CO-0444-2023 ;--~ CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit#: c1b - Ek 2O?
Town afQurcn+lion• Permit Fee:$
�� '� Q ! Invoice#: b5
742 Bay Road,Queensbury,NY 1280 - -Wry-net
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P:518-761-8206 or 518-761-8205 en r .net
V U L JUE 9 2023
pp TOpitbn;Wf,�w� o work requiring a building permit****This a lication is for occu
G CODES
BUSINESS INFORMATION:
Name of business: 5ara-ma 11n
Busines Address (including suite, space, etc.): 78 j i� " P,
A(�—
la- Roy
Detailed explanation of business (attach a separate piece of paper, if necessary): ,`/
***Please provide an accurate layout of your space showing
all walls, exits, 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: CrC4 Oi—i
Applicant signature: Date: 7,611 l
Property Owner name: GVY►L �Q-L- 1 �✓ l''� �'V \
Property Owner signature: Date: t li
Certificate of Occupancy Only Revised September 2022
Town of Qgeensburu
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: 7/1 / n
Business Name: Si?1 1r114' RAllo (ren
Business Location (including suite,space,etc.):SZ8 A V 1 o4i on_IRpCcLJ
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Business Phone#: ( a`ZC5 zgn
1. Business contact name: `
Main Phone:_( 5�)yao Secondary Phone:_( )
Contact is coming from what town/village? w>—d"
2. Business contact name: A�ckwedt
Main Phone:_(� ) 744-yc��17 ;Secondary Phone:_( )
Contact is coming from what town/village? D
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P:518-761-8206 F:518-745-4437
FIREMARSHAL@QUEENSBURY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Feyised Sgpternw 2022
7inrn of c Lrccnslwy
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): `Q
Mailing Addre , C/S/Z: 961 -965&n Ukf-
Cell Phone: ( 09 %26 706,q Land Line:
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z: -bovi-
Cell Phone:_(� _) 5 _ � Land Line: _( )
Email:
• Manager:
Contact Name(s): r.ru .9crkwelt
Mailing Address, C/S/Z:
Cell Phone:_(61g ) 764-5�5� 7 Land Line: _( )
Email:
• Property Owner(s):
Business Name: y� t'a� AtAtL-
Contact Name(s):
Mailing Address, C/S/Z: '1 12
Cell Phone:_( '3tg Land Line: _( ) `�9 3� LS
Email: C-V"
Contact Person for Compliance in regards to this project: 6-7e S4r-omk&a4
Cell Phone: ) 709 Land Line: �)
Email:
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 "
PLAN REVIEW
Spirit Halloween
578 Aviation Road
CO- 0444-2022
7/20/2023
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• Verify paths of egress
• Verify storage
• Verify clearances to electrical service panel
• CO detection is required
• Fire alarm system inspection required
• Sprinkler system inspection required, unless completed by Mall previously
• Provide key for Knox Box
• Provide current layout drawing for the space
• Function test exit and Emergency lighting fixtures
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office - Phone: 518-761-8206 - Fax: 518-745-4437
firemarshal@queensbitrt .net - 7MMqueensburil net
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