CO-0486-2022 IC EH
AUG 0 4 2022
iCtEATIFIC ATi OF OCCUPANCY ONLY Office Use Only
G s. r;Ol3 ES
____j Permit#: CD rC46(o -?�Z.Z
APPLICATION 11t�_
Town of cZuccnshun Permit Fee:�$ 41y
742 Bay Road,Queensbury,NY 12804 Invoice#: 5V�
P:518-761-8206 or 518-761-8205 www.gueensburv.net
"This application is for occupancy only, with no work requiring a building permit"
BUSINESS INFORMATION:
Name of business: jN1 I- a\ a 'k L &c--
Business Address (including suite, space, etc.): 6 len 54r,�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 fbdwes
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: `� �¢ tk ,-) �`_Z �12.
�i/l
Applicant signature(_ � 21�
Date:
Property Owner name:
Property Owner signature:
CL4 Date: )2
Certificate of Occupancy Only Revised June 2022
Toim or(2twcnsbun•
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: /�h �-
Business Name: I U �(,t \��� A
Business Location(including suite,space,etc.): 6 I--1 5+C Ec,-+
e-S� r- t U /- 0
Business Phone#: Q ' / 0
1. Business contact name: VIA L
Main Phone:_( S l�. )_`/ �� -7 U Secondary Phone:
Contact is coming from what town/village? Q'S =j ti.1
2. Business-contact name:
Main Phone:_( ) :Secondary Phone:_( )
Contact is coming from what town/village?
TOWN OF QUEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 F:518-745-4437
FIREMARSHAL@QUEENSBURY.NEr
FIRE MARSHAL MIKE PALMER DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised June 2022
Town of( rccnsbun•
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): i'v1 A k : ' .
Mailing Address, C/S/Z: L,, .C✓ems Se 5L AXA, /='> 113 iy-
Cell Phone: ( 5`l ij' ) j 3j - 9 -)oS Land Line: q_2
Email: Vvi @ vo 4-j i�4 l r�w �9 . r e
• Business Owner(s):
Contact Name(s): inn(
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _( )
Email:
• Manager:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone:_(� Land Line: _( )
Email:
• Property Owner(s):
Business Name:
Contact Name(s): A 1 ''
Mailing Address, C/S/Z: (,L
i
Cell Phone:_(� Land Line: _( )
Email: o
Contact Person for Compliance in regards to this project: vv� A-1-C I` i
Cell Phone: (.S(� ) `!3 `i --)a!F Land Line:
Email: v,\n Q r-,4,cA 1_,,, P r C a ^'i
V
certificate of occupancy Only Revised June 2022
FIRE MARSHAL'S OFFICE
Town of Queensbury
742 Bay Road, Queensbunj, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
AN REVUE '
M&M Digital Printing
726 Glen St
CO-00486-2022
8/1/2022
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) CO Detection
5) Purchase of a Knox Box for fire department Access
6) Verify aisles & storage
7) Fire Alarm NFPA 72 Inspection and Testing Report ( if applicable)
a 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
-flremarshal@queensbunt net - z WW,queensbuni net