CO-0421-2022 CERTIFICATE OF OCCUPANCY ONLY office use Only
APP ICA'� Q 0)N1011n8 Permit#: CO— -�q,21 - 2022
9nD JO NMOl
IRIONSW
Tom of Qgvensbun
ermit Fee:$
742 Bay Road,Queensbury,NY 12804 ��oZ d 0 111� nvoice M. 5�
P:518-761-8206 or 518-761-8205 www. ue
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business:�� �� n C kard, is
Business Address (including suite, space, etc.): 9-Oy vp - r -`in
Nq 2S--0L4
Detailed explanation of business (attach a separate piece of paper, if necessary):
'P1g 0�0 WWhU S-�Ud i 0
** *Please provide an accurate layout of your space showing
all wails, a db,, 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: I"; c O
Applicant signature: Date: 7 '" ) `" z
pp g
Property Owner name: co"r
Property Owner signature: Date: i -22
Certificate'of Occupancy Only Revised June 2022
Tb.m of Q_..bwy
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: —7 `- 1 "ZZ
Business Name: 1 Y 1`r �� nC.�NV
Business Location (including suite,space;etc.): a Go_q "IC?kr 1`en
(N b �O
Business Phone M.
1. Business contact name: '0cAv'Li f' l P9'� L<,CL r
Main Phone:_( 7Q8 ) G9 -�1Z'Z :Secondary Phone:_( )
Contact is coming from wheat town/village?
nU4�V\SC U('!.I
2. Business contact name: dam, r i ACIKGCrA.
Main Phone:_( j e6� �39_ :Secondary Phone:_( )
Contact is corning from what town/village? Luezw�loxA-L4
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 TYSON CONVERSE
Certificate of Occupancy Only Revised June 2022
Torn of(Zmcnabury
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:
Name(s): 12 y!, l
Mailing Address, C/S/Z: G P,~xg-S P1
Cell Phone: ( "[d$ ) Z cz Land Line: �)
Email:
• Business Owner(s):
Contact Name(s): La Lt
Mailing Address, C/S/Z: G Av Lei �). [3�A�yt��ur�1 , JOY It-now
Cell Phone:_(L ) 6�3 3�q Land Line: _( )
Email: Iaura�e�a�rLccirc� L) l
• Manager:
Contact Name(s): �Dcy.vl-itA R'IvL Cl�P
4
Mailing Address, C/S/Z:
Cell Phone: _( . ) Land Line: _( )
Email:
• Property Owner(s):
Business Name: uc�
Contact Name(s): V Y'
Mailing Address, C/S/Z: g ^ Y + 0 L Wq 12
Cell Phone: _(51 $ ) (Q—(fit-It0 Land Line:
Email: j Ohn C&yy hqcLu Ohm
Contact Person for Compliance in regards to this project: t3o�n NYC
Cell Phone: 4R, • L d Line: �" (Okl
)
Email: hn
Certificate of Occupancy Only Revised June 2022
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
The Pinckards
704 Upper Glen
CO-0421-2022
7/6/2022
The following comments are based on a review of submittals:
• Verify fire extinguisher location and inspection
• Location of exit/Emergency lighting appear adequate. Function test will be
required
• Lock/ latches shall comply with Chapter 10 of 2020 IFC.
• Verify paths of egress
• Verify clearances to electrical service panels
• CO detection is required, if source is present
• Knox Box key is required
• Verify Truss ID signage
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
iremarshal@queensbur</net ■ zuww.queensbumnet
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