CO-0246-2023 CERTIFICATE OF OCCUPANCY ONLY Office Use Only ^ A
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+ APPLI�GAT°ION
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ermitFee:$
742 Bay Road,Queensbury,NY 12804
MAY 15 2o23 � Invoice M Io
R:518 7ii1-8206 or 518-761 8205 WWWAl cer�sk�`u'r:}�,ietr- j
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**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION: �06�)4\
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Name of business: S' I?VC &IMPAw/1
Business Address (including suite, space, etc.): 04�,A-s c� Lo k& C.Borne_ T=Nay-
Detailed explanation of business (attach a separate piece.of paper, if necessary):
\,10TAI �j'+` ?VP-1't-a�( Ncc-y.,55a17—'t(z-S j �`—ao�-y.��•►r�`�'
* * *Please provide an accurate layout of your space showing
all walls, eidts, 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: Vkk .l
Applicant signature: C Date: 5 tt ^
Property Owner name:
Property Owner signature: G'A)7-EtN Vnv5 Date: 23
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certificate of Occupancy Only Revised February 2022
fUN'n V��jllt'Cfl?�Rlf l'
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.clueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): LbypG
Mailing Address, C/S/Z: LP- N SCIEv�Ct✓ Aker L�nv�. tors}� p OIZ �12Z�t
Cell Phone: Land Line: 50' ) ltlef - LQ►�'D
Email: MAWTE� i�p1.U4v15tr�.. ��r`n
• Business Owner(s):
Contact Name(s): +� cJt�Cz��W�'VkV' tnn-� L
Mailing Address, C/S/Z: t�,4J ScA&Acc. �Y�V1� �Siv�, ��rk1�a DtZ cl.-a `l
Cell Phone: _{ ) Land Line: _{ �) � ,- 5oL)p
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z: 'L'Z EASY
Cell Phone: _(16 0 )_ Land Line:. _( )
Email: LOX0 C_pIUftotca . CovA
• Property Owner(s):
Business Name: E7v- \t:Vs o - Uk e- Ge wf e-
Contact Name(s): 5ho-nus
Mailing Address, C/S/Z: '2500 WAS Lh�S F�?r Utz i Zvi U� , NYc� A5 e' t�`f IU5:iq
Cell Phone: _{ 1 )_ 253-tp5oo Land Line: _( )
Email:
Contact Person for Compliance in regards to this project: Wy-w yt--z
Cell Phone: ( ) 4'Zl• c14-4T- Land Line: S)o ) 6A t,5- c
Email:_(\AWM7, n &w%Ab 1.1,, . Aw)
Certificate of Occupancy Only Revised February 2022
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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,.space,etc.):
1�k'2 5 � vi✓C1 ,
Business Phone#:
1. Business contact name:
Main Phone:_(SV& ) 30-1— \1--%0 ;Secondary Phone:_( )
Coming from what town/village?.
2. Business contact name:
Main Phone:_( ) ;Secondary Phone:_( )
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761.8206 F: 518-745-4437
rrl�l r;�n!� rinr r..c' i_!! ! rt!sl surli.r rr r
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
certificate_of occupancy Only Revised February'2022
--- {- — '_ — -- -- 288.16-1-1 CO-0246-2023
Columbia
c 1424 State Rte 9, Suite 9 i^ -# -
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Certificate of Occupancy - —3-- i
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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 "
PLAN REVIEW
Columbia
1424 State Rt 9
CO-0246-2023
5/15/23
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Storage
2) Verify Fire Extinguisher's
3) Locks / Latches shall comply with 2020 NYSFC.
4) Verify operation of existing exit/ emergency lights.
5) Verify paths of egress
6) CO Detection required
7) EVAC plan
8) Verify Knox Box Key
s
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
tysonc@queensbury.net
Fire Marshal's Office • Phone: 518-761-8206 Fax: 518-745-4437
firemarshal@queensburt/net • zuww.queensbury.net