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2015-203 Speedway TOWN OF QUEENSBURY ` � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 irre Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150203 Application Number: A20150203 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 2015-203 Speedway 24.56 sq. ft. canopy sign change of copy from Hess to Speedway 26 inch high channel letters; Identification on site map location: E02 ($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 To n of eens a ugust 18,2015 SIGNED BY �d for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only Town of Queensbury Building & Codes Received: SIGN PERMIT APPLICATION ,q" ° w... . _ Tax Map ID: a Permit No.: ,�0('�—�3 i '' 0 J MAY 2 6 2015 Permit Fee: $ ,�.� c • ILi Date -- SE314 IST engineers Inc. l 1 eta 40 f � pD , 534 Broadhollow Rd. , Suite 305 Tax Map ID 309 . 10-1-38 li si ` Melville, NY 1174"/ Zoning CI Hess Retail Stations LLC doing business as Speedway Philadelphia Sign Co. Property Owner Contractor/Agent: 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 Location of proposed installation Existing canopy sign reface o w Business Complex/Plaza/Mall name Business name Speedway N c Type of Sign proposed ui m If sign is to be illuminated, indicate x internal _external _Incandescent _neon _other N Do signs currently exist on property? X Yes No(if yes, list all existing signage) m o Change of word/copy From HeSS to Speedway o Sign Wording/Copy Speedway a) Sign Size Length ll 1/2x Width =Total sq.ft. -o-I / C , Sign Height(freestanding) S'In ' 20 " L v �, o' Q Color&Material to be used red ai Q�j This application creates a change in the New >'� c o following existing site conditions(fill in all Change in number of signs from to . .c� o) applicable spaces) Change in setback for sign from to cal 2 " m Ct.,- .;j -C Change in size from to cn oo N 0 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 Debra Cianciulli of FST APPLICANT-SIGNATURE: „._,U1/0 0 n C& t(', 1 Date: 5Ia Ji c Declaration: I hereby authorize the applicant to place a sign on my property or building: OWNER-PRINT NAME: 14, l4 .LA V'e�J g 19.-L f-1-6A. �N OWNER-SIGNATURE: h� Date: 3 //q/1 Town of Queensbury Building&Codes Sign Permit Application 518-761-8256 I Client#: 122011 PHILSIG ACORD. CERTIFICATE OF LIABILITY INSURANCE Ds oa/2015 Y) ' 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 CONTACT Mary Ann Masullo Huntington Insurance, Inc. PHONE (A1C,No,Ext):412-667-6544 FAX (A1C,No): 877-489-9126 310 Grant Street, 2nd floor E-MAIL ADDRESS: maann.masullo huntin ton.com rY g Pittsburgh, PA 15219 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Phoenix Insurance Co 25623 INSURED INSURER 6:Travelers Property Casualty Co 25674 Philadelphia Sign Company Travelers Indemnity Com raveersCompany C: P Y 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. EXP LTR TYPE OF INSURANCE NSR SUBR WVD POLICY NUMBER (MMIDPOLIDY/YYYY) (MMIDEFF DYIYYYY) LIMITS A GENERAL LIABILITY 6604B139679PHX14 12/31/2014 12/31/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY Ru1MGE n REt ED ce) $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 JJEC LOC $ C AUTOMOBILELJABIIITY 8103203R4531ND14 12/31/2014 12/31/2015 COMaccidBNEDent) �SINGLELIMIT 1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X AUT NONOS- WNED (Per acddent) O $ B X UMBRELLA LIAB XOCCUR CUP4B13967911114 12/31/2014 12/31/2015 EACH OCCURRENCE $20,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $20,000,000 DED XII RETENTION SO $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY / TORY I!MRS FR ANY PROPRIETOR/PARTNER/EXECUTIVEYN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe uncer DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it 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 DELIVERED IN 742 Bay Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Queensbury, NY 12801 AUTHORIZED, jREPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #51028463/M968411 PADI1 NY VIInsurance NEW JERSEY MANUFACTURERS INSURANCE COMPANY Il Group 301 Sullivan Way,West Trenton, N.108628 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. tiff ir CERTIFICATE HOLDER Town of Queensbury 742 Bay Rd Queensbury NY 12801 ISSUE DATE 05/12/2015 H.A. (Andy)Laulenbacher,PP Permit Manager Speedway LLC One Hess Plaza Woodbridge,NJ 07095 732-750-6192 732-750-7038(Fax) halsutenbacht s eeawo.cam 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 B give permission to FST Engineers inc. to submit all applications for the sign reimaging. Thank you,. H. A. Lautenbacher Manager, Permits Speedway LLC 732-750-6192 T . •C_V• I :WC,A1A3 Ri-..•L.D.C-AD AND 1....V•L'D•.L:nLDL ,., nr,i,zunini.,ot.. I r..51'4,5'2,7a '90.•E3' ------ ----_-- —- _____„,4„, _.--,.- , 'T 71-------1----1 _ WALL .11.11'3,i Ll sr,.,PtC.Sr,r , '. 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AFTER I - SCOPE: _awn= min = . -CUSTOM REFACE OF EXISTING PYLON - REFACE PRICE SIGN HEADERS Speedway 237 '-.?, 26 : v- -110 Jf. 2 9 Yjj lie319 'Ire.. , OVUSF ' - .---- \4 �.7-.,v,,,,,,,,,,,.. . PYLON ELEVATION I L- ; SCOPE: - CWITH 7" RED VINYL 3M 7725-63 CERA! #, -20"H ILLUMINATED RESTRIPEANOPY LED "Speedway" CHANNEL LETTERS 8'9" .....---- cl sp e e d w 2° ,. kir ..... Speer /+ /` ___ _ , ,.. - ____ 1 • "Speedway" ILLUM CHANNEL LTR ELEVATION „ _ EA7OPE ■ w ar`mi • SCOPE: _ ,. ,. - . - -. - PAINT FASCIA WHITE WITH 2” RED STRIPE SPUN - PAINT GREEN CHECKERS ABOVE WINDOW"HESS" RETAII sffeei C roz4 - REMOVE "HESS EXPRESS"AND INSTALL 20"h VINYL"Spee -- - - --- - - - — - - - -a. 1 L: ' — 4f. -a 2:40, Speedway _„ _ • VPPS4,-. •UNa� Iee '' 1 roZ • .ciriare 111 T.N.f.'N- .7..-.^^- 55. riirs.'` SCOPE: rrrrrrrrorar �_ .. ,, "''s,,, - PAINT FASCIA WHITE WITH 2" RED STRIPE �. r ` - PAINT GREEN CHECKERS ABOVE WINDOW"HESS" RETAII . 6. -� il�a � r . s '. • '1 , - REMOVE GREEN CHECKERS FROM BRICK 1 .- . - REMOVE "HESS EXPRESS"AND INSTALL 20"h VINYL"Spee i " m aE ir_ ii , =.--11' .t' ', ,3i. —7, 7 . awi 41.r A*.ten.' . ,t �„ ,�,.....•`-.*.."�.•- """""� SCOPE: - PAINT FASCIA WHITE WITH 2" RED STRIPE - PAINT GREEN CHECKERS ABOVE WINDOW"HESS" RETAII 11 - REMOVE GREEN CHECKERS FROM BRICK 1111111 mi . a■El 111 - REMOVE "HESS EXPRESS" •