CO-0676-2022 CERTIFICATE OF OCCUPANCY ONLY. - : office.use onw
Peemit#: : C7 O -� •2d.2Z.:
APPL
ICATION
town of Permit Fee.$ 1
742 Bay Road,.Queensbury,NY 12804, v
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in oice#:
P:518=761-8206 or 518-761=8205 www.gueensb&wnet
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This application is for occu .anc _onI' with no work
BUSINESS INFORMATION:: 0 7 N22. ::
Name of.business:
Adirondack Mountain;Club; lnc.:. : urY:
Business'Address'(including:suite;space .etc.:): 959:StOtte.Rte.-9 't Queenspury;NY 128p4
Detailed explanation of business (attach a separate piece of:paper;if necessary):
:Administrative.Offices
Please .provide an accuOta layout of your apace showing
aii walls;:.a is stoc[arolpms rest rooms; counters and lbi*Oe's
on a separate tieet of paper**:
IMPORANT::The business owner is responsible for.:keeping exits clear:and.maintaining exit
. _
signs and emrgency I,igli s. Fire extinguishers;fire sprinkler systems, and fire-alarm.systems
req 'ire:annual inspections:b' outside contractor and:the corresponding--doctimentation
must..be provided°to the:Tovun:of Qu.eensbury'Fire:Marshal`s office:: Fire-ektinguishing systems . -
•found in kitchens and gas:stations;require.sem:i=annual inspectibhs: Any violatiohsnote.d
durin�.an inspection require immediate corrective.action:and a:re-inspection.
Adirondack Mountain Club, Inca
.Applicant�name: ..: :.
Appli.cant:signatu.re: ��" V� Date:
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Mount R al`Plaza:,.LLC
Property-Owner name: .. . QY
1, 11 2
. . .
Property Owner signature.
Certificate of Occupancy Only. Revised September 2022
Town af.CLucensbuiy
742 Bay Road;Queensbury,NY 12804
P::518=761-8206.or_518-761-8205. www.aueensbumnet
EMERGENCY.CONTACT:INFORMATI.OU.
**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:.Nove r 4, 20 mbe 22 •
Adirondack Mountain Club; Inc:
Business Name: . .
Business Location (including suite,space;etc.):.959.State Rte..9.'(Suite.Z); Qu,eensbury, .NY:128.04
Business Phone 518-668-4447
1. Business 'contact name: Laurie Sch 'eighardt
518-9.35=04.31
Main Phone:_(_) ,Secondary Phone::_( ) -
Contact.iscomingfrom.whattown/village? Glens. Falls
-
a inia'Etu .
2. Business contact name: .. g...
Main Phone:_(_)5.1.8' 79.6 .7907 Secondary Phone:_( )
Contact is coming_from what town/village? QUeensbLll')/
TOWN OF QUEENSBURY._FIRE'MARSHAL'S OFFICE: -
P:518-76.1-8206 F: 51&745-4437
FIR EMARSH4L@QUEENSBURY:NET . -
FIRE MARSHAL MIKE.PALMER DEPUTY FIRE.MARSHAL;TYSON CONVERSE
Certificate of Occupancy Only. Revised.September 2022
Tot;n of Qurcnibun
742 Bay Road,Queenibury,NY 12804
P:518-761-8206-or 518-761-8205 . www.gueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY QR TYPE,.PLEASE.INCLUDE AN EMAIL
Applicant.. .
Names : Adirondack-Mountairi Club, Inca
O
Mailing Address, C/S/Z:. PO Box:4390, Queensbury,NY 12804
Cell Phone.:. )_ Lan d_Line: ._ �518-668-4447:
Email: . .
:.Business.OwnerW:
Contact:Name(s): Michael Barrett, Executive Director
M' iling.Address- .C/S/Z: ry,
PO Box 4390; Queensbu NY 12804.
C6U.Phone:_( :: 1573-355-6030. Land Line: . ( : . )518=668-4447
Erna i l:.michael@adk.org
• . Manaeerc.
COntact Name(s): Jen Shepherd :
„ ..
Mailing;Address, C/S/Z:.PO Box 4390,:Queensbury; W 12804
Cell Phone:.:_( ) Land tine: _(- )518-668-4447:
•en adk:or .
Email: . @ . g.
PropertV.Owner(s): ..
BUSInesS Name: Mount Plaid, LLC,
Contact Namb(s): Andrew Laakso -
Mallih Address,.:C/S/Z: 959.State Rte.9;Queensbury, NY 12804
CeII.Phone;.._� j 51s=79s:-0026. Land Line: .'. ( :. )518-798-0026
Email:,andrewlaakso@zinidevelooment:com
'Contact Person for Compliance in regards to.this,ot 'ect: Michael Barrett,Executive:Director
_ .
Cell Phone: ( : . - )a73-355 so3o:. .:Land Line: _)s1s-6ssa447 . .,
• michael@aclk.org
Email @ 9
Certificate of Occupancy Only. :Revised September 2022
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
' LAN REVhE '
Adirondack Mountain Club Inc
959 State Route 9
CO-0676-2022
11/07/2022
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
518 761 8205
garys@queensbury.net
Fire Marshal 's Office - Phone: 518-761-8206 Fax: 518-745-4437
firemarshal ftueensbun.net - zvzvw.queensburit.net