CO-0441-2022 CERTIFICATE OF OCCUPANCY ONLY office use only
Permit#: C' G-0Ll i(1-2.Ozz_
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fown of(Lirccnsbun Permit Fee:$ L y
742 Bay Road,Queensbury,NY 12804 Invoice#:P:518-761-8206 or 518-761-8205 ww 2022-O0
QUEENSDURY
L-1I'_ LDING P r0Dc,
"This application is for occupancy only,with_n,o_work requiring a building permit"
BUSINESS INFORMATION:
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Name of business: i X «' ��
Business Address (including suite, space, etc.):
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AA
Detailed explanation of business (attach a separate piece of paper, if necessary): yV �
CA Ef r,,-Ac.,&C,� C4,J Cy,e(C!
�0)/\C.J o's Aell 's
* * Please provide an accurate layout of your space sho
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: )�c,,jc l C, M(IAL Ilk
Applicant signaturAI -0-
Date: b ZZ
Property Owner name:
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Property Owner signature: � r ,. eR4� , Date:
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Certificate of Occupancy Only Revised June 2022
i
Town 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
• A licant:
Name(s): a U r�C, ) ; 1 eC
I I A MCA ;MW-P—
Mailing Address, C/S/Z: G61 J CJ
Cell Phone: 1 ) 2(— Land LI e: �)
Email: TGo, R c a
• Business Owners : 1
Contact Name(s): (,4r i 1
Mailing Address, C/S/Z:
Cell Phone: _(�IS�) I L n ine:
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Property Owner(s):
Business Name: r* Za�AA Luc- Ca�
Contact Name(s): � j �Qj Q Wts A'%%'b nrU
Mailing Address, C/S/Z: tV 4 Cell Phone:Phone:_( ) Land Line: _( )
Email:
Contact Person for Complia ce in regards o this project: 6644C-hdc
Cell Phone: ( ) La ne: �)
Email: !)
Certificate of Occupancy Only Revised June 2022
ro,m d CLrccnsbun,
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:
Business Name: f f' ►� "00 LL --
Business Location (including suite,space,etc.):%s�j 'S, AA
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Busi s Phone#: -- 2—( SIP —b
1. Business contact name: J—c� �l G� 1 ►�
Main Phone:_( _) +��' 1�� ; Secondary Phone:_( )
Contact is coming from what town/villa2(-
2. Business contact name: C�.d'—c1 'Y\
Main Phone:_(c)W ) •Secondary Phone:_( )
Contact is coming from what town/village? t'PN
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 June 2022
296.13-1-8 CO-0441-2(122
Serendipity Tattoo LLC/Patrick Dingman
959 State Route 9 Suite M
Certificate of Occupancy
Cos II
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FIRE MARSHAL'S OFFICE
Tozvn of Queensbury
742 Bay Road, Queensbunj, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN RFVyI+J
Serendipity Tattoo LLC/Patrick Dingman
959 State Route 9 Suite M
CO-0441-2022
7/15/22
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) Verify Knox Box key.
5) Verify aisles & storage.
6) Verify CO Detection
e
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
tysonc@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@queensbuill net - zvzvzv.queensbum.net