CO-0047-2023 r:
CERTIFICATE OF OCCUPANCY ONLY ofriceuseoniv
F f`� APPLICATION Permit#_Co-CQA� - 2026
_
Toctin ofQucrnstrun• Permit Fee:$ `CL ✓
742 Bay Road,Queensbury;NY 12804 Invoice#:
P:518461-8206 or 518-761-8205 www.gueensburv.net
ECER V E
This application is for occupancy only, with no vpc rj�-rupri hig�a bull permit"
BUSINESS INFORMATION: FEB 0 6 2023
TOWN OF QUEENISBURY
Name of business: OR-Wt-, ) KOTAL LA6 R1 III n NG& CODES
Business Address (including suite, space, etc.): � r_LZ ��� : �`„,7-r Z
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 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:
Applicant signature: Date: 1.126 2
Property Owner.name: •14 ►Kc- J�_,ft Cep
Property Owner signature: Date:
Certificate of Occupancy Only Revised September 2022
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Tower of Qucrnabu
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensbury.net
CONTACT INFORMATION:-PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• _Applicant:
Name(s): NuelL Vx)m
Mailing Address, C/S/Z: '2fo 1% � 9, . �G�►rsRcs �;� - jnl�xe-,jJUti1 l 1 �L
Cell Phone: ( Sto) ) Si7-gpZJ Land Line:
Email: C14 u huL4,& ('�►-j
• Business Owner(s):
Contact Name(s): C
Mailing Address, .C/S/Z: .
Cell Phone:_( SPAS' ) Z 39 -b i i1 Land Line: _( )
Ema i l: VoCu i ti it nit�_r- I)r ; c Zya
• Manager:
Contact Name(s): l uuGt. loorue-
Mailing Address, C/S/Z:_(� ttk �i� Sw r� 2 (�� � 1 1200
Cell Phone:_( 5;10 Land Line: _( )
Email: Ct�lUl'Y�A� Cfltk�E �yu-ckLLi��, 4�
• Property O.wner(s): c-
Business Name: OLD ep-t"L- LTt rLG-
Contact Name(s):. RIM Fi&a-o
Mailing Address, C/S/Z:
Cell Phone:_( 462- Land Line: _( )
Email:
Contact Person for Compliance in regards to this project: C geti- V[Uo r--V-
Cell Phone`( Lh ) Sil A yM- Land Line:
Email:
Certificate of Occupancy Only. Revised September 2022
I f ,
Tosim of CLcYnsbun
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: 0 123
Business Name:
Business Location (including suite,space,etc.): dU4?,A: P.11, �II IZM<* -, aurew-silaw
Business Phone#:
1. Business contact name:
Main Phone:_( SLR ) 511 q1)2 7 ;Secondary Phone:_( )
Contact is coming from what'town/village?C-,ALAr,-Qct•• f . Ivy
2. Business contact name:
Main Phone:_( ) :Secondary Phone:_( )
Contact is coming from what town/village?
TOWN OF 0UEENSBURY FIRE MARSHAL'S OFFICE
P: 518-761-8206 'F: 518-745-4437
FIREMARSHAL@QUEENSBURY.NE-r
FIRE MARSHAL MIKE PALMER. DEPUTY FIRE MARSHAL TYSON CONVERSE
Certificate of Occupancy Only Revised September 2022
FIRE MARSHAL'S OFFICE
Town of Queensbunj
742 Bay Road, Queensbunj, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Crane Dental Lab
63 Quaker Road, Suite 2
CO-0047-2023
2/8/2023
The following comments are based on a review of submittals:
• Verify fire extinguisher location and.inspection
• Verify paths of egress
• CO detection is required
is Locks /Latches to comply with Chapter 10 of IFC
• Provide Knox Box and entry key for FD
• Function test exit/El lighting
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
firemarshal@queensburj.net zvzvzu.queensbum.net