CO-0016-2021 CERTIFICATE OF OCCUPANCY ONLY office Use Only
APPLICATION Permit M C'O ' CAW ( • 2-0Z 1
TaKmofQirecncbury QL Permit Fee:$
742 Bay Road,Queensbury,NY 12804 Invoice#: 6 1 "P
P:518-761-8206 or 518-761-8205 www.aueensbury.net
"This application is for occupancy only, with no work-requiring a building permit"
CONTACT INFORMATION:
• Applicant:
Name(s): Michael Alford/ Burch Bottle & Packaging
Mailing Address, C/S/Z: 430 Hudson River Rd, Waterford, NY 12188
Cell Phone:( 518)369-6245 Land Line: (518)273-1845 x104
Email:malford@burchbottle.com
• Business Owner(s):
Contact Name(s): Michael Alford
Mailing Address, C/S/Z: 430 Hudson River Rd, Waterford, NY 12188
Cell Phone ( 518)369-6245 Land Line: (518)273-1845 x104 t��1E0
Email:malford@burchbottle.com D
Email:malford@burchbottle.com BAN 1 �+ 2021
• Manager: TOWN OF QUEENSBURY
Contact Name(s): BUILDING&CODES
Mailing Address, C/S/Z:
Cell Phone: Land Line
• Property Owner(s):
Business Name: 428 Corinth Rd LLC
Contact Name(s): Michael Alford, George Ide IV, Daniel Rainville, George Ide III
Mailing Address, C/S/Z: 428 Corinth Rd, Queensbury, NY 12804
Cell Phone: ( 518)369-6245 Land Line: (: (518)273-1845 x104
Email:malford@burchbottle.com
Contact Person for Building & Code Compliance: ): Michael Alford
Mailing Address, C/S/Z: 430 Hudson River Rd, Waterford, NY 12188
Cell Phone: (518) 369-6245 Land Line: (518) 273-1845 ext. 104
Email: malford@burchbottle.com
Certificate of occupancy Only Revised February 2019
r
Torn of Qucensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
BUSINESS INFORMATION:
Name of business: Burch Bottle & Packaging, Inc.
Address (including suite, space, etc.): 428 Corinth Rd, Queensbury, NY 12804
Type of business (i.e.: retail, car repair, etc.): Packaging Distribution Company
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: Michael Alford
Applicant signature:-Z
✓��
Date: 1/12/21
Certificate of Occupancy Only Revised February 2019
Town of Quccnsbuq•
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.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: 1/12/21
Business Name: Burch Bottle & Packaging, Inc.
Business Location (including suite, space, etc.):428 Corinth Rd, Queensbury, NY 12804
Business Phone#: 518-273-1845 x104
1. Contact name: Michael Alford
Main Phone (518)369-6245;Secondary Phone: (518) 893-0332
Coming from what town/village?Greenfield Center, NY
2. Contact name: Dan Rainville
Main Phone: (518-369-5221);Secondary Phone: ( )
Coming from what town/village? Ballston Lake
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised February 2019