CO-0674-2023 •A
CERTIFICATE OF -ANCLQNjL Office Use Only
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APP feE MI it#: CU- 0to7`I-Z. 2-3
APP I
Town oPC erccnsbury OCT 2 3 2�? emit Fee:$ 1/ �9,51 (JQ
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.quel nsb.6 �/ �F tJE I�iS UI�
ILDINC&CODES i
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION:
Name of business:
Business Address (including suite, space, etc.): ) I - 6t-(06-, y,i-
OLL0_,ms10-2)Nr-cj 0 ) 2 Fa 'A S p ovs_i____. IR 1 0 k
Detailed explanation of business (attach a separate piece of paper, if necessary):
. ,01 /1';., ?I' Sc.,,„( ci RLItei
***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: iti 0 lit i-Givi4/
Applicant signatures Date: ars (c7k ?�
Pro ert Owner name: 'Ci'- L kk,
N Y
Property Owner signatur . Date: /b7�3/
Certificate of Occupancy Only Revised February 2022
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P �a
ry C
Town of Qgccnsbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensburv.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: ---7
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Business Location (including suite,space,etc.): SlE
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Business Phone#: S — -I clJ c)f
1. Business contact name: C . 15("44GH
Main Phone:_( sic/ ;Secondary Phone:_(
Coming from what town/village?
2. Business contact name: 1"a Z. d Wl eck n 7
Main Phone:_( (0 12 ) /4 ' GZ ;Secondary Phone:_( )
Coming from what town/village?
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 February 2022
.' .
r
Town of Q2ecns1 ury
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: �, p
Name(s):
Mailing Address, C/S/Z: c4c. - C Crud- min (rM ()r ricfr7
/,
Cell Phone: ( 310j ) v(q)- a,s2 t/, Land Line: ( )
Email:
• Business Owner(s):C__ l I
Contact Name(s): s�, ( `p
Mailing Address, C/S/Z:
Cell Phone:_(S_) Li r- pjLo__ Land Line: _(
Email:
• Manager:
Contact Name(s): j(
Mailing Address, C/S/Z: 17t1 C.„,J-- LI
Cell Phone: _( C4/1- )6T1 C- b? Land Line: _(
Email: Al e/7 b v,r ,���►�-.
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• Property Owner(s):
Business Name: OgM�5 GI(1-1-t" i f
Contact Name(s): f1 vi ct t' or) Pi /1IZw Let. L G G
Mailing Address, C/S/Z: J ani e.s 5 r i-f i t i i e py vp•Il/dn48 •(-oh-)
Cell Phone:_( ) Land Line: _(
Email: S 8 ,4 vi ct fiot-i vol r/e-e.116 6ur'y/ Ay JZ 8 01
Contact Person for Compliance in regards to this project:
Cell Phone: ( ) Land Line: ( )
Email:
Certificate of Occupancy Only Revised February 2022
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302.5 1 92.11 CO-674-2023
Just Cory
578 Aviation Road .
1 Certificate of Occupancy .
01.64 FIRE MARSHAL'S OFFICE
Town of Queensburi
J
�� 742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Just Cozy
578 Aviation Rd, Suite B101
CO-0674-2023
10/23/2023
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.
-rL (2-911.,.wA r
D uty Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
tysonc@queensbury.net
Fire Marshal 's Off ice • Phone: 518-761-8206 • Fax: 518-745-4437
firemarshal@queensbunj.net • www.queensbuiy.net