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CO-0192-2022 i
CERTIFICATE OF '�f �o ice use Oni
t
APPLI rmit#: ' O -O
CIS'
Town of Qaccn.-bus), APR 15 2,022 rmit Fee:$ /10-O o
742 Bay Road,Queensbury,NY 12804 - s Inioice t
TOWN OF���E��,SEU�
P:518-761-8206 or 518-761-8205 www.guee:sbury.'ahb D9lNG &CODES
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:- n
Name of business: A l S G A Q2A kc
Business Address (including suite, space, etc.):
3qa A Ui TIO' ,
quffr)Wy9 ) � N —. Q. Z p
Detailed explanation of business (attach a separate piece of paper, if necessary):
TA 0- L-E To-T k L49
Q 00Y Ib®o<
* * *Please provide an accurate layout of your space showing
ail walls, exits, stockrooms, rest rooms, counters and factures
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: /N n Fe4i Al
Applicant signature: Date: Q ZZ--_
Property Owner name:
Property Owner signature: Date: IS� ZZ
Certificate of Occupancy Only Revised February 2022
1
Town of Qucensbury
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): M
Mailing Address, C/S/Z: Av"ali on o �,C'rt (�
Cell Phone: ( ) T M I I Land Line: 0 -
Email:_ar }2 f66q;25 -, ( Co�1
• Business Owner(s):
Contact Name(s): ( ')1To, An
Mailing Address, C/S/Z: 340 AVrcL-L-'On aegis btwl NY 12?0
Cell Phone:_( ) �5 .- Zq Land Line: _( 5 $ ) 111�-�}-g�
Email: "A 2.0 C - 6 cl n1 ed L 6em
• Manager:
Contact Name(s): rIATT SOK02
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( S t ) 3 6 rl
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:L ) Land Line:
Email:
Certificate of occupancy Only Revised February 2022
.y
i
Town of Qgcrnsbur),
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: :cam f S 2v?Z.y
T
Business Name: 1WJ� '1S3'e Q� !1<'�
j
Business Location(including suite,space,etc.):-ok
'R
Business Phone#: s I1�— 4?.© S a
1. Business contact name:
Main Phone:_( I.� ) .31�I-CfAO ( ;Secondary Phone:_( r ' 24(-3-oQZ,(
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
2011-09-07 16:31 REJINENATIONSSPASERHICES 5187986302 >> 5187454437 P 1
C)l Ul
EMPRGENC.5
OATH
H W H .
U ur�r�..TrY T a�k7-AfAfr !
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! EMER6ENc.Y
E C E gy/ E
BUSINESS CERTIFICATE APR 15 2022
TOWN OF QUEENSBLJRY
BUILDING& CODES
I HEREBY CERTIFY that I am conducting or transacting business under the name or designation of:
Business Name sj,Ao SVA
Business Address 3 0 ' A71' �) -�4 WARREN A� 1 0
(Street,City,State&Zip) (County)
MY Name is
3 ,
I reside at 55
I FURTHER CERTIFY that I am the successor in interest to: 0 P-F-Iv ?A
the person or persons heretofore using such name or names to carry
on or conduct or transact business.
IN WITNESS WHEREOF,I have signed this certificate on
If under 18 state age
Signature
STATE OF NEW YORK
COUNTY OF
'On before me,the undersigned personally appeared
personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose names(s)
is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their-capacity(i'es), and that by his/her/their signatures(s) on the instrument, the individuals(s), or the person
upon behalf of which the individual(s) acted,executed the.instrumqpj..—
tary Pub1C
ROSIN J. GXREY
Notary Public, State of New York
Washington Co.#01GO6335630
Corntnission-&pires Jan. 19,21-24
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN REVhE
Asian Spa QBA, Inc.
340 Aviation.Rd Suite 8
CO-0192-2022
4/19/22
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 Smoke Detectors
6) Knox Box verification
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
firemarshal@queensbury.net www.queensbury.net