CO-0719-2019 CERTIFICATE T' I OCCUPANCY CY NL APPLICATION
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"This application is for occupancy ol T in a building permit"
CONTAU INFORMATION:
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Cell Phiofte�' '77 Land Line.
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42 Bay Road; Queensburr ,,NIA" 12'804
Name of busines S'. 4 J� P.-0 C)"." 'C'
Address (including suite, space, et , �� �� � V fAu. a ey),
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Type of business (i�; .: retail, car repair, etc.):
Please provide id are, accurate layout,of your stage showing,alit wailiis, exits, stockrooms, rest
r oms, counters rs n fixtures,our a, separate sheet f paper.
IMEORAINIP., The, business ner is responsible for keeping exits clear aired, maintaining exit
signs and emergency lights. Fire e tinigu.u,ishers, firs sprinkler s' sterns, and fire ailarm systems
require anin ual inspections, by an outside contractor and the corresponding documentation
must be provided to the Town of Queensbury Fire Marshal"s office. Fire extinguishing syste ws
found in kitchens and gas st ti nis require seam- n nual inspections. i l tions noted
du.uri irnmediiate orrecti e action and a ire-ins cticuru.
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Applicant u arne _ �.�..�
Date,.
Revised Julle 201
terlificateuwf Only
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EMERGENCYCONTACT INFORMATION
"THIS FORM 15 USED TO ASSIST EM ERGENCYERVI E PERSONNEL WHO MAY BE CALLED T'O YOUR
BUSINESS AFTER HOURS. 'PLEASE RF SURE THE CONTACTS LISTED BELOW ARE WILLING AND,
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AVAILABLE TO REPS ND DURINGFFm HjO URS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
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AI N I NG FNTRY TO YOUIR BLIILDING.
PLEASE RE ADVISED THAT FAIN,.Iy.IhRE TO,ASSISTEMERGIENCY SERVICE PERSONNEL MAY RESULT IN
DAMAGE TO YOUR BUILDING BY POLICE ANNCIi R FIRE, PERSONNEL.,
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BiusInke Location (A611cludGmq, suite, af ',w4E'tc):
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Coming fr m what town/village? � � ��� �� � �¢��,�� �' � �
-TOWN OF QUEENSBURY FIRE MARSF..IAl. " OFF 1(;F7,
03 DtMi5is'&& Ajl,'r�oV
FIRE, AR'S HAN..MIKE E)EF3Lf i'Y F)FRE M ARSHAI..GAff' Sill _MAN
C rt�rfl l gar; c u, i°G Vr y ra,-rieel Jurbe 201
EXISTING FLOOR PLAN PROPOSED FLOOR PLAN
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