CO-000254-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
4W Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000254-2015 Date Issued: Wednesday,November 4, 2015
This is to certify that work requested to be done as shown by Permit Number CO-000254-2015
has been completed.
Tax Map Number: 296.17-1-39
Location: 105 WEEKS RD
Owner: Whispering Pines Association,LLC
Applicant: CW1
This structure may be occupied as a: C/O only,transition living quarters
Location: 15 Needle Park Circle,Apt.4 By Order of Town Board
TOWN OF QUEENSSBBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the
Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
...... ........... .....
Community Development O ice
11 ,
Town of Qfleensbar'I/ • 742 lidli Road ` Q It, it 1'11, .N,'W 1 i4'L •1'So4 (7 •
I)nnidtialin. Director nfBuilding t*('nJr� ;\li�llrlrll. l'nlrre•r•. lrrr.\I,u.lnd
Crnig Brown, Zouing Adruini.lrnlnr-
NEW BUSINESS CERTIFICATE OF OCCUPANCY PERMIT
APPLICATION
TAX MAP # BLDG. PERMIT FILE# 25 6 2� 15
It applicable
Name of Business: Community Work and Independence, Inc. (CWI)
Address
of Business: 88 Broad St. QUESTIONS? CALL 761.8266 OR
EMAIL codes(@clueensburv.net
Person in Charge or Manager: Martha Bonan VISIT OUR WEBSITE FOR MORE
INFORMATION
Business Phone Number: (518)793-4700 X12135 www.auccnsburv.net
Type of Business: Not for Profit agency Providing community and residential services to persons with
developmental disabilities.
Owner of Property: Whispering Pines Association, LLC Phone Number(s): (518)793-3831
Home Cell
Owners
Address: P.O. Box 945 Brewerton. N.Y. 13029
Please provide an accurate layout of your store showing all Walls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sh(e�e,t.of paper.
Signature: IPILA' ( Date:
n
Of parson submitting Nis lam
Notes / Comments:
EMERGENCY CONTACT UPDATE
Please print clearly
DATE: 11/2/15
BUSINESS NAME: Community Work and Independence, Inc. (CWI)
BUSINESS ADDRESS: 88 Broad Street, Glens Falls, N.Y. 12801
BUSINESS PHONE: (518) 793-4700
PHONE 1: (518)761-9366
CONTACT 1: PHONE 2: (518) 793-4700
IRA Manager/Residential P C X12135, X12141, X12142
TOWN/VILLAGE RESPONDING FROM: Queensbury
PHONE 1: (518) 748-1400
CONTACT 2: PHONE 2:_(518) 791 -1716
Manager on call/Administrator on Call
TOWN/VILLAGE RESPONDING FROM: Varies
This form is used to assist Emergency Service personnel who may be called to
your business after hours. Please be sure that the persons listed on this form will
be willing and available to respond during off-hours to assist Police and/or Fire
personnel in gaining entry to your building.
PLEASE BE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERVICE
PERSONNEL MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACILITATE ENTRY BY
POLICE AND/OR FIRE PERSONNEL.
TOWN OF QUEENSBURY FIRE MARSHAL' S OFFICE
Phone: 518-761-8206 • Fax: 518-745-4437
firemmrshal@queensbui-it.net • znunn.queensburit.net
Fire Marshal Michael J Palmer Deputy Fire Marshal Gary K Stillman