CO-0750-2022 I
, ,ii E CERTIFICATE OF OCCUPANCY ONLY office use only
4
APPLICATION
Permit#:CO-0750-2022
1 110.00
yOhm ofcw 5 ury Permit Fee:$
742 Bay Road,Queensbury,NY 12804
Invoice#: 5677
P:518-761-8206 or 518-761-8205 www.gueensbury.net
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business: Queensbury Billiards & Cafe DBA: Mystery box
Business Address (including suite, space, etc.): 324 Quaker Rd Queensbury NY 12804 Suite 8
Detailed explanation of business (attach a separate piece of paper, if necessary):
looking to temporarily use space as a retail location to resell MISC items such as:
Clothing, household items , footware , electronics ETC
***Please provide an accurate layout of your space showing
all walls, eats, stockrooms, rest rooms, counters and factures
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 r I i -'ns ection.
Applicant name: kevin Jaikeran F[=DEC 28 2022
111
n TOWN OF QUEENS U3 RY 12/28/22
Date:
Applicant signature: —
Property Owner name: Kevin Jaikeran (Leasee)
Property Owner signature: — Date: 12/28/22
Certificate of occupancy Only Revised September 2022
*I
Qf�c-h-ory
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
• Applicant:
Name(s): kevin Jaikeran
Mailing Address, C/S/Z: 260 Big boom Rd Queensbury NY 12804
Cell Phone: ( )347-882-4209 Land Line: � )
Email:Queensbury Billiards &Cafe LLC
• Business Owner(s):
Contact Name(s): Kevin Jaikeran
Mailing Address, C/S/Z: 260 Big boom rd Queensbury NY 12804
Cell Phone:_(_)347-882-4209 Land Line: _( )
Email:
• ' Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Property Owner(s):
Business Name: 1606 LLC
Contact Name(s): Ron Striegel
Mailing Address, C/S/Z: 73 Rockburn Pass West milford , NJ 07480
Cell Phone: _( )973-997-5857 Land Line: _( )
Email:
Contact Person for Compliance in regards to this project: Kevin Jaikeran
Cell Phone: ( 347-882-4209 Land Line:
Email: Uueensburybilliards(ggirnaa
Certificate of occupancy Only Revised September 2022
ToNM of C�tnccns ury
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: 12/28/22
Business Name: Queensbury Billiards & Cafe
Business Location (including suite,space,etc.): 324 Quaker Rd Queensbury NY 12804 Suite 8
Business Phone#: 347-882-4209
1. Business contact name: Kevin Jaikeran
Main Phone:,._(347 )882-4209 ;Secondary Phone:_(347 )990-6480
Contact is coming from what town/village? Queensbury NY
2. Business contact name: Neelo Jaikeran
Main Phone: 347 990-6480
_( ) ; Secondary Phone:_( )
Contact is coming from what town/village? Queensbury
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 September 2022
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Hone of Natural Beauty ... A Good Place to Live "
LAN REUhE '
Mystery Box
324 Quaker Rd
CO-0750-2022
12/30/2022
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@queensburu.net • www.queensburIL.net