2024-0335 CERTIFICATE OF OCCUPANCY ONLY Office Use Only
APPLICATION Permit#: 2O24 Permit Fee
Town of Quccnsbui
Road, Invoice' :
742 Bay
Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION: (�
Name of business going in to location listed below: 1 ' o\-\\ p C)c)c4 \ " oe\
Business Address (including suite, space, etc.): 15I15
La\SQ. C3oc- P . `I 10,BR
Detailed explanation of business: I C ' E
JUL n g 79 b
TOWA:Ly nuP,E ccuRy
fNO& CODES
*** On a separate sheet of paper please provide an accurate layout of your
space showing all walls, exits, stockrooms, rest rooms, counters & fixtures ***
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: 3_,0Nicx\.\:::)e.\0 IS?(:),VA
Applicant signature: Date:Att )c `�-
Property Owner name: Am\V-\c\rna-(-
3 \ ,NA
19Property Owner signature: °erDate: 07/° a1f
Certificate of Occupancy Only Revised May 2024
Town of 2uccnsbwy.
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE and INCLUDE AN EMAIL
• Applicant: n
Name(s): O. CAM' \\
Mailing Address,C/S/Z: 4 R1 POE 1J00P �2 , MF_CN4t.uc v1LLE,N y /IIIr
Cell Phone: (=j\6, ) sag-coo-1 Land Line: (
Email: { \ fl sly)a.:\sc.°NI
• Business Owner(s):
Contact Name(s): A 'oi- \i\v%,r c C
Mailing Address, C/S/Z: P FOOD 7)R, MECWA-NICVTLL E,1')y ! .211
Cell Phone: _(5/$ ) 36,C 6a y/f Land Line: _(
Email: J cN Qc \�-i1 Q �Y�c.a, co,fYl
• Manager: �J
Contact Name(s): .‘ NQec\se r Q &i \\Co
Mailing Address, C/S/Z: 1k (' p,n, 3O ock o we
Cell Phone: _(5Ck )3k.10 — \ 1 \ Land Line: _( )
Email: M®\1 Ccm,\c2SOc'N.V.! I ,o,`\,CniNn
• Property Owner(s):
Business Name: MOHXCP-N , fOSPlTi4LIT)'' L�L�
Contact Name(s): 94yAL136/•/ 1< PATEL
MailingAddress, C/S/Z: 1/ R�9GE0ooj D ,, MF0- -tolevLLLFN4t
Cell Phone: _( 5/$ ) '2S 9I O 7 Land Line: (
Email: pVco /Lt7 7rnct.i/, cmr�
Contact Person for Compliance in regards to this project: Kcy.\\-)es-\ ccoQ_ A\`®
Cell Phone: (50i3)31'1C-1')--1 I Land Line: isIg ) -0M14
Email: \-\'‘CoACe.c)c)CI --a yr\()\-, Ccm,r)
Certificate of Occupancy Only Revised May 2024
Town of Qu.xnsbuly '
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.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: 11L1 ( ,9
Business Name: \-\(-)0\-)\Q.CAc P2 c'ck \' \o\ \
Business Location (including suite, space, etc.): 15 9 5 S kaN-Q. (�1 "1 Lt'caGecr3e
.
Business Phone#: S\ l a-04 1 H
1. Business contact name: YVV-1\ a "\\ \ c \\c1
Main Phone:(5cR1 "SL\C _ I cJ.--1 1 ; Secondary Phone:
Contact is coming from what town/village? 0,Ukee,ACI\DUkcj
2. Business contact name: 09A)/ALBE.N1 k- FATE
Main Phone: 5 8 9ac3 9107 ; Secondary Phone: ag 39 6 4 a y Ct
Contact is coming from what town/village? fI E_r-H A-M X C V2LLr
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8205/8026 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
DEPUTY FIRE MARSHAL TYSON CONVERSE DEPUTY FIRE MARSHAL JOHN SCHADWILL
Certificate of Occupancy Only Revised May 2024
•
288.8-1-5.1 2024-0335
Mohican Resort Motel
•
1545 State Route 9 \
Certificate of Occupancy \ ,r --
Abu RNrrrere_—_ _ __ _ __ -- ___ ___ _--_ — ___ _ _ _ _ _
Lands of
Lap of a Survey made for 1552 Route 9,EEC
1545 State Poore 9 to B.5203 P.10 \ \
Dated:June 2,2000
last Revised:kay1e.f 286 a.s
Filed In the Darren County Clerk's •
Office on May 31.2024 E
As Instt went Na 2024-3000035 '
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➢md Reference. 449.0' ��'I••N' 2
Meisel BorBos.Anfrrrr .B N�eri i
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Dated:A'ovem6er'3.2012 '� ��'• � •
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