CO-0626-2023 CERTIFICATE OF OCCUPANCY ONLY f office Useoniv
} ,I 'Permit#: CO ' O C =h — ZO Z3
11 Permit Fee:$ "D
Invoice t#:
742 Bay Etoad,Queensbury,NY 12804
P:518 761-8206 or 51S-761-8205 www.clueensbuty.net
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**This application is for occupancy-only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business: �a�i( ►� r
Business Address (including suite, space, etc.): Via.c e
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Detailed expianation .of business (at ach a separate piece of paper, if necessary)t
*'Please provide an accurate layout of your space show
was, Qrits, stockrooms, rest rooms, counters and fixttwes
On a separate sheet of paper*
IMPORANT:The business.owner is responsible for keeping=exits clear and maintaining exit
signs and emergency fights. Fire extinguishers, fire sprinkler systems; and fire alarm systems
require annual inspections by an outside contractor and the cor respond ing.docurnentation
must be provided to the Town of.Quei�nsbury Fire.Marshal's office. Fire extinguishing systems
found in kitchens and gas stations require s0mi-annual inspections. Any violations noted
during.an inspection require immediate corrective action and a re-inspection.
_Applicant namo:
_ 1JP4-A/D
Applicant signature: Date:
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Property Owner name:
I
Property Owner signature:
Certificate of Occupancy only P>evised September 2622
2�rr et(t'uc�sJrin
742 BaV Road,Queensbiury,,NY 12804
P:k8-761,8206 or 518-761-8205 wuimr.c>ueenshury net
CONTACT INFORIVIAT]ON: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Applicant:
Names): � '
Mailing Ad re ,.C/S/Z: C�
Cell Phone: land Line: ( )
Email: ,
Business Owner(s):
Contact Name(s): W
Mailing Address, C/S/Z: .
Cell Phone: Lan line: _( )
Email-
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• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_�� Land Line: _( )
Erriail:
• Property Owner s :
Busiiness Name: 011.IX n 'k0. t�l�
Contact Name(sy: e- 4,- model
Mailing_Address; C/S/Z: v S t'yf T..
Cell Phone:-!_ ). — a.'i Land Line: _( 1 _7q
Email: A o_nt,4y a, 2��, v-� d-no( e^.4-
Contact Person for Complian a in regards to this project:
Cell Phone: ) 77- Land Line:.
Email: ( , '
Certificate of Occupancy Only Revised September 2022
rtjw,q
.742 Bay Rqaq,.Queensbury,NY-12204
0:51&.761-8706or-519-761-8205 www-guee sbyry_net
EMERGENCY CONTACT INFORMATION
*THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLW70 YOUR
B,USINE$$-AFTER HOURS. PLEASE BE SURE THE CO.NTAcTs.LISTED BELOW AkEWILLING.ANDi
-AVAILABLE TO REPSOND DURING To ASSIST PO.UtE AND/OR.FIRE PERSONNEL IN
GAINING ENTRY TO YOUR BUILDING.;-°*
PLEASEARtADVISEID THAT FAILIURE70.ASSIST EME96ENCY"SERVICIE PEAWNINEIL, MAY RESULT IN
DAMAGE TOYOUR BUILDING BY POLICE AND/OR:FIRE PERSONNEL...
Wte:
Business Name:
Busifiess,16catibh-(indudingsuite;space,'eft.): >
Ilk
Business Phone 4k
'L Business contact name:
Mairi,Phone* :'Skohdaiv Phpn6:._t C/li 0�/6
Contact is corning.from,What-town/vi L _e_ -OL 47�7,a_,_
4;
2. Business c6nta(ft name:: + �\/U&v"C_ -
ii7-66 Main' Oh666: Sdcondainj Phone' : 71-
Contact As coming from fi 't ttbwn//vHIafjgze?
TOWN OF.'QUEENSBURY-FIRE.MARSHAL.'S OP ICE
P: 5 i 8-76 1'-'82Q6, P:5 1 8-74a,4437
,FIRE MARSHAi-MjK'PAi_m'E.,R DEpu-r.y FIRE MARSHAL.TY50,N-CONVV RSIF
'Cwflficate'cf 0ccupan.0 Only. Revised Septernber 2022
FIRE MARSHAL'S OFFICE
Tozvn of Queensbunj
742 Bay Road, Queensbunj, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Reflexology Rehabilitation
959 State Rte 9, Space X
CO-0626-2023
10/12/2023
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) Verify aisles & storage.
7) Maintain 18" Clearance from ceiling for sprinkler system
D uty Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fi r e M a r s It a l 's Off i c e - P h o n e: 518-761-8206 - F a x: 518-745-4437
flremarshal@queensbuCl.net - www.queensbury.net
- C 0-0626-2023
a 296.13-1-1$Re„abil� t1On
RetjeAo o9y 9, Space X
959 SC' of OCCU, cY
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