2024-0138 a
CERTIFICATE OF OCCUPANCY ONLY Office Use Only
00 ` Permit#:X 2,4. — O 1' 15
?� APPLICATION I
Town ofQlleenstiury Permit.Fee:$ I b
742 Bay Road,Queensbury,NY 12804 Invoice#:
P:518-761-8206 or 518-761-8205 www.queensbury.neti ni IE et3 LE il i
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**This application is for occupancy only, with no work requ��ri�ng��alhui�ldi ng peii it
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BUSINESS INFORMATION: I -{. }, _ -a_. �i
Name of business: J3 �'� gill- :' - �_ ____
Business Address (including suite, space, etc.): Lig 4 AVlinOtt.) 7cAO
Detailed explanation of business (attach a separate piece of paper, if necessary):
('o�� k\v I MAC -N . eW s 0 C i'n--LA
***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: STD l 10., EN
Applicant signature: Date:
Property Owner name: v 414. csoe1 A -S
A LLC
Property Owner signature: ' Date:
Certificate of.Occupancy Only Revised September 2022
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EMERGENCY,CONTACT UPDATE
TO..:. Warren County Sheriff s Department
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1. This.form:is used:to assist Emer enc Service::personnel who ma be.called.to your business after hours: 5,i
lee
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be'sure that the persons listed on-this form will;be willing and::available to respond during off hours to assist Police
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and/or Fire personnel in.gaming,emt tn‘bue building:
= 2:'; Please be 'advised that.failute.to. respond ao assist emergency:service personnel'_may result in damage,to:your. ::
building to:facilitate entry:.by police and/or fire;personnel
PLEASE`PRINT
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DATE 3 .'Lp j
BUSINESS NAM..-..'..----....:-.:---.'-•--. .:-:.:--r--.:;.:--,...-.'---.--.--..•.:.-:---1-:::3;:-•-•A,---.:{:--_--•,A;;.::ri•i-_,---_f•!.1.1.-''..b•'---.--':-:l.e...E 2 -
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BUSINESS ADDRESS. .
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BUSINESS--PHONE '' %( ( W
:. CONTACT 1 /�1G HOME PHONE Gc� 9/
ADDRESS: $ __,. --.--_:-:-:,_-,_.
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CONTACT 2.. '':: .. :._.....` '.�A . .. HOME PHONE,� ..:.. .. .
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ADDRESS:. �d
Town of Queensbury Fire Marshal-New Business Permit. 518-761-8208
- ' Office Use Only
Town::of Queensbury Fire Marshal
Received
ESTABLISHMENT OF:A NEVV BUSINESS::. Tax Map ID:
CERTIFICATE OF:000UPANCY PERMIT APPLICATION Permit No.:
.. Permit Fee:
*Note: This,application is.for occupancy;only;:with no work requiring a building permit.
P+ �2
Name of Bus_mess .
Address A"11Q1'1 g A.t Af1� of
Type of Business -`• 6i' .
Manager.. _ l�"tf f � l` Ir I f Ihx, ar w I ,, Y�, t ' i
ORS 3rii
ti :
Perso:'in:;:charge tri1�e i I r ''� I/IjBusiness:'Phone-No. : - cp t �` ° 25 2O4 ��
,l^ ")k.'i}f 7,•.,.I sal v fly. C ;�i:� �-r..:-i.. "�
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yg
Property Owner.: Y .LL
Address ,' Wes. : "? _
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:-.2-56;)
Phone P o- .: e9) -'IL
ZZ� .?, "
.'::;✓Provide:-an:accurate layout:of.your store:showing:all walls;exits,stockrooms,rest rooms,counters,and`fixture layout„on a
separate sheet of:paper.:
:-.:Print Name e �/
Signature _.
1
Notes!Comments: ALL_ ),3 f • . 'N''.''
/ — I �e
IMP.06tTANT The business;owner-is responsible:for keeping exits clear and:maintaining :exif'-,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 Fire Marshal's office Fire:extinguishing;systems;.found in kitchens and gas stations require -.
: semi-annual'_inspections.: Any violations noted durinq.an inspection;:require immediate corrective'action:
:.CONTACT:NUMBERS :.' -
Director,Building and Codes 761=8253 Zoning Administrator-761-8218 Zoning-761-8238`
Fire:Marshal:=761-8206: - . Planning-76.1-8220
:Town of Queensbury FireMarshal New:Business.Permit`. 518-761-8206 •••• : : ':: '-.' : ..1::,is ,
Town of C rccnsbury
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: _
Name(s): ��P��1)iv1 /A/CLsN1 aw�
Mailing Address, C/S/Z: C -TIZAVIS 1—(ii L
Cell Phone: (fit$ ) s; S`3- im--1 ) Land Line: ( -- j
Email: CI?) • 9c0— O 0_1
• Business Owner(s):
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(
Email:
• Property Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(
Email:
Contact Person for Compliance in regards to this project:
Cell Phone: ( ) Land Line: ( )
Email:
Certificate of Occupancy Only Revised September 2022
• 011406k FIRE MARSHAL'S OFFICE
Town of Queensbury
Vir 742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Bambaz
474 Aviation Rd
2024-0138
3/26/24
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Storage
2) Verify Fire Extinguisher's
3) Locks /latches shall comply with 2020 NYSFC.
4) Verify operation of existing exit/ emergency lights.
5) Verify paths of egress
6) CO Detection required.
7) EVAC plan
8) Electrical Panels to be labeled with proper Ledger
9) Verify all cooking Appliances are Existing and no new additions
have been added.
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
tysonc@queensbury.net
Fire Marshal's Office • Phone: 518-761-8206 • Fax: 518-745-4437
firemarshal@queensbunj.net • zvww.queensbury.net
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Lic? y. A V1 ATI 014 , - t1D
Exhibit A
Plan
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302.5-1-98 2024-0138
' Bambaz
474 Aviation Rd L----'.
Certificate of Occupancy