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742c Bay Road,Queen sbuiry,NY
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AUG1 210119
*`phis li ation i foir occu, rirv , , �t re wring a building permit"
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CONTACT INFORMATION; Eel oII.V l� &
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BysinessQwnerLs
Contact Namt,(s)�:
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Mailing Address C/S/Z,
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Cell Pho,,,ne: �WDI Ear"jrJ Line.,
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MailIng Address, C/S/Z
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742 Bad woad,Queensbury,,NY 12804 ��°NW �d i�" °..° C r
P'':'518-761-8206 or'S18-76 -8205 ww um mg
BUSINESS INFORMATION:
Name of business: SDI r,
'4 41'[DwLn
address (including suite, spoke, etc.),
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Type f b u.�iness (i.e.. retain, ca r re,p a ir, €rtu )
Please provide, an accurate layout of your store showing all walls, exits, stockrooms, rest
rooms, counters and fixtures,on a separate sheet of paper.
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I FORA' a The business, owner is responsible for keeping exits clear and maintaining exil
signs, and emergency lights,. Piro extinguishers, fire sprinkler s sterns., and fire alarm s sterns
require annual Inspections by an ClUtside contractor and the corriespondiing, documentation
rn'uust be providled to, the Town of Queens,buiry Fire rsh li's office. Fire extinguishing systems
fund! in kitchens and ,gas stations require semi-annual inspections. Any violations noted
uEururu . ru emu sp [CIO rub gire irnmediate correctiveaction rn,d a r ii s Ctii n,,
Applicant rniarne.
App[icant sl n atuur ;
Date:
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yens,'4 Iry
742 Bay Road,a ;uu ensbor'y, NY 12804
518-76 - 206 or 519-761-82.05 ww qua ensbury.ne
EMI,fBiGENCY CONTACTINFORMATION
**1 HIS FORM IS USED10 S I:Sl EMERGENCY SERVICE PERSONNI-1:,.'WHO MAY BE CALLED TO YOUR
BUSINESS ,AFTER FIO R, . PLEASE BE SURE TI-IE CONTACTS LISTED BELOW ARE '"t WI LUNG AND
V ILABLE 1-0 REPSOND DURI NG OTF-140,URS TO ASSIST POLICE . ND/O,R H RE PE RSONINEL IN
GAINING ENTRY 10 Y'O .IIR. BUILDING."
PLEASE IBE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL,NEL MAY RESULT IN
DAMAGE TO FOUR BUILDING By POLICE AND/OR FIRE PERSONNEL.
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Date
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2. Contact
Main I'fmone: Secondary Flat�r7r"
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1'IVYEL MARS f,"4:rr.._MIKIE"P,P-"I_ML.I I... _I"'1..7 i Y F n,�� MAUGI lA l_Gr"sHY Sl VL_t...PAAN
Certificate ut OcK.upHrrcy Gmy &tr.vised Jlunc 20I..7
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578, Aviation Rd
Certificate of Occupancy Only
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