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2015-205 Speedway 1411fti TOWN OF QUEENSBURY '� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 0,40 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150205 Application Number: A20150205 Tax Map No: 523400-309-010-0001-038-000-0000 Permission is hereby granted to: FST ENGINEERS INC. For property located at: 81 MAIN St 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 Owner Address: HESS RETAIL OPERATIONS LLC PO BOX 1580 St Sign SPRINGFIELD OH Total Value Contractor or Builder's Name/Address Electrical Inspection Agency PHILADELPHIA SIGN COMPANY 707 W SPRING GARDEN St PALMYRA NJ 09065-0000 Plans&Specifications BP 2015-205 Speedway 24.56 sq. ft. wall sign- change of copy from Hess to Speedway Location on site map identification: E04 $0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 18,2016 (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 T n of eens ry A► • , • ugust 18, 2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement f Office Use Only Town of Queensbury Building & Codes Received: SIGN PERMIT APPLICATION �" Tax Map ID:' 5.(5q .10 -1_ 3(e Permit No.: r6/-��Sr Permit Fee:' $ h C, _— !% ' _ .4.0 MAY 2 6 2015V ( / Date S a ,)..c4) Applicant FST Engineers Inc . ( Tax Map ID 309 . 10-1-38 Address 534 Broadhollow Rd. , Suite 305 Zoning CI Melville, NY 11741 Hess Retail Stations LLC doing business as Speedway Philadelphia Sign Co. Property Owner ContractorlAgent: Address One Hess Plaza Address 707 West Spring Garden St . Woodbridge, NJ 07095 Palmyra, NJ 09065 Phone 732-750-6192 Phone 856-829-1460 Contact Person for Sign Code Compliance: Debra Cianciulli of FST Day Phone: 631-756-2841 Building Street Address: 81 Main St . , W. Glens Falls, NY Site Plan,Variance,or Subdivision Approvals .1- Location rLocation of proposed installation Existing wall sign reface o 0 LU Business Complex/Plaza/Mall name !V Q Business name Speedway T Co Type of Sign proposed `0 a) If sign is to be illuminated, indicate x internal external Incandescent neon other w 0- c Do signs currently exist on property? X Yes No(if yes, list all existing signage) CO o c Change of word/copy From Hess Express to Speedway o Sign Wording/Copy Speedway co(.) O Sign Size Length 11 ' 4 x Width 26" =Total sq.ft. 24 . 56 J Sign Height(freestanding) Q Color& Material to be used red ca 2 .�0 This application creates a change in the New 3 tii = o following existing site conditions(fill in all Change in number of signs from to W .� 3 c applicable spaces) Change in setback for sign from toCD CL u7 m Change in size from to ° N 0 Change in height of sign from to I Declaration: To the best of my knowledge, the statements contained in the application, together with the plans and specifications submitted, are a true and complete statement of all proposed work to be done on the described premises and that all provisions of the Zoning Ordinance, and all other laws pertaining to the proposed work shall be complied with, whether specified or noted, and that such work is authorized by the owner. APPLICANT-PRINT NAME L1&Debra� � Cianciulli of FST APPLICANT-SIGNATURE: U/x Co244/rceati Date: 5 ")) Declaration: I hereby authorize the applicant to place a sign on my property or building: OWNER-PRINT NAME: 14 . A� j b ISA-'G'bf'Llk / OWNER-SIGNATURE: P- ✓1Av"" Date: f,4 /S Town of Queensbury Building&Codes Sign Permit Application 518-761-8256 H.A.(Andy)Lautenbacher,PP Permit Manager Speedway LLC One Hess Plaza Woodbridge,NJ 07095 732-750-6192 732-750-7038(fax) Dalouten bacAsoeMke,cel May 7, 2015 Re: Speedway sign reimaging To Whom It May Concern, As property owner of the site indicated on the applications being submitted to your department € give permission to FST Engineers inc. to submit all applications for the sign reimaging. Thank you, H. A. Lautenbacher;. Manager, Permits Speedway LLC 732-750-5152 An Client#: 122011 PHILSIG ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)5/08/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME:ACT Mary Ann Masullo Huntington Insurance, Inc. PHONE 412-667-6544 F"X 877-489-9126 (A1C,No,Ext): IANC,No): 310 Grant Street,2nd floor DREADSS: maryann.masullo@huntington.com Pittsburgh, PA 15219 INSURER(S)AFFORDING COVERAGE NAIC# _INSURERA:Phoenix Insurance Co 25623 INSURED INSURERB:Travelers Property Casualty Co 25674 Philadelphia Sign Company , INSURER C:Travelers Indemnity Company 25658 707 W Spring Garden St INSURER D: Palmyra, NJ 08065 INSURER E: . INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR W pR POUCY NUMBER (MMM/DDDY/YYYY) (MM/DDS) LIMITS A GENERAL LIABILITY 6604B139679PHX14 12/31/2014 12/31/2015 EACH OCCURRENCE $1,000,000 PRE X COMMERCIAL GENERAL LIABILITY MISES(EirolITErrence) $100,000 CLAIMS-MADE X OCCUR MED FRCP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 _GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY JPERT n LOC $ C AUTOMOBILE LIABLITY 8103203R4531ND14 12/31/2014 12/31/2015Ea OMacaBwdent) �EosINGLELIMIT 1,000,000 ( X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) B X UMBRELLA LIAB X OCCUR CUP4B139679TIL14 12/31/2014 12/31/2015 EACH OCCURRENCE $20,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $20,000000 DED X RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITYTORY I IMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ I OFFICER/MEMBER EXCLUDED? N 1A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Queensbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN 742 Bay Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12801 AUTHORIZED ,REPRESENTATIVE IZ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 1028463/M968411 PADI1 NNInsurance NEW JERSEY MANUFACTURERS INSURANCE COMPANY Group 301 Sullivan Way,West Trenton, NJ 08628 609-883-1300/www.NJM.com CERTIFICATE OF WORKERS COMPENSATION INSURANCE INSURED Philadelphia Sign Company 707 W Spring Garden St Palmyra NJ 08065 PROJECT Operations in the State of New Jersey POLICY NO. W22515-1-15 EFFECTIVE 06/01/2015 EXPIRING 06/01/2016 This policy insures the obligations imposed upon the Insured by the provisions of the Workers Compensation Law of New Jersey. The limits of liability for Part Two- Employers Liability-under this policy are as follows: Bodily Injury by Accident$1,000,000 each accident, and for Bodily Injury by Disease$1,000,000 policy limit, $1,000,000 each employee. NOTE: Waiver of subrogation and/or inclusion of interests not owned in the majority by the insured are not permitted under this policy by New Jersey Workers Compensation Statute. If this policy is cancelled prior to expiration, the company will provide the certificate holder named below with thirty (30)days advance notice of such cancellation, unless the policy is cancelled for nonpayment of premium, in which case ten (10)days advance notice will be provided. With respect to the New Jersey Compensation law, coverage extends to New Jersey employees emanating from the State of New Jersey. The issuance of this Certificate imposes no liability on the Company beyond that provided by the terms, conditions and exclusions of such policy as are described above by policy number, effective and expiration dates. P_f , CERTIFICATE HOLDER Town of Queensbury 742 Bay Rd Queensbury NY 12801 ISSUE DATE 05/12/2015 PNp Gl PNp AEPNR FEGUAR 6Y NEW CONsIAU�D�ONQU'fleo l v°SEMG°"i 1 A I PXF. eA, s. - ( 1481'43'20"E 190,18' EM I STORY RESIDENCE I i . 011 11111 PAYiMENf AS �N611iUG1pRN� DISPENSER ISLAND. 4009 PSI CONCRETE WIM 1.9 IS OF FlBERMESN° AOMI PDD E PER CVBIC YAR.. INSTAR STAINLESS STEEL CURB (ORM %1TN 6' LPN. REVEAL. 8° TRICK 0009 P51 CONCRETE MAT-� REINFORCED OLD /LAYER OF B 0 L9d.8%Wd.B WELOFD WIRE m. S E7 d -l1 BELOW UR D MAI: SLOPE q 19 ipYlARO 1RLCUflBEO STDG I�O�Er WSfNMFl. BRAYOW00%(1) NOSfi PER R' -0'i LONG K 900 $CITED. 49 STAINLE55 STEEL CONCRETE Y8LE0 POST WRN "I., LAPS. INSTALL d' -P' RELCW GRAPE IN A ALE kvENN SDNGflE PCO BEP I i I �PMERATIM1-NEGs° SPEGIFlCARONS. 3''?� �sRasertie DIRRE(d®eg 1saAcv® a o I F+ tiPPAO%, I i@GATRIN PF IIa-- 1 APPRO%. LOCA101 OF P 2' G4S halve (9'-P° VEEP),a -INGIALL(2) uNP€RGRopNp 1 APPADx Lacn17PN I' E+6. 1WATER ,PAIN M TPT.WR9NE Mitt 4TIATL RE AflSHDONLP Ofl. PESTflGTE OF TIIP a LGOflINO I 1 PM€flAVh-N[6R�IOR NThTNEN 1 I ' p i I N.V7&h7 Tws WE PLAr1 HA8 @E@N PflEPARE4 iP.NK PSR auERAAa.NEAS° Le!aYTRMlNETsEIOfTIR=AZI@NGEB@PRINIA9AN. @POAE PR, Kim, /B ! FOR A9PRIPNAL fl I T INFOflMATNPl AND A flEMEIOG, "s PRPTFCTE -INGIALL(2) I I I NTnOY�ERY M %b 6N:NW.B9 N .- NP M ( ' Mitt 4TIATL RE AflSHDONLP Ofl. PESTflGTE OF TIIP a LGOflINO PM€flAVh-N[6R�IOR NThTNEN 1 I ' _INSTALL riuE�nPEPGI�As. iP.NK PSR auERAAa.NEAS° Np¢Sn 6 E ( I A.. 3 I to 09p. RF:YI@EO PER.M.G, W RLMMUD 1S ..._ 9RNN LINE FXG• N.Y. I11/94 T@W REYISPP PER i.T• INsiAU&RVN�+ TWIIDNE M.". Lw.e��= 1`i TOP EI.- 38 6 - .. CNECK AP me OF FX,. PAVEMENTr MAIN STREET ICOR04TH ROAD COUNTY ROAD NO. 801 SITE F'L. iV SCALES M - Ah P° b ^ AI j ( BLV. WW�PA19 wb�Ta ( PpEyGpSgBMm" AMFRADA HESS CORPORATION 1 HISS PLAZA/ WOODBRIDGE, N.J. ...._ -.-_ EIWA51 a, .. 08AEI-� wu .....F.R09k1(& 1SPF"AND r',TR0NIR AS KnO-18-9. M01(I7OIRN0 9YS7 4 RDDITIgON PIAPd +WEST GLERS FALLS, NEW YO Y EQ7S ENb P(OO . PV VI T(O0I 91 PINE STP,�OT ... .. Y Pl,vE1 w. - eo a