2012-013 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
et Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20120013 Date Issued: Tuesday, January 24, 2012
This is to certify that work requested to be done as shown by Permit Number P20120013
has been completed.
Location: 379 BAY Rd
Tax Map Number. 523400-296-019-0001-033-000-0000
Owner: KENT& CHERYL SMITH
Applicant: UPSTATE NY AUTISM AWARENESS
This structure may be occupied as a:
Certificate of Occupancy (COM) By Order of Town Board
TOWN T V OFF QUUEENSBURY
f k-
Variance,Issuance of this Certificate of Occupancy DOES NOT relieve the -property owner of the responsibility for compliance with Site Plan, ''w 2E'or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120013 Application Number: A20120013
Tax Map No: 523400-296-019-0001-033-000-0000
Permission is hereby granted to: UPSTATE NY AUTISM AWARENESS
For property located at: 379 BAY Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Crooner Address: KENT& CHERYL SMITH Certificate of Occupancy(COM)
P.O. BOX 4396 Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name / Address Electrical Inspection Agency
Plans&Specifications
2012-013
UPSTATE NY AUTISM AWARENESS - CO ONLY
$0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,January 24, 2013
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town�f Que a 4�TuEs `vlxRpary 24,2012
SIGNED BY X!-_ for the Town of Queensbury.
Director of Building&Code Enforcement
... .. . . . . . . . . . . . . . . -
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York .12804
David Hatin, Director of Building& Codes E lSv LS V E
Craig Brown, Zoning Administrator• Michael J. Palmer, Fire Marshal
- IAIV732D12
ESTABLISHMENT OF ANEW BUSIN SS
yv�t�y,Q
CERTIFICATE OF OCCUPANCY PERMIT AP LI �( (&coDESRY
*Note: This application is for occupancy only, with no work requiring a building permit. �^v^
TAX MAP # / BLDG. PERMIT FILE# Z
I If(� / app ica e
Name of Business: ���51 (it/fl . N`7 ITt --hyy 1 l.(!w o (c(/l,Q Ss
Address n Qx�J�u 'A tj my
of Business: I(.5.�- QUESTIONS? CALL 767-6256 0R
1� EMAIL codes(dclueensbu rv.net
Person in Charge or Manager: Lyt I 1 � I ((7UaAt y-) SIT OUR W INFORBSITEMATION
FOR MORE
INFORMATION
q ` 2 www.aueensburv.net
Business Phone Number.
Type of Business: ND✓)— Vy k & (),'u �{ is ro a ( t ( Q✓? eL
Owner of Property: 1 Cn+- Jw Phone Number(s):
p� (� (� Home Call
Address: O'-C4A air j� ����_ ut e—VIS19V�4 IV y f-,)- ' `mil
Provide an accurate layout of your store showing all walls, exits, stockrooms, rest rooms,
counters and fixture layout on a'sI a Ipa�ral teI sheet of paper.
Signatur Date:
person submitting this forth
Notes / Comments:
EMERGENCY CONTACT UPDATE
TO: WARREN COUNTY SHERIFF'S DEPT. FAX. 743-2502
PLEASE RINT
DATE: L
BUSINESS NAME: Apo �
BUSINESS ADDRESS: 66k--/ �J � � (M b V 12�O q
BUSINESS PHONE:
CONTACT 1: � �/ HOME PHONE
ADDRESS: , O (J U l� CGC C",
CONTACT 2: 1� Y 1� �YV� HOME PHONE I b — Jd L/
ADDRESS: (11ct �� UVI QUe �hS� JU�1
This form is used to assist Emergency Service personnel who may be called to your
business after hours. Please be sure that the persons listed on this form will be willing
and available to respond during off-hours to assist Police and/or Fire personnel in
gaining entry to your building.
PLEASE BE ADVISED THAT FAILURE TO RESPOND TO ASSIST EMERGENCY SERVICE PERSONNEL
MAY RESULT IN DAMAGE TO YOUR BUILDING TO FACILITATE ENTRY BY POLICE AND/OR FIRE
PERSONNEL.