CO-0678-2022 CERTIFtC AM-OF—OCCUPANCY ONLY office Use only
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E c r E Permit M CO D U - 2_0 12—
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Wnsm dQuccnsbuty Permit Fee:$
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N 2022
Invoice#: t>tAoZA
742 Bay Road,Queensbury,N 12$0
P:518-761-8206 or 518-761-8 05 1 �eenst;t7�lnetllRY
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business: 6 M � --�Z�--
Business Address (including suite, space, etc.): 951 (OU C &Ife- �Z
Detailed explanation of business (attach a separate piece of paper, if necessary):
***Please provide m acmate layout of your space showing
A walls, Wdts, 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:
Applicant signature Date:
Property Owner name: M daJ Pa7c l Pl%-Lc
Property Owner signature: , '~ Date: 0V
Certificate of Occupancy Only Revised September 2022
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ToHm of Q_zkvnsbuzy
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensburV.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):
Mailing Address, C/S/Z: _
Cell Phone: s S 90)C41 - �/l ,7 Land Line: � ).
Email:
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z: c/"
Cell Phone:_�S"w ) Land Line-(—)
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
.Cell Phone: _( ) Land Line: _( )
Email:
• Property Own r s •
Business Name: I*
Contact Name(s): cs
Mailing Address, C/S/Z: ®1 t- c j e&v
Cell Phone:_(� ) Land Line: 06'z
Email: 6L17 cl Z LA/ n c:. i o 2—,_*'Av 'ems,4-t ozo
l
Contact Person for Compliance in regards to this project: I 'lctrcccG
Cell Phone: 57 o Co Z2'7 -O S5cj Land Line: L_)
Email: Ck(J(-0 S?i AG 94-1 0
Certificate of Occupancy Only Revised September 2022
Town of Qrrccnsbury
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:
Business Location(including suite,lace,etc.):
Business Phone#: 1-5--90 `7� <7 z�
1. Business contact name: A. Gt��l Gl
Main Phone:_( -7 b ) �0\27 `G S5 ;Secondary Phone:_(_)
Contact is coming from what
2. Business contact name: a4 w
Main Phone:_( 70 ) �{Z3`"�GJ�� ;Secondary Phone:_( )
Contact is coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P:518-761-8206 F:5 18-745-4437
FIREMARSHAL@QUEENSBURY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised September 2022
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296.13-1-18 CO-0678-2022
BMILLZZ
959 State Rte 9, Space ZZ
Certificate of Occupancy Only
44
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296.13-1-18 CO-0678-2022
i BMILLZZ
959 State Rte 9, Space ZZ
Certificate of Occupancy Only
04
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FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN REVh '
BMillzz
959 State Route 9, Space ZZ
CO-0678-2022
11/09/2022
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
-flreniarshal@queensburil.net - 7V7V7V.queensbun/net