FMP-0456-2022 07/20/2022 09:45AM 15187985394 FAMILY FOOTWEAR CTR PAGE 01/06
Office Use Only
Permit#: P_®�l'56 ZO 22..
Permit Fee:$ !(O —
Invoice#• `JyL 1
Town of Oweens ut y ._
FUM MARSHALS OFFl E C E a
742 Bay Road,Queewbwy,NY 12804
518-761-8206 www.queerlsbury.net J U L 2 0 2022
TOWN OF QUEENS6URY
FIRE MARSHAL SPECIAL PERMIT APPLIC ILDiNG&CODES
Project Location: K C0 S%-m F-Ouric . .Tax MAP Id#:
Business Name, if applicable: FP1Akk fOOTw4AK Cgw"Mg 1fk1C" gUR=C6z=
Brief description of scope of project:
.�c' Ni°�t_ puT �ai2 SAt - o 1jf.LZ� A4uGtj= P'T 774 R-C,06N
IS�+S
**PLTAM MAKE SURE TTOI NCLTJDT,A. SKT"CH
SHOWING IHEIOCAMON OF
'THt PROPOSM WCMK
OR-PPMECr'ON PA-RCEL**
FM Special Use Application Revised December 2020
07/20/2022 09:45AM 15187985394 FAMILY FOOTWEAR CTR PAGE 02/06
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
a Applicant:
Name(s): Marc 1309 D kk M, C&
Mailing Address,C/S/Z: 16`ao $ 1&vrt Q, LA4-4c 6EcCa , Nw h26q;F
Cell Phone: .1 S/6 ) 4 - t! b 0 Land line: S!B 174 8 - Y6 QB
Email: ` . burd%*t-K a
• Primary Owner ):
Name(s): 4P%M(6trG a Oc.a-C�-E"CS LL C- /C-09' Vk60 DeVL%:QBMAtj
Mailing Address, C/S/Z: 60 Qq,w 5.'r: b"m f-c.r��s� � f}L- tq f� QcZ a')
Cell Phone: f 5718 ) `4 a- 1411 Land Line: �)
Email ±5 tInim� cVc6r\&%je(cemrn1, rwt
�'(Check if all work will be performed by property owner only
Contractor s : (List all additional contractors on the back of this form)
Contractor Name(s):
Contractor Trade:
Mailing Address,C/S/Z:
Cell Phone:, �) land Line: (
Email:
"Workers' Comp documentation must be submitted with this application"
DECLARATION,,
1. 1 acknowledge that no work shall commence prior to approval of a complete building
permit submission.
2. If,for any reason, the building permit application is withdrawn, 30% of the fee is
retained by the Town of Queensbury. After 1 year from the initial application date,
100%of the fee Is retained.
I have read and agree to the above:
PRINTNAME: -r
"?120/da
SIGNATURE: DATE.
pM Special Use Application Revised December 2020
r - ".11
.6.�4 4 1.
'.�n,�..-(,+>'lf.'^•'•,„',``..,.tiNI;a4ti`7�.5l:�:r•-G..•��?:OiIT•'i F�E iS;��ti',��.;=,'���'�.'•'"*�;��=,f"-•�1I'+{_.[.�r.r,.�`.i.'-�`'u;,_`��.,.-11.\�1..r+,-Q�s•{r'V4c i�$i�^}A`l�„'�\`,+:ti 4h}�'s.J i,-'t1
"'A
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g 111P�11
CERTIFICATE Of, FLAME RE S ISTAN%,*U
y
Issued b Eureka! Tents
A div.of Johnson Outdoors Gear, Inc.
625 Conklin Road
Blngharnton. NY 13903
(800)235-2607
.............. Issued to:
a e: _&A k Li DcAweeff cetclf-y' i Company.N1 M!
Address:
wstatwz4, a Lar ncqe, N 9E
L)
This is to certify that the products herein have been manufactuired from mAteklial flame-retardant-and
inherehtly iianflarnmable,as bere after specified by the materiat-supplier. V,
See page 2 for supplier and fabfic informagon.
Description of-item,(s): -Date-.of Manufacture:
2-410222 PARTY CNPY 2OX20 Y/W (Made in USA) Sep�01 9
hal:The artioles'described on this cer5ficate have been
Certification is hereby made I manufactured with flame-retardant
fiabric or material registered and ap ja State Fire Marshal.The fabric has-been tested and passes the
proved by the Californ
fo llovil ng ('current and previous)udes: N FPA-701 an d C AN 111.11 Ld-S I GS-.
THE FLAME RE7ARDANT PROCESS USEd WILL
NOT BE REMOVED BY WASHING AN IS
EFFECTIVE FOR THE LIFE OF THE FAB C. 711m Andersen,)fice President
..........
07/20/2022 09:45AM 15187985394 FAMILY FOOTWEAR CTR PAGE 04/06
near t r cuz r a:urpm rKMIly F-DOLMMr%1WIMai —
,Jan 29 202111.'58'a h Fdit*Footwear Corner 8882915356 PAR
y
1
Parce( Information -
Municipall�yy: Ccpnabury
New Tax Trap t+ikWt- 288-12••1-15
Qtd Tax Map Number: 38.-1-35
Locations id98 State Rnuto® v+rvat,xr ewrK�,v�va�uuuas
Frontage: OUV rwo
Depth: U MA$*A n wxartaa�4�NU
Acres: 7.�10DOpg7Q37 'N oaaar�tQo�O'"aa"m
Property Class:
ower. ceM.rprns +�roi cFr"
Lake CieaggePsmdaCee FORx.Nrslouw�rwtroaew>
Curnut Land Assenment: 497000 ssa��wawon+e naa
ro►nDhEAE1FL VlEit �►LL CuM4t TotEG AawessrrlarlC 11 '
N0ghborhood Code;Youir BUM, •• q = °pad
SgLmre Footage: 13020, a u+ps NorUiatym,q qrs�
' titQrl98: '� muc�Is�Ma�Wnwiwa.gxslenoprgew,kq�,.e y„ '
Bedroom: %M&-
- kVimnCauc�i�tn9A+si�oa�akomn�dut■
Batftrctomsi� p sar�Ma6imr�•6�h'Nrm.�,�na.ee,.�.oa,r�W��o • .
+gathrassl�d '80% tar .uue
5evileC_ PriY9te �°i4aw.af�s���ais�gn
Water: t arnmlpubltc Vts my
utilmeS_ EleCtriG %dwWdbeamu -waftw "wmy
Heatwpq n�"rnI va
ra'1 $ S2)MW+absyt
Back. 787
'ago: 179 +�+n.^cwa+,R.ut�w�►r�.�.:acDtt �+
S81es G13tpSi "� ia`."iie wa»d rwtaawad.
Sates PrIeds: O
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07/20/2022 09:45AM 15187985394 FAMILY FOOTWEAR CTR PAGE 05/06
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07/20/2022 09:45AM 15187985394 FAMILY FOOTWEAR CTR PAGE 06/06
1500 U.B. 91 Lake tleomge, NY 12845
Ph: 518.798.9658
20' x 20' Pole Tent with Anchored Weights
Soo IN 500 lb. 500 lb.
500 1b >;oo lb.
.
5001b. 500.1b. 2 i
500 tb. 500 1b.
5001b. 5001b. 600 IN