CO-0222-2022 CERTIFICATE OF OCCUPANCY ONLY office use only
APPLICATION Permit#: Go - 022Z-2o22
Totm of Qucensbun Permit Fee:$ I�nQYYut, '
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 re40 i g a ermit**
BUSINESS INFORMATION: T60hUIOp
Name of business: A100A hiSf-Ic 1�)c c�o���Ry
Business Address (including suite, space, etc.): I s 6e,Z.#C_ �
Detailed explanation of business (attach a separate piece of paper, if necessary): << —
�Dczj at nc ar?d Sc► yl/i ao�i���rs crne S44ccll Kee e44-e j/ _zVrAts
f zinc in k-c cv Cd of he l yr , f✓Ioq SST 10.Go 4.tn
***Please provide an accurate layout of yow space showier
all wails, exalts, stockrooms, rest rooms, co>®ters and des
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: ':::!Zecf1'c11ra yr `t f
Applicant signature: XvU AL4 Date:
Property Owner name:
Property Owner signature: Date:
Certificate of Occupancy Only Revised February 2022
Town ar(Lucrncbun,
742 Bay Road,Queensbury,NY 12864
P:518-761-8206 or 518-761-8205 www.aueensbury.net
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): -'S:ccl/' t44 v( k• Nv/,,C- a✓n
Mailing Address, C/S/Z: Cxaeen r I ZYIP
Cell Phone: sf r-P
Email: �Jct�of �fkRTf Ptzzc (/✓!kr!•c��"`
• Business Owner(s):
Contact Name(s): -�cli�;�� zd�j��/
Mailing Address, C/S/Z: $5 Mf cffc ¢ v-rCAA V", A/ "c
Cell Phone:_( s/�) 4YI -14W _( 5�8 ) 7Ah"Zd?'
Email: i+c
• Manager:
Contact Name(s): ����,✓� �"uUn4
Mailing Address, C/S/Z: 3 'lirar ✓c A,-nLk IS SUPM46 dc- 12d
Cell Phone:_( SI 7Rv'-20sy tarsd-ttr�; _ S/( e ) 7q(-y3(
Email: <<��
• Property Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/SjZ:
Cell Phone:_(� Land Line:
Email:
Contact Person for Compliance in regards to frf s nroge : ��%d%�h !✓�U//,.��f�
Cell Phone: Sl( of /`(// Land Line: �)
Email: Gt✓MAPt �AkR7X Mr-e,c rA) a/'� r •c ��
Certificate of Occupancy Only Revised February 2022
a 11 — -
Toam of QucrnsburY
742 Bay Road,Queensbury,NY 12804
P:518-761-8206or518-761-8205 www.gueensbury.net
EMERGENCY CONTACT INFORMATION
"THIS FORM IS USED TO ASSIST EMERGENCY SERVICE PERSONNEL WHO MAYBE CALLED TO YOUR.
BUSINESS AFTER HOURS. PLEASE BE SURE THE CONTACTS LISTED BELOW ARE WILLING AND
AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE AND/OR FIRE PERSONNEL IN
GAINING ENTRY TO YOUR BUILDING."
PLEASE BE ADVISED THAT FAILURE TO ASSIST EMERGENCY SERVICE PERSONNEL MAY RESULT IN
DAMAGE TO YOUR BUILDING BY POLICE AND/OR FIRE PERSONNEL.
Date: Z Z 2-
Business Name:_ �Ud� �sr/L )be' /I-
Business Location(including suite,space,etc:; /S 14
�c�ccnSy✓rY ,✓y ��$�`/
Business Phone#: sag 7,q e
1. Business contact name:
Main Phone:_( 579 ) X-/5111 :Secondary Phone:_( )
Coming from what town/village? V rGh S '0✓./
2. Business contact name:
Main Phone:_( SN 79a/-tqi 6 Secondary Phone:_( )
Coming from what town/village? a,/T✓hs
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P:54 8-761,8206 F: 518-745-4437
FIRE MARSHAL@QUEENSBURY.N E17
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised February 2022
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
LAN REUIiE '
Noon Whistle Deli
15 Lafayette St
CC-0222-2022
4/28/22
I have reviewed the submitted drawings for the above project; and offer the
following comments:
1) Verify Fire extinguisher locations & inspection.
2) Locks / latches shall comply with 2020 NYSFC.
3) Verify operation of existing exit/ emergency lights.
4) Verify CO Detection
5) Verify aisles & storage
Deputy Fire Marshal
Tyson Converse
742 Bay Road
Queensbury NY 12804
518 761 8205
garys@queensbury.net
Fire Marshal 's Office - Phone: 518-761-8206 - Fax: 518-745-4437
,firemarshal@queensburt/net - MVIV.queensbunt net
—moo i LAFhYETTF
w F,L'4 i
iMpa./
F
F�sr
rs
s7�✓F;
n
ern
- ate i
1
1 �D7
4 302.7-1-17 CO-0222-2022 i
Noon Whistle Deli
' 15 Lafayette St - — --
Certificate of Occupancy - ownership change