CO-0113-2021 i
r =- CERTIFICATE OF OCCUPANCY ONLY office Use only
r
Permit#:
Permit Fee:$ �»
ria«n ut CLrrrn�bun D
742 Bay Road,Queensbu y 24dAR 15 2021 Invoice#:
P:518-761-8206 or 518-7 1-8 0 vvvu et-
TO N OF QUEENSBURY
BUILDINIG& CODES
"This application is for occupancy only, with no work requiring a building permit"
Gk
CONTACT INFORMATION:
• Applicant:
Name(s): W t<- ICI AJ�NHWA
Mailing Address, C/S/Z: •S acr\j D k p g ° h �2utiSw1Gl� , n! o g
Cell Phone: 08 S' ) S S� 4 (3 �3 Land Line: �)
Email: At-0V- @_RPr\JIi Sill NLRSiHLF- fah(
• Business Owner(s):
Contact Name(s): ALo(K_ iJ MmV W A L i J&r P_ U k'D\J
Mailing Address, C/S/Z: 59 tt, 4 oA-l- r-,R Na9" /3RU,vsivi&x NT 0 ? 4 0 L
Cell Phone: _(�°g ) 4 �3 Land Line: _( )
Email: LAM
• Manager:
Contact Name(s): tJ( (-O LL Po A RT H °L" /4 l>J
Mailing Address, C/S/Z: 2y �('Lc- Gf� 13LV� , QuP�v�i3Uu'C�' �f
Cell Phone: _( ) Land Line: _( ) TT
Email:
• Property Owner(s):
Business Name: ICI fl.M ART-
Contact Name(s):
Mailing Address, C/S/Z: 2 4 QUfkk (Zsl�a� lit-Un, y����P,��y , 1�1 y 12-9 C�
Cell Phone: _( ) Land Line: _(S IS ) -793 -73 0
Email:
Contact Person for Building & Code Compliance: �-
Cell Phone: Land Line: �)
Email:
Certificate of Occupancy Only Revised September 2020
limn of(�rc•rn.lwn•
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
BUSINESS INFORMATION:
Name of business: SM A-2TSTy L�l
Address (including suite, space, etc.): 2L NX&VZ es66F_ 6Lvt_-,� C C ry wNLM-(- TD
�,U r(zNS ('>U?-� , �j `-( I )_g o � -
Detailed explanation of business (attach a separate piece of paper, if necessary):
***Please provide 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: K Lot_ �Ij ki'�,N `"SA-
Applicant signature: ad Date:
Property Owner name: Kl A LM KT
Property Owner signature: Date:
Certificate of Occupancy Only Revised September 2020
Tcnvn of c,creen.hun•
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:
Business Name: S K-T-Sg-1 L(~
Business Location (including suite,space, etc.):
&-U&&NS (,U-'P�y , �J� 1 ZStiy
Business Phone#: LeS � 9) -7'�3 -7 -3 0
1. Business contact name:
La k Ai,,>nW-A
Main Phone:_( 4�Og ) 5 6 - � 8-2-3;Secondary Phone:_( )
Coming from what town/village? Vj ' P'J'MTh U IUS i U ILK
2. Business contact name:
Main Phone:_( ) ; Secondary Phone:_( )
Coming from what town/village?
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 September 2020
FIRE MARSHAL'S OFFICE
Town of Queensbunj
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Smart Style
24 Quaker Ridge Blvd
CC-0113-2021
10/15/2021
The following comments based on review of the submitted plans:
1) Verify Fire Extinguisher locations.
2) Locks & latches shall comply with 2020 NYSFC.
3) Verify CO detection. Wal-Mart has system in place.
4) Verify existing Exit & Emergency lights in space.
5) Verify aisles & storage.
Deputy Fire Marshal
Gary K. Stillman
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fire Marshal 's Office - Phone: 518-761-8206 Fax: 518-745-4437
-flremarshal@queensbitril.net ■ zvzvzv.queensbunl.net