CO-0610-2023 4
CERTIFICATE OF OCCUPANCY ONLY office useoniy
Permit#: r o 6�
_ APPL—ICATItONb
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rt of cLrrct��Gi;n• mm � .,a.. Permit Fee:$
742 Bay Road,�Queensbury,NY 1 Invoice#:2804 4 SEP 2 2 2023
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:
Business Address (including suite, space, etc.): [® t4yNVfl_ IWO//— L6
(Q q C00A gufN 12 obi
Detailed explanation of business (attach a separate piece of paper, if necessary):. .
TI C.L'/MGM , i)F-F-Icr Awl lo ) I - SN66HftN fill-fb ica - pu_e__
* **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: .&)7OV/NO, Y—!�
Applicant signature: ''Date: r`1141023
Q�lNL�2�MR��G-�12 �l�
Property Owner name. 'ez- .��� U-0
Property Owner signature: Date:
Certificate of Occupancy Only Revised September 2022
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742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensburV.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): N _
Mailing Address, C/S/Z:
Cell Phone: )` ) Land Line: r
Email: ,
• Business Owner(s):
Contact Name(s): hDOVI tJ
Mailing Address, C/S/Z: albe-EKX&( J 1, "oka-4-
Cell Phone:_( _) jq�j D` 6Z Land'Line: _( )
Email: f,�(L�- (a� I/��t7?J `�•/.6i'Vt
• Manager-
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Property Owners
Business Name:
Contact Name(s): d
Mailing Address, C/S/Z bt
Cell Phone:_( I ) �/ J-Ff Land Line: _( )
Email: �1 -� �� �C4
Contact Person for Complia ce in regards to this project:
Cell Phone: ? ) Land Line:
Email:
Certificate of Occupancy Only Revised September 2022
fi0.ti`ll i:t C�:CCn}(purl'
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: ` i �l l �Q.'2'zs
Business Name: 1 A—Z
Business Location (including suite,space,etc.): I6 oJ
Business Phone#: U�Vu � I b
1. Business contact name: 4ttktqAl2ynov0
Main Phone:_( '�I ) /_ `iT�(` � ;Secondary Phone:_( )
Contact is coming from what town/village?
2. Business contact name: r
Main Phone:
_ Secondary Phone:_( )
Contact is coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@CQUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised September 2022
FIRE MARSHAL'S OFFICE
Tozvn of Queensbunj
742 Bay Road, Queensbury, NY 12804
"Honze of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Elevation Aesthetics
10 Hunterbrook Lane
CO-0610-2023
9/26/2023
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) Maintain 18" Clearance from ceiling for sprinkler system
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@queensbury.net - www.queensburii.net
289.15-1-5 CO-0610-2023
Elevation Aesthetics ��'''—�T 'FLQLi ? , G\JA 6uAk-Tt0r0 euAih3
10 Hunterbrook Ln
Certificate of Occupancy
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289.15-1-5 CO-061072023
Elevation Aesthetics 4'AeL,c A'11 aNJ PC4AJ
10 Hunterbrook Ln
Certificate of Occupancy
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289.15-1-5 CO-0610-2023 - � -
Elevation Aesthetics
10 Hunterbrook Ln
Certificate of Occupancy