CO-0438-2021 CERTIFICATE OF OCCUPANCY ONLY office Use Only
Permit#: Coll Z®ZI
APPLICATION Permit Fee: $ 11D"'
t irwrl cat t�xrnslrunr
742 Bay Road,queensbury, NY 12804 Invoice#:
P: 518-761-8206 or 518-761-8205 www.gueensbury.net
"This application is for occupancFTO
RNIZouw & �i1-ing a building permit"
CONTACT INFORMATION: UN 0 7 2021
OF OUEENSBURY
DING& CODES
• Applicant:
Name(s): me
Mailing Address, C/S/Z: L G 2-gO
Cell Phone: 5 tg ) - 7 Land Line:
Email: a
• Business Owner(s):^ j(f (� t
Contact Name(s): Mrs tt�. A \`1a�. ` 4l V�✓�c'
Mailing Address, C/S/Z: A/v 12
Cell Phone: _( S k Land L e: _( s(� ) LfC)
Email:
• Manager: t ^
Contact Name(s): wies
Mailing Address, C/S/Z: 7 (-oAve, A>1 i /V( z o
Cell Phone: _( gam_) C — Land Line: _( 516' _) `t0- �I Z
Email: CL k'c rob4j
• Property Owner(s):
Business Name: 7`{ r,
Contact Name(s):
Mailing Address, C/S/Z: 74 Q 12-S:-0 '/
Cell Phone: _( Si ) (���� I Land Line: _( )
Email: z
Certificate of Occupancy Only Revised June 2017
of Tinvn t�i.. 'y
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.gueensbury.net
BUSINESS INFORMATION:
Name of business: _ NI 6ALt .1 wKr e�� , Luc'
Address (including suite, space, etc.): U
J
-I ( , � 0 `�
Type of business (i.e.: retail, car repair, etc.):
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: e.A
Applicant signature: " ,-
Date: </ I / Zo -z I
Certificate of Occupancy Only Revised June 2017
Town of thxrn. uty
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: Z
Business Name: J Uch,4y L .. �,/ti�Se., ��
Business Location (including suite, space, etc.): -7 1 01- AQ'c R',h� ?•�e��
Business Phone#:
1. Contact name: �,��� Jr AA`�c
Main Phone:_( S(8� ) 2C0 — 3 7 c K' Secondary Phone:_( )
Coming from what town/village? -(e,
2. Contact name:
Main Phone: _( ) ; Secondary Phone:_( )
Coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 51 8-761-8206 F: 51 8-745-4437
FIREMARSHALCx"QUEENSBURY.N ET
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL GARY STILLMAN
Certificate of Occupancy Only Revised June 2017
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Northern Wardens LLC
74 Quaker Road, Suite B
CC-0438-2021
6/8/21
The following comments based on review of the submitted plans:
1) Verify Fire Extinguisher inspection & locations.
2) Locks & latches shall comply with 2020 NYSFC.
3) CO detection required.
4) Verify existing Exit & Emergency lights.
5) Verify storage & aisles
C---?-
Deputy Fi Marshal
Gary K. Stillman
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fi r e M a r s h a l 's Off i c e • P h o n e: 518-761-8206 F a x: 518-745-4437
firemarshal@queensbury.net • wwmqueensbury.net
1
,
302.6-1-62 CO-0438-2021
Northern Wardens LLC
74 Quaker Rd, Ste B
Certificate of Occupancy
D CEL772021
0
JUN 0
TOWN OF QUEENSBURY
BUILDING& CODES