CO-000254-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: CO-000254-2017 Date Issued: Friday, June 23, 2017
This is to certify that work requested to be done as shown by Permit Number CO-000254-2017
has been completed.
Tax Map Number: 303.19-1-71
Location: 308 DIX AVE
Owner: K Mart
Applicant: Phantom Fireworks Eastern Region,LLC
This structure may be occupied as a:Certificate of Occupancy for 20 ft.by 40
ft.TENT By Order of Town Board
June 22,2017 thru July 4,2017 TOWN OF QUEENSBURY
Temporary Structure
Cross Ref.P-SSE-0006-2017(Special Sales Event)
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
OL Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: CO-000254-2017
Tax Map No: 303.19-1-71
Permission is hereby granted to: Phantom Fireworks Eastern Region,LLC
For property located at: 308 DIX AVE
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Tyne of Construction
Owner Name: KMart Certificate of occupancy $0.00
Owner Address: Total Value $0.00
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
Certificate of Occupancy for 20 ft.by 40 ft.TENT
June 22,2017 thou July 4,2017
Temporary Structure
Cross Ref.P-SSE-0006-2017(Special Sales Event)
$0.00 PERMIT FEE PAID-TMS PERMIT EXPIRES: Tuesday,June 19,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Q eens onda , m J9,2017
SIGNED BY: ` for the Town of Queensbury.
Director of Building&Code En orcemen
=f,/JO
Town of Queensbury Fire Marshal
-I) ,�
ESTABLISHMENT OF A NEW BUSINESS ti 3; f 9-l�7/CERTIFICATE OF OCCUPANCY PERMIT APPLICATION � ?'Note: This application is for occupancy only,with no work requiring a building permit. ,ti I- e
Name of Business Pd..9wirm d=1.eewo J2I:s
Address 301r A i X q Ve*
Type of Business /? `v eF JVY SNFE /°rI .OtOO C r� O tip r�
Manager l� L� V t5 D
OR
Person in charge _V-1ye'BJ✓ 7 cSY q B D
Business Phone No. S/1}-12S7-OVA-? TOWN OFQUEENSBURY
COMMUNITY DL'_-ELOPMENT
Property Owner /►1 WPA'
Address V f A Ore Rd&
Phone XY 7 -443 — ISS/
✓Provide an accurate layout of your store showing all walls,exits,stockrooms,rest rooms,counters,and fixture layout on a
separate sheet of paper.
Print Name: Ar/dT ,$zagoD
Signature:
Date: S-/4-17
Notes 1 Comments:
303.19-1 -71 CO 254-2017
Certificate of Occupancy for 20 ff. by 40 ft. TENT
June 22, 2017 thru July 4, 2017 Phantom Fireworks
Temporary Structure Tent at 308 Dix Ave. / K-Mart
Cross Ref. P-SSE-0006-2017 (Special Sales Event) C/O June 22 thru July 4, 2017
IMPORTANT: The business owner is responsible for keeping exits clear and maintaining exit signs and emergency lights. Fire
extinguishers,fire sprinkler systems,and Tire 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 during 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-761-8220
Town of Queensbury Fire Marshal—New Business Permit 518-761.8206
EMERGENCY CONTACT UPDATE
Please print clearly
DATE: -5-
BUSINESS
BUSINESS NAME:
BUSINESS ADDRESS: J99' r01 X nV&_
BUSINESS PHONE: SLS7-0%C%r
f PHONE 1: S/8"oZa7•° Yb8
CONTACT 1: PHONE 2:
TOWN/VILLAGE RESPONDING FROM:
PHONE 1: S'!8" 61i-
CONTACT 2: PHONE 2:
TOWN/VILLAGE RESPONDING FROM:
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
fCremarshal@queensbu!�L.net • 7vmzv.queensbui3l.net
Fire Marshal Michael r Palmer Deputy Fire Marshal Gary K Stillman
20 x 40 Tent Layout and Table Bunting Guide
VERY IMPORTANT
This side towards street or busiest area of shopping center - See placement guide
Dashed lines = Walls Open During Business
11111111IM!""m liltI
I
I
water Fire extiguisher on rear table
Entrance/Exit Entrance/Exit
I Wrap bunting all the way on these tables because I
I Hang EXIT customers will see both sides of the tables Hang EXIT I
sign here sign here
I Hang 1 fire Wrap these tables 3/4 the way around because Hang 1 fire I
I extinguisher on customers will not see the back tables extinguisher on I
either one of either one of
(` these tent poles these tent poles
t� Employee
only area
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2V
a'
LO
N
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Solid lines = walls Closed ,e
Product should be placed according to price.Start with the lowest priced Item andthen work yourwayaround the tent IN NUMERICAL ORDER. H
All items that are priced the same should BE RIGHT NEXT TO EACH OTHER.This is VERY IMPORTANT to ensure a smooth buying experience. Y > >
OQ L
3 x n
all merchandise by price order ^ i N
Co
W
E rci
Green Table- Place your register and safety table information on this table as outlined on the o C
safety table document ri a c 0
U
Always comply with ALL local fire department requests,even if it requires changes to this layout guide.