2024-0093 ' r
CERTIFICATE OF OCCUPANCY ONLY Office Use only
APPLICATION Permit#:
ToH7n of Qirccnsbury
Permit Fee:$ �B2
24
742 Bay Road,Queensbury,NY 12804 Invoice#: 2-0 "
P:518-761-8206 or 518-761-8205 www.queensbury.net
**This application is for occupancy only, with no work requiring a building permit**
BUSINESS INFORMATION:
Name of business: Ro,e,en N1 C _.
Business Address (including suite, space, etc.): -3 ea G1\Er\
ce¼e h hu r taut
Detailed explanation of business (attach a separate piece of paper, if necessary): Li -
S`,\ be- a CA 0c,rloAI DR1( , ssDe C)krA \ (AV Vk hver-AyS-
- ot\c cr\6
***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: Naclh e-V 0 c coo r\
Applicant signature: ///4 p Date: 021 2..3i 2.0 2.24
Property Owner name: f L. tL p 11(-3 0 7 s
Property Owner signature: ,��s. �� � Date: 0 2I 20 214
Certificate of Occupancy Only Revised September 2022
n_,..,-.
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Town of C�rccnsburr
r
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 www.queensburv.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: Oa J i ` RoaL\
Business Name: U v€tI 1 N C "O�\
Business Location (including suite,space,etc.): —I ( )1 @t\@r\ WIR.."0)
(NQ,ef\ bk.KU I I\ J \ (a(�®L
Business Phone#: ( 2\ ) 2 0\ 401 a,
1. Business contact name: NC heX mahkc1I 1
Main Phone:_( pa kR ) 2,V1 1)l) 13._. ;Secondary Phone:_(N S ) 513 OK II
Contact is coming from what town/village? I"1 E\(\i'Q O4f (A I AlbCUI
2. Business contact name: PTYIAC ea DhCbcon
Main Phone:_(qV\ )\ 1 144 1\ ;Secondary Phone:_(, )
Contact is coming from what town/village? NCM- r\
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 September 2022
Town of C�rccnsbury
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): Nac er D hobCAG\
Mailing Address, C/S/Z: In 46 1-kudcO n PU e- . i��. 1 Sty\11>vcV$e.°‘ Ny, al 90
Cell Phone: ( 2_\$ ) 2�(7i '40 tz Land Line: (S1 Z ) 5)1?) Ot3 \\
Email: Q nd recaV ail • CO n'\
• Business Owners :
Contact Name(s): QG es orylbcon
Mailing Address, C/S/Z:
Cell Phone:_( ) Land Line: _(
Email:
• Manager:
Contact Name(s): h11OY&2Gl 1*'c han f1
Mailing Address, C/S/Z: 1,04(o 1-Auds.on Jk1je . T\?-. P Ski\vrnk e 'Ny )a(90
Cell Phone:_(9-0 k ) \ Lk14 1 Land Line: _(
Email: d\rlai r\011(iVeCkP,„Cr1G1t
• Property Owner(s):
Business Name:
Contact Name(s):
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(
Email:
Contact Person for Compliance in regards to this project:
Cell Phone: ( ) Land Line: ( )
Email:
Certificate of Occupancy Only Revised September 2022
44% FIRE MARSHAL'S OFFICE
._� 1 Town of Queensbury
f 742 Bay Road, Queensbury, NY 12804
"Home of Natural Beauty ... A Good Place to Live "
PLAN REVIEW
Queen NYC Deli
731 Glen Street
2024-0093
Certificate of Occupancy
02/28/2024
I have reviewed the submitted documents for the above project, and offer the
following comments:
1. Verify fire extinguisher location(s) and current inspection tag(s)
2. Verify paths of egress
3. Verify storage
4. Verify clearances to electrical service panel
5. Verify locations of and perform function test of all exit and/or emergency
lighting
6. Verify installation of CO detection
7. Verify locks and latches
8. Order Knox Box system
a. Verify Knox Box installation and keys that are to be provided for FD
access
9. Need current hood inspection/cleaning report
10. Need current fire suppression inspection report
11. Complete emergency contact form
12. Confirm that there will/will not be any tables/chairs for dining for patrons
13. Confirm removal of hood & suppression system from front of store
(former hot dog cooking/prep station)
Fire Marshal's Office • Phone: 518-761-8206 • F a x: 518-745-4437
firemarslual@queensbury.net • www.queensbury.net
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Deputy Fire Marshal
John Schadwill
742 Bay Road
Queensbury NY 12804
518 761 8206
schadwillj@queensbury.net
•
Fire Marshal's Office • Phone: 518-761-8206 ■ Fax: 518-745-4437
firemarshal@queensbunj.net • www.queensbunf.net