2002-115 BP File# -J I
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Dept. of Community.Development �`✓Esl"�1f1Cc�'�e d �
EDTown of Queensbury �,, ��
742 Bay.Road FED � � 2QG�
Queensbury, NY,12804
(518) 761-8256 TOWN OF QUEENSBURY
C DE occupancy-only, with no work requiring buildingPermit: nofee re uiredfor t si m "
Name of Business: 490 0/ S/ny 20 0
Address: P S, SU �Tt
Person in Charge or Manager:
Business Phone Number: 79 > 7Y3
Type of Business: (i.e.,mercantile,restaurant,hobby shop,plumbing store):
R00--pox
Owner of Property: 14 ess T_t.`4a
F;
Address:
Phone Number:
Please provide an accurate layout of your store showing all ivalls, exits, stockrooms, rest rooms,
counters and fixture layout on a separate sheet ofpaper.
Signature: f Date: C'r of person submi ting this form:
Property Tax Map No. / I
Notes/Comments:
I RE-
Y`C)NAINI OF C;lLJF=E=M3E3UF,`Y
"'Y -12804
(518) 76-1-82O5
FIRE I ECTI(DN REP(DRT
RE U T RE EEIVEID RMIT
,0
NA k& I'> era (--,5
L(D ATIC3N 44 A v
z
SCH IDULE INSPECTION C:)N
�JQPfutPM NYTIME
APPROVED
N/A YES NO
EXITS
AISLE WIDTHS
EXIT SIGNS
EMERGENCY LI(33;HTlw. 0
FIRE EXTINGUISHER X:
FIRE ALARM SYSTEM
\
FIRE SPRINKLER SYSTEM
FIRE SUPPRESSION SYST M
HOOD INSTALLATION
INTERIOR FINISHES
STORAC3F=:
CLEARANCE T0:/1S RI I*lg L.EE
CLEARANCE TO EATI UNITS
REQUIRED SIC3NA(:3E
CHIMNEY
WOOD STOVE
FIREPLACE - MASOJOR-Y
FIREPLACE - FA0TF:;,,Y" BUILT
REMARKS: OK TO THIS DATE
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