CO-0215-2022 C
E CUPANCY ONLY office use only
A � �7 ��Z�AP C TION Permit
7bI,n Permit Fee:$ 1 1 0
TOWN OF QjjEEN BU Y
742 Bay Roa ,Queepo ,liii F Invoice#: �
P:51&761-8 6-r-5W761-8205 www.gueensbury.net
"This application is for occupancy only,with no work requiring a building permit"
BUSINESS INFORMATION::
Name of business: 71S
Business Address (including suite,space,etc.): e
Detailed explanation of business (attach a separate piece of paper, if necessary):
4
c� 4 5b /
IV
**P e provide an accurate layout of your space showing
A watts, 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: S
Applicant signature: Date:
Property Owner name: o
Property Owner signature: — Date: q 27 Z z
Certificate of Occupancy Only Revised February 2022
r •
Toga of(Zoecru6u�
742 Bay Road,Queensbury,NY 12804
P.518-761-8206 or 5111-761-8205 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:
Business Name: 7/
Business Location(including suite,space,etc.):
1290
Business Phone#:
1. Business contact name:
Main Phone:_(6a. ��S, Secondary Phone:_(_____.)
Coming from what town/village?
2. Business contact name:
Main Phone:—�_ ��SS 'Seconddary Phone:,,(�.1
Coming from what town/village? 6-�Jzisllw
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P:51&761.8206 F.5 1 8 745-4437
FIREMARSHAI @QUEENSBURYMET
FIRE MARSHAL MIKE PAUviER DEPUTY FIRE MARSHALTYSON CoKvERSE
cerNBeate of ompancy only Revised February 2022
Town ofQu_
742 Bay Road,Queensbury,NV 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): C� s
Mailing Address,C/S/Z: e OHO
Cell Phone: , S- 7 Land Line:
Email: * ,
• Business Owners :
Contact Name(s): s
Mailing Address, C/S/Z: 1Z 9�
Cell Phone:_( � ��S` Q�_ Land Line: _f )
Email:
• Manager:
Contact Name(s):
Mailing Address,C/S/Z: v
Cell Phone:(.�/f� 1 9 --' Land
Email: d v
• Property Owner(s):
Business Name: vier+"nn Mail NEyicOI LLC
ContactName(s): Jason Tile/'
Mailing Address,C/S/Z: S?'i yic,+ion,Rd
Cell Phone:_( 1 Land Line:
Email:�asov,I�11Te �a rv� ca ram .cDn�
Contact Person for Compliance in regards to this project:
Cell Phone:(_ 1 Land Line:
Email:
Certificate of Occupancy Only Revised February 2022
FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN ' E VhE '
Sharp Presents
578 Aviation Rd
CO-0215-2022
4/27/2022
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Fire extinguisher locations & inspection.
2) Locks / latches shall comply with 2020 NYSFC.
3) Verify operation of existing exit/ emergency lights.
4) CO Detection
5) Verify Knox Box key.
6) Verify aisles & storage.
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518161 8205
garys@queensbury.net
Fi r e M a r s h a l 's Off i c e ■ P h o n e: 518-761-8206 - F a x: 518-745-4437
-firemarshal@queensbur<J.net - zvzvzv.queensbunt net