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2015-204 Speedway TOWN OF QUEENSBURY ..40a, 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 4.1r01 1 Community Development- Building& Codes (518) 761-8256 i BUILDING PERMIT Permit Number: P20150204 Application Number: A20150204 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 ( Sign PO BOX 1580 St Total Value SPRINGFIELD OH Contractor or Builder's Name /Address Electrical Inspection Agency PHILADELPHIA SIGN COMPANY 707 W SPRING GARDEN St PALMYRA NJ 09065-0000 Plans&Specifications BP 2015-204 Speedway 24.56 sq. ft. wall sign - change of copy from Hess to Speedway. Location on site map identification: E03 ($75.00) 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 wn o iu4 ay,August 18,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only Town of Queensbury Building & Codes Received: SIGN PERMIT APPLICATION it f Tax Map ID: , �� . lG - 1 - 3 !` d - Permit No.: - I 41 - (72-6 Lfr [i HAY 2 lerr2b,� e: S '---0 s u Date ApplicantFST Engine ers Inc. 5,34,J3roadhollow Rd. , Suite 305 Tax Map ID 309 . 10-1-38 3ess 1w- ^c.�. , Zoning CI e' 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 CO Tr 0 W Location of proposed installation Existing wall sign reface N ii Business Complex/Plaza/Mall name � co Business name Speedway 0m Type of Sign proposed If sign is to be illuminated, indicate x internal external _Incandescent _neon other m o c Do signs currently exist on property? x Yes No(if yes, list all existing signage) o Change of word/copy From Hess Express to Speedway coo Sign Wording/Copy Speedway J Sign Size Length 11 ' 4 x Width 26" =Total sq.ft. 24 . 56 .. a Sign Height(freestanding) ca m .�' o LSU Color&Material to be used red 3 o This application creates a change in the New d .� 3 a, c following existing site conditions(fill in all Change in number of signs from to Q v applicable spaces) Change in setback for sign from to of (NI 0 Change in size from to Change in height of sign from to 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 L&Debra' 7Cianciulli •of FST APPLICANT-SIGNATURE: L& 6,0A//C.U&f Date: -Oda/)5 Declaration: I hereby authorize the applicant to place a sign on my property or building: OWNER-PRINT NAME: 4 - A L.. is vi-e./64-t-IL OWNER-SIGNATURE: V-' ✓( Date: 5I MIS )1L-;-(113 Town of Queensbury Building&Codes Sign Permit Application 518-761-8256 l i Client#: 122011 PHILSIG ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(Nlm/DDmrY)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 N FACT Mary Ann Masullo Huntington Insurance, Inc. PHONE 412-667-6544 FAX 877489-9126 (pc,No,Exit: (ANC,No): 310 Grant Street,2nd floor E-MAIL ADDRESS: maryann.masullo@huntington.com sullo huntin ton.com Pittsburgh, PA 15219 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Phoenix Insurance Co 25623 INSURED INSURER B:Travelers Property Casualty Co 25674 Philadelphia Sign Company Travelers IndemnityCompany 25658 INSURER C: p y 707 W Spring Garden St INSURER 0: 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 WVD POLICY NUMBER (MM/DDY/YYYY) (MM/DEFF DY/YEYYY) UMITS A GENERAL UABILJTY 6604B139679PHX14 12/31/2014 12/31/2015 EACH OCCURRENCE $1,00%000 X COMMERCIAL GENERAL LIABILITY PREMISESO(Ea oFrr°nce) $100,000 CLAIMS-MADE X OCCUR MED EXP(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 JECT LOC $ AUTOMOBILELIABLITY 8103203R453IND14 12/31/2014 12/31/2015 COMBINEDSINGLELIMIT 1,000,000 C (Ea accident) $ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY accident) GE $ _ AUTOS $ B X UMBRELLA LIAB X OCCUR CUP4B139679TIL14 12/31/2014 12/31/2015 EACH OCCURRENCE $20,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $20,000,000 DED X RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY I IMITS FR ANY PROPRIETORJPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I 1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION Town of QueensburySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 742 Bay Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12801 AUTHORIZED REPRESENTATIVE ED ©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 PAD I1 1 N Insurance 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. or,„, CERTIFICATE HOLDER Town of Queensbury 742 Bay Rd Queensbury NY 12801 ISSUE DATE 05/12/2015 _ I 1 f _S H.A. (Andy)Laulenbacher,PP Permit Manager Speedway LLC One Hess Plaza Woodbridge,NJ 07095 732-750-6192 732-750-7038(Fax) hainutenbachOsoeedway corn 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 I give permission to FST Engineers Inc. to submit all applications for the sign reimaging. Thank you, H. A. l.autonbacher )40 Manager, Permits Speedway LLC 732-750-6192 E%0. 1 STORY RESIDENCE 107 -4000 TV CONCRETE CURB TO BE INSTALLED PER 'AMERADA -HESS' SPECIFICATIONS. 6' THICK 4000 PSI CONCRETE MAT •---^ ' REINFORCED WITH I LAYER OF 6/0 W2.R%W2.D WELDED WIRE MESH C7 2-1/2'. BELOW TOP OF MAT; SLOPE 9 I% TOWARD IINCUROEO SIDE. f DISPEM1tSER: A o OVAL; IOKHkIM" 162 WIIN (1) HOSE PER SIDE; INSTALL 'BRAVO' BOX. CURD PATCH AND REPNP EM' I S' -Q' LONG X 4'1 SCHED. 4Q AND MVEMENT AS flEPUIflCO $1C€L CONCRLIE FlILCO POST WR4 END BY NEW CMVT ACTIEQ GPS, INSTALLz'-P' DEEO'W QFHDE N A N81'43'7.0"F. 190.18 ^ ^ I I ( I sL°rkvc"w EOQCRiTP Pie EMA€p ^..—.—_ — __. — — — � ,—_.... --.. — ( 1 AMERADA HF?5' $PCGFlCATIQNS4 .. ^ �— _.. NOTEI �' ^ --^ ^ ^ � �_-^ INSTALL VONT flISEft 11" SUPPORTS { PICPOJ$CR ISUNR - ' ft "'D REPAIR P"PC1NE I I CURB AND PAVEMCNT AS I 1 REQUIRED BY NEW PG. IPMR AREA coNslRPelwn. I ( KEROSENE OISP�NBER ISLAND D TAI METAL SLAT I ( ( I I SCALE. 1/4' M 1'=0• 1 fE,NCE 2' VAPOR LINE O R�1 LOCATION PP '- 1 �R�%.Nt {Nit � QCe� � G $' KEROSENE E% t IG UNOERGLJOUNR I APPROK.APON OF TELEPHONE I ExG, I t/2a WRiER LYNN ( CQncPCT€ .-. ,, - I i GABLE{§' -p' QEEP>, CORP PP, CO e' --NCRETE LNT f I 1 ... -♦w I.-EXG. CANOPY_ ` $o.WCUT PATCH ANY \ i i RER!�.IR FXP, PAVCMENi AS a ( I 1" RCDUIflER Ett NEW - I I 1 •.. 94IT.v, cAMC u - . I j GO iSlfl CTION, ( )1 - f EKG, MPM1T P.401441 `i:Y I 1 I P I NMI; ...- - �' �"' �" V ♦® I I LOCATION OF fy�'' I I IL DSSEPIIOR INFORWTION OryTNNEl EO INAQSIIE .. _.-ESO, $IOCWAI:K 1Q , _. I C.C•T.v. MONITOR ON.. ( EKG TELEPHDH€ „ P PREPARED AY M€TSKY-IUCM@RN A PA:, X6 ..A .s CLECT POST '. UNE; VCPoFY IN O I I W � 'ENCS ..... ...... ..._-... _- i ELEC7ALCAL CQNRUIT f0 ^ PAYED 4/18/84. POWER AN9 CONTROL WRINA, l I z 6[C "ACOPE QF WPW FOR APOT19NAL 1 C 4 HE48 MART I INFOgMAiptl ARP flCQU1REM€MS _.—_.._. .. - _ - ]/4 ELEC/RICAL GPNAUII ' TO $A'-{.. 'I I_ , r ! q. ALL E%W PNG MANnPPAING Q E OR FOR INTERCOM SPEAKER. lE } —INSTALL `REP JACKET ST I ` 1 _:{` M$lAll {2) W CCPYCRY ELLS L EPR CTEO. NO pN I CIECR{ONIC MONRQRRiG SYSTEM. I I , 4"f I W lE $14811 BE A9ANORN€P QA GES7gOYE0 Plus .� i .POU@([ WAµ R@EflOLA¢$ :. 17'" L { i I J T... i •. �1 1 N fllNa I I E g r 1 WITHOUT TH€ P OR AInNDW7APpN OF Tti€ o I 1 r } rW�PE 61NE (} 4CCQNDMY -I I _ I 1 WEi45 I g C7 I 1 Q 4 CIO 1 1 P 1 ovEq ? PR MAR r A ... -NESS R.P -NTA NE. N I 4,� - I I _ s° 1 APPROX. IOCATIftgN OF M. 5 _ -� 1 �� SIDEWALK AS REIN EW I I I W1LOE OO)DA 009 I - 1 1 1 I W ER LIN.' VERIFY IN . ELD. 61P IREO RY N I! { t• - _ I 1 t CONSigUCT1AN N .REE MERwA r.a._.- %0. PEG) { 1 " - .ii .. ° s• �: = T K PA. ER 9ENI$ O 1 O q [>. _. A i /i nl • I 1 I "AMERADA.. HESS I . • _ _ lr . f%..FRVAT1ONS S S •'" 1 i' I (3) D/4' CLECTRICAI. 3/4' - CTRICAL I l I F 1 1 1 __- . EKG. SINCRE WALL TANK (1YP0Q r�° I CONDORS FOR CONDO FOR SWD, I I I-CKPAYSIPIi JPINT I i - MOH No SYSTEM PQMP WEIR I j•j tt - >' 1 1 '� PflEMJ I I RAWCUT PATCH AND REPAIR EXG. CONCRETE SLAB I i P Q Li P 1 AS RE9LIRED BY NEW CONSTRUCTION,ON RETE NAT L , ' IRAW HESS" I S ---- Z s I I 17111 - rSPECIFICATIONS 1 Q Q PIOELI { 1 I I I! i �•., -- 1 ---- �oJ ., l I Co`F; ---------'<'f' '1 1t Exal PUMP ISMNO ♦', 1 I _ -. I AND PISPCNSEA 1 1 I _14 1 1 ExG. 40. C INSTALL DIRECT I R P CT PLR P I I I W SIGN-- CONDUIT CARIE UNLC¢S ' I �•,/ 1 4 CONDOR E%ISiS ._:I I\ `/ S u - ..... EKO, ASPHALI PAVCMCNT-.—.., I G. /\ F. G. CONIC. Q TO SEAWN I LOQ I I i 1 CURB (TYPICAL) U --) EMG. YARDIIGMT �ttP�C@AL, � 4/1 R CJB REVISED PER M.6 N51RMTKiNS ^ _ - _� ^ - —, ., ^ ^-^ - ^ ( I.,,) I 4/1/96 iD�J RLl'ISEQ PER ET, INSTRUCTIONS DAT@P 4/10/06 St31'44'00"W 186,00' GRAINCLINE FXG. N,Y.—ter RLYI¢€P PER CT• INSIRUCDONR IZAA'1"""'�" TELEPHONE M.N. TOP Et-- 381.76 .. I EMC. Q7T. I , RET'. PM[ PT PCSPPIR)KN1 �..-- SHECK AF GITAIE EL» ppppAm�� _-_.. ,.,]BI.A//4 '' I {w1 APaMMPM YT•3l� IMV PEEP •/n9v �� ._ .. __ MAIM 3T Ii�E 1 EDGE OF E%O PAYEMENT AMERADA HESS CORPORATION I HESS PLAZA, WOODBRIDGE, N.J. 1GORINTN ROAO COUNTY ROAD NO, 201 - .. .. 132401 Wl[I— KEROSENE DISPENSER AND MCTRONIC AS NOM TOM 04-16-0 moi - MONITORIND S TEM ADDITION f 1JJ) MAINN N7OT (yCgO. RD. !film 8 PINE STREET WEST. OEENS FALLS. NEW YO WEST OI.ENs FAIT$• NEW YORK SCALE: f.V •. ll