022
FIRE MARSHAL'S OFFICE
Town of Queensbunj
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN R V W
Glens Falls Country Club
Snack Bar
211 Round Pond Rd
CO-0105-2022
3/17/22
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Fire extinguisher location & inspection.
2) Locks /latches shall comply with 2020 NYSFC.
3) Verify Layout of cooking appliances
4) Verify Gas or electric cooking appliances
5) Verify CO detection If Required
6) Truss ID may be required
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fire Marshal's Office - Phone: 518-761-8206 Fax: 518-745-4437
-flremarshal@queensbu!21.net - 7MMqueensbui2l net