CO-0314-2022 CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit N: cc
A
rimu Li(21 n-,L.1u11, Permit Fee:
742 Bay Road,Queensbury,NY 12804
Invoice#:
P:518-761-8206 or 518-761-8205 www.gueensbury.net
This application is for occupancy only, with no work requiri
BUSINESS INFORMATION: 3 20
Name.of business: J`i r�i'—�Y' UEENSBURY
Business Address (including suite, space, etc.): BUILDING&
0 L,1 r_- 9 ON f=6l=c it
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:.—//'-acL
Applicant signature: Date: ZZ.Z_
Property Owner name: r ri
Property Owner signature: Date:
t
d
Certificate of occupancy o-,
Town of(Lmvnsbun,
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensburV.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:
Business Location (including suite,space,etc.): 11-1102 I 1 14
44 (Vdrcil, �jY
Business Phone#:
1. Business contact name: J I 1
Main Phone:_( S ) y�q— �q;Second y Phone-_( )
Coming from what town/village?
2. Business contact name: \1Ol,
Main Phone:_( Jr( ) 0 — q •Secondary Phone:_( )
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised February 2022
WITHIlN 48 HOURS
OF RECEIVIING
YOUR PERMIT APPROVAL PACKET
YOU MUST CALL,
518-7 61 -8 2 0 6 OR 518M7 61 -8 2 0 5
TO SCHEDULE AN IINSPECTIOIN
WITH THE FIRE MARSHAL'S OFFICE
PLEASE REFER TO THE PLAIN REVIEW
ENCLOSED IIN YOUR PACKET
PRIOR TO CALLING. FOR
AN IINSPECTIOIN
THAINK YOU I
Certificate of Occupancy Only Revised February 2022
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