2024-0382 CERTIFICATE OF OCCUPANCY ONLY Office Use Only
Permit#: ge49-41
7ir++n of(jtmn�bun �J 1 q � '4 Permit Fee:$ 1 f S 60
742 Bay Road,Queensbury,NY 12804 JUL 3 0 2024 Invoice#: �a
v-76(
P:518-761-8206 or 518-761-8205 www. u b r .net a.
TOWN OF QUEENSF3URY
**This application is for occu anc d`ntirwifijoh &ork requiring a building permit**
BUSINESS INFORMATION:
Name of business going in to location listed below. aL 5 (r, ,J;v4, yice ear),)
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Business Address (including suite, space, etc.):
Detailed explanation of business: 1U tch6. Chncc9 5-I�rJ,� -Q®r,secl or-)
�Ca -Po), (4arscers .
*** 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: l3f1-1?n
Applicant signature: ay 0, j no Date: 1/2Z 2L-j
Property Owner name: hc nn 011 c r-d
Property Owner signature: Date: 5 3C3 D.my
Certificate of Occupancy Only Revised May 2024
ru i Of(1 zc n.hun•
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:
Name(s): -nr-ol nCa
Mailing Address, C/S/Z: t1oloV y v /2 7004
Cell Phone: (5)-6 ) '521-7T7I, Land✓Line: ( r
Email: r-ccif Q6J �J jc�mai)-cam
if
• Business Owner(s): sorra as above
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _(_ ) Land Line: _(
Email:
• Manager:
Contact Name(s): &,V erCir-,Or)
Mailing Address, C/S/Z: 2c i Q 64)6, 7), f� ( j,, Falb i ) (; )Z$3c!
Cell Phone: _( 5i ( ) 6`7 - Land Line: _( )
Email: rc_ 1-C)I0yadrr al.1 -CiSr-r)
• 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: Cr-® );rya v
Cell Phone: (Si( ) - `7 cr7 ( Land Line: ( )
Email: r-pa -Cc�,7
Certificate of Occupancy Only Revised May 2024
--
ran.',argym,,burs
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: -7/Zz 2_6Z1{
Business Name: Ira 1 y
CC9nrli i-i-i vtl r-M'anCfa 7;arri 8 -E5-1-
Business Location (including suite, space, etc.): 29D
Business Phone#: Si.46) Z,/ —?9---7�
1. Business contact name: C.r-O lir)�' . 1-fAr)
Main Phone: SI' Z/—797,C ; Secondary Phone:
Contact is coming from what town/village? OVEansicv
2. Business contact name: em ) GrCJ r' an
Main Phone: ) 1 �--7 —i a ; Secondary Phone:
Contact is coming from what town/village? H ct5cn Fars
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
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BUILDING&CODES
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Reality Competitive Dance Team •
& 578 Aviation Road, Space 29D
Certificate of Occupancy
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/ . NOTE: THE DEPICTION HEREON DOES NOT CONSTITUTE A WARRANTY OR REPRESENTATION OF
ANY KIND.ALL MEASURES,DIMENSIONS AND DISTANCES TO BE FIELD VERIFIED BY TENANT.ALL
UTILITY LOCATIONS SHOWN HEREON ARE APPROXIMATE,EXACT LOCATIONS TO BE FIELD VEp
BY TENANT.
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NOTES:
TENANT SAIL REFER TO
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AND�NEN VERIFIED i/i ♦ ENT CONTRACTOR.
LOWER LEVELTENANTS
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SYRACUSE,NY 13202
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