application „ ,, CERTIFICATE OF OCCUPANCY ONLY Office Use Only
^
is Permit#: C O L% d)am , /Q
APPLICATION elj
.,,: .; .. Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: W«
P:518-761-8206 or 518-761-8205 www.queensbury.net W/1404P 303 . lC0-4—31
**This application is for occupancy only, with no work requiring a building permit**
CONTACT INFORMATION: i\)C&vi Opie n I?O Ct.C1 3ctrale
• A licant: Bosh{?“ ..
Name(s): .�vai'y L, jGkirc,,, g.o'�''a-+&yn T e G, ►� Son
Mailing Address, C/S/Z: (Oti° C( ^)rll� Q4 N(I,tLer4i c N'f( /27ON
Cell Phone: ( VI. ) 32I^ 16Q, Land Line: GI- ) 7i-0' 6
Email: nP-G,N d 4arosle @ yr,cti Ii t
04h Orel ea a oti&, j c@ g0-,aiL. com
• Business Owner(s):Contact Name(s): dOtick 7iyr L, Joky
sa
Q, J E C EE
Mailing Address, C/S/Z: '1 73 Ply {\ve auep,, (V IZQ 1-{
Cell Phone: _(_ ) Land Line: _( ) ,)U(`1 2 4 2019 \,
Email:
TCV N CM- uOtTNSBUR1
COMMUNITY DEVELOPME
• Manager:
Contact Name(s): JohC, 7n �leIhsort
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _( )
Email:
• Property Owner(s):
Business Name:
Contact Name(s): 14.)iL. ia."-.. X C-1.61-1-�ci4 Oe,,,,,te-H-”
Mailing Address, C/S/Z: Li'7 3 n I?e ,4-t,-c- ecku-e / Ajv /radii,
Cell Phone: _( ) Land Line: _( ) (�
Email:
Contact Person for Building & Code Compliance: To►-, a-1. .yrl c�d1-lhso ri
Cell Phone: ( ) Land Line: ( 1 )
Email:
Certificate of Occupancy Only Revised December 2017
r
303.16-1-31
Open Road Garage CO-0436-2019
473 Dix Ave
Tmn��((rxrn.hur Certificate of Occupancy
742 Bay Road,Queensbury, NY 12804 y Only
P:518-761-8206 or 518-761-8205 www.queensbury.net
BUSINESS INFORMATION:
Name of business: c .p-qv Rom,
- J
Address (including suite, space, etc.): " ( 73 L7v Ue/tAt
(teeNbvt/ V'( () Jc (
Type of business (i.e.: retail, car repair, etc.): /'470.
Please provide an accurate layout of your store 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: �aL k/5-c44,
p hv/v
Applicant signature:
Date: ‘72_ / a/9
Certificate of Occupancy Only Revised December 2017