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CO-0052-2023 } s . } CERTIFICATE OF OCCUPANCY ONLY - 6ebk-004 4. APPLICATION Permit'#: C'O—Q.052-'Z0 .. 'Permit Fee:$ �: 5 -Toll•n,drzs: 4ils`F, 742 Bay Road,Queensbury,NY 12804 Invoice#: - f P:518-761-8206,or 518461-8205 _www.aueensbury.net ' .**This application is for occupancy only;with-no work requiring a building permit** 4 BUSINESS INFORMATION: Name of business:: Business Address (includingsuite,space,etc. : 7S �4`� " �� = " .12 Detailed"explanation of business-(attach a-separate piece of paper, if necessary): t . RZIJ - { 0 PI ase pro :`de- an accurate .layout "of your space stio. . ail:wails, ;exits, .stockrooms, rest roonms, counters ana ;fixttWts . oin: 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 proviidedto the-Town of Queensbury Fire"Marshal's office. Fire extinguishing systems. . -found in kitchens and gas stations require semi-annual ins.pections.�.Any violations noted during an inspection require immediate corrective action and a.re-inspection, Applicant name: .f t�;Olt Applicant - signature: L - Date: - i Property Owner name: Property Owner signature (' ..: . ae: . _` p- 3 ! q . .Certificate of Occupancy Only FEB U.8 2023 Revised September 2022 s TOWN OF VJEENsBURY DES BUILDING EK: t:16 ;.; + .�.2 i i '/`inn of t7itt�n+biuj` _ i 742 Bay Road,Queensbury,NY 12804 . P:S18.761-8206 or S18-761-8205 www:aueensbury:net { } EM ERG ENCTCONTACT INFORMATION,- "THIS FORM IS USED T0:ASSIST EMERGENCY SERVICE PERSONNEL WHO MAY BE CALLED TO YOUR BUSINESS AFTER HOURS. PLEASE.BE SURE THE CONTACTS LISTED BELOWARE WILLING AND : AVAILABLE TO REPSOND DURING OFF-HOURS TO ASSIST POLICE.AND/OR FIRE PERSONNEL IN t 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:_t'7 h -� ------ Suit . Business Name:,. �r ; .Gir n._ _ .:�UeirS� Business"Location(includinge space,etc.::: 14i Business Phone#: © 1."-Business contact name:: ►-{ hoeek1.,%- Main,Phone•_( 5) )- b : . rS► :g '1:3`7D Zeconda Phone: 51 S 3`7:4► ...: :15 �1..- Contact is coming from what town/village -_ " 2. Business contact name: Main-Phone: - 3) -Secondary Phone, Contact is coming from,what town/village? . TOWN OF QUEENSBURY FIRE_MARSHAL:S OFFICE " P:51876:1-8206. F:51.8-745-4437 FIREtv1ARSWAL@QUE-ENS6URY:NE7`, FIRE MARSHAL MIKE-PALMER DEPUTY FIRE MARSHALTYSON CONVERSE E i t .Certificate of Occupancy Only. Revised september 2022- i. is S ' 4 5 i E i Town�<jttccri�fiiiri• 742 Bay Road,Queensbury,NY 12804 P.518461-8206 or 518-761-8205 fNfnrUu.giieen§burMeif } .CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE,.PLEASE INCLUDE AN EMAIL ; i 9 a y Applicant: Name(s): Mailing Address,C/S/Z: Cell Phone: 5'l;S:. . j!` � Land Line: ( - 3 a3 . ): Email: a :..D' Y ,m Business'Ownerf s):,: Contact Name(s):.fA7:'n .a, rfVYtCo Mailing Address,C/S/Z: . 4 = _ Cell Phone:..(-_ ) Land L-e: Emaii:- • Mana�er:� Contact Name(s): r;✓Mailing Address,C/S/Z: ,, Cell Phone:_( ) Land tine: _( ) Email: Property:Owner(s): Business Name:, Contact Name(s):;6r,A1�it ,.' -- Mailing Address C/S/Z:" , d na ui/'A112 >'1 . 1_' ' �� Cell Phone:._( �•):.�'` -�: �`7� ?, LandLine: ,,- Email: jCY .,/- ltl G7 Contact Person for Com ;liance: n regards to this project: PA VI IJ EA 11:e;k k i 'Cell Phone:. fi I: ::j rr Land Line: L61;R) Email:` i j Certificate of.Occupancy Only, Revised September 2022 � ' FIRE W RSHAL'S OFFICE Tozon of Queensbunj . 742 Bay Road, Queensbury, NY 12804 "Home of Natural Beauty ... A Good Place to Live " PLAN REVIEW Northern Rivers 375 Bay Road Suite 100 CO-0052-2023 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 • 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• Off ice Phone: 518-761=8206 Fax: 518-745-4437 firemarshal@giceensbury.net zuzvzu.queensbunt.net