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. _ CERTIFICATE OF OCCUPANCY ONLY .Office Use Only Permit:it:. CO - CAI( 2°2-C3 APPLICATION Permit Fee:$ -s TC11171 GireelOirry 74A Bay RoRoad;queen*uni,NY'r,12804: Inyoice#: P:518-761,8206 or 518-761-8205 iguiniv.clueensburvmet • **This application is for ocupancy onlyiw(th no work requiringa building pertrilt**' CONTACT INFORMATION: I: Applicant: Mpthe(s): Mailing Address, C/S/Z:12-0. 109(, S Ltle___ Ounfet•Cii _4)2.61 _ Cell Phone: ) g •;•-• 42G-I Land Line ( V11Y. ) Email: SekS3-RN6 -e naal:k-totk Business OWner(s): Contact Name(s):: 6AtY1 ) Mailing Address, C/S/Z: • Cell Phone: :( ) Land Line: _( ) Email: • Manager: • Contact Nanne(s)': Mailing Address,.C/S/Z: CellPhone:_( ) Land Line: ( ) I • Email: Property Owner(s): Business Name _ STA-CA ::B itk-x Contact Name(s): Snort-A Mailing Address, C/S/Z: 01-2-0 PikatVeLe— (Auv co phone: ) Land Line T51t ob Email Statt.-6 e h610, -.4\a‘reA . tovt Contact Person for Building& Code Compliance: ,),(10(16 ( ): Land Line: •( Email: Certificate of Occupancy Only ReVlsed December 2017 _ — — - Town c r ClgveniFury 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 www.queetisbumnet BUSINESS INFORMATION Name of business: g p ilMet_cr-s cw e.b.AJ /2--0-zwe Address (including suite, space,.etc -2 P ) .): 14 _0 rpi..„,s6(Aei \ M ° Type of business (Le,: retail, car repair, etc.): Pe_rson C,Nte tcS 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: .44'15 Applicant signature: -41 Date: 2074 Certificate of Occupancy Only Revised December 2017 , , . . . . . . . . . . . . . . . .:. .;,- . '1,••'-1. . • .::--0,74t_i.„,_,';.:,, • • ::,,0**.-,-.4-f.,..„,::, ....•.'n'P''—''''" -.' • • .. ...,--_-.,.., ..,...,..--.:. • 742 Rail:Road,AugenikilifVNY 12804 , pt151.8=7.61A32(.1§v$18.,76148265:. tiiiiiin&qudansbtitv!.nat .. ,., ._. . ........... INFORMATION EMERGENCY. • • ,CONTACT : . ,• 4:417HI5 FORM IS 1:I.S_Ef,1 TO ASSIST',EMERGENCY SERVICE PERSONNEL:WHO MAY ogscavo ToYciuR • 1310KSS.;;AFTEkHoW35,-IN:gAs .BE' 1)11E THE CONTACTS LISTED BELOW ARE'.WILLING AND AVAILABLE TO REPSOND DURING OFF-MaWig TO ASSIST POLICE:AND/OR Mkt PERSONNEL IN. GAINING ENTRY TO YOUR BUILDING:" PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE:PERSONNEL mAy RESULT.IN DAMAGETo youo giimpiNG.•BY:ObticgA.NIVog iF.I RE PERSONNEL.. ! . . .Dat6t. If 11•0 1 . )1 1, Businas5•Namez, 44. :SIAAA fb..471411(b1kLa-ys. 'LL(...„. *t_.2.___H- ( V67' t-e-AieA) 04.1.6:00g.Locgipn(iodutiitig.t.tii*vage,feta -,..•_ fl• '... . ' - - - .i • _ ,. .... . . ,--. . ,._. . - 1. ',t)eit'41- i' -)(6 _ :KAAJ. raP14- . . .. . ..._.. . .. --. - 13•Litines :Olo.h.e#: . 51 ,,._. .. -.., .. • .. - .:.. 1, •COntact.namet .:• ., ,,Se.4,. .:V- .. aAl, •_ )3-:: ._..... k ' .'....,)- ' . • ' - . .. .. Main Phone 2 5t.g. .) :76)1(0.„:ttAks . . ,;SeccindaryPhd06: (51g...)37.:---45.3 -.1-1-. ' 1 Coming frpmwnattoWiiiiiillage? v•.:4.71)._/-'—.W%-. LAV:ei KW... ..In1:2. .. .._.. _ 1 . I. • • • • -. 2 :Contact inarn0..S•ft-"(401,,„A..--7-g‘4,....),ip 5ig - •::04: 541,-4-- - mairiPharid.:: (91 : )114- 1ZI ,Secondary PhOne: ). .: - •••• - —.-, : : • .' ,.,-..i:-- , .,-1._—_-_-. . _.. . Coming from what town/village? .$ -1-1 -17.-A`.4...A., ,, t:In 1:71%'1).f... , . . . • TQw1S1•QFCILIEE.Nq3:PRY FIRE.IVIAR5IIALOFFIOIE , F:.;510.-X1,6159206 F 5 1•8474.5-44$7. .. FIREMARSHAIAQUEENSBLIW:NET: • , FIRE PIAR$El'Af.MIKPAU,VIER: DEPUTY Flftt MARSHAL GAIRY: ria,m_AN • . . ceoloitolsoeciiparprorijy. Avise51.pe001nber: 01/ 1 . .. ._ .. . . .. -..