CO-0157-2021 CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit#: 01
orn of(�i�cnsdiun' Permit Fee:$_
742 Bay Road,Queensbury,NY 12804 Invoice
P:518-761-8206 or 518-761-8205 www.gueensbury.net
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION: L� W
Name of business: p iVv O 1 �k D Qvf� VE
BusinessAddress (inclluding suite, space, etc.): ✓�f
Detailed explanation of business (attach a separate piece of paper, if necessary):
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SW� � � 5***Please provi a an accurate layout of your space 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: d✓�-e �
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Applicant signature. ,l/U C_ (1JGt - Date: If q a
Property Owner name:
Property Owner signature: k,f' a to G.Lacl le GL Date:
Certificate of occupancy Only Revised December 2020
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742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: Za cs�c leC,WL e C:
Name(s): �C}62tc�d 1 � d�f/ '� CvZ�� , /15Wq
Mailing Address, C/S/Z: five .) Sau-ft'
Cell Phone: Land Line: Le It : 5/�`-�}'Ft, - ,5rqc9 4 s ��- e9-
Email: �(,tC�� �dr2udl /`v9��`i�• 6cy;l
• Business Owner(s):
Contact Name(s): saw ecS 6Zt-h-'✓{
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
• Manager: ,,
Contact Name(s): AtikP
Mailing Address, C/S/Z: Cti S
Cell Phone: Land Line: vwt
Email: f�1,� (GPC�c)�D(rgif-o}ivLu�J C6711
0 Property Owner(s):
Business Name: � ' J aVW S j6e'L
Contact Name(s): f
Mailing Address, C/S/Z: P 0.
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line: LGI CJ'A pESL, -,Ft/ a
Email:
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Certificate of Occupancy Only Revised December 2020
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742 Bay Road,Queensbury,NY 12804
P:5:18-761-8206 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:
Business Name: &'h a fiU40 aai lle l_
Business Location(including suite,space,etc.):
Business Phone#:
1. Business contact name: Al i"
Main Phone: ;Secondary Phone:
Coming from what town/village? c�n S
2. Business contact name: �e v) e U
Main Phone: ;Secondary Phone: S/y- /- Z71/'9 Cj
Coming from what town/village? �)Ltl_k Y,
TOWN OF QUEENSBUR,Y 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 December 2020
FIRE MARSHAL'S OFFICE
Tozun of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Romeo Auto Outlet
674 Quaker Road
CO-0157-2021
3/29/2021
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• CO detection required
• Verify location and operation of exit/Emergency lighting.
• Lock/ latches shall comply with Chapter 10 of 2020 IFC.
• Verify paths of egress
• Verify storage
• Provide Knox Box for emergency entry, and entry key.
• Verify clearances to electrical service panels
Michael J Palmer
Fire Marshal
742 Bay Road
Queensbury NY 12804
firemarshal@queensbury.net
Fire Marshal 's Office • Phone: 518-761-8206 Fax: 518-745-4437
flremarshal@queensbury.net • 7 MMU.queensbuni.net