2012-392 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120392 Application Number: a20120392
Tax Map No: 523400-296-019-0001-003-000-0000
Permission is hereby granted to: THE REHABILITATION & WELLNESS CENTER T
For property located at: 2 COUNTRY CLUB 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
Owner Address: QUAKER COUNTRY CLUB ASSOC
784 TROY SCHENECTADY Rd Sign
LATHAM,NY 12110-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
K.D. WHEELER CUSTOM SIGNS
HOLLY 793-2620
16 RICHARDSON St
OUEENSBURY NY 12804-0000
Plans&Specifications
2012-392
20'x 5' Wall sign The Rehabilitation& Wellness Center
(the sign is a 2nd wall sign facing Quaker Road-needs Sign Variance)
$300.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(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 of Queensbury; Friday,September 28,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
•
• OFFICE USE ONLY '
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TAX MAP NO C(Q.t� " 1*'3ERMIT NO. ERMIT FEE iif •
APPROVALS: DEPOSIT ikJJ
SIGN PERMIT APPLICATION:
A permit must be obtained before installation of your permanent sign. All applicants'spaces on this application must
be completed and must appear on the application form.
OWNER:Q1.4 A k-r - eG`lcesT)'l {._.lti3 /�SSo( • INSTALLER/BUILDER: /� L• GLS'NE L/-ER CV-SA 1-4 S i 3S
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ADDRESS: Cc tt_r r yC. u- !Vt . Qg)/ ADDRESS: I (D fZ So rJ S.T • (tel ue�73ZLie
PHONE NOS. %3- I 3 PHONE NOS. 3- Co 2-0
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) C C Lr tJ i,LV C.i...u 12-b . c: ►3 y
BUSINESS COMPLEX/ :
BUSINESS NAME: THE REHR(31kITynv,J IAA-I_ i.) C'c iTEi€ 7E REfi/-ip/6=
CONTACT PERSON FOR SIGN CODE COMPLIANCE: PO/-1.1 IL)fi PHONE: -7423-2(ZO
TYPE OF SIGN PROPOSED: _freestanding /wall awning projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: _Internal "External _Incandescent _Neon _Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? ' Yes No
IF YES,LIST ALL EXISTING SIGNAGE: CCC i- I fJ;u 2A i1/4
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The application creates a change '/ New
in the following existing site Change in number of signs from to
conditions(fill in all applicable Change in setback for sign from to
spaces): Change in size of sign from to
Change in height of sign from to
Change of wording/copy from: to:
Sign Wording/Copy: THS , ,TPTrc )e- c s s C' - C Cz�
Sign size: Length AO' x Width 5' =Total Sq. ft. I of, Sign Height(freestanding sign): —
Color and Material to be used: N Du - (.J i-I'Tz , 131-Ac , (--
1/
'✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
o Location of sign (walls signs: drawing of the facade
the sign will be located on,indicate sign on facade)
o Height of freestanding sign QUESTIONS? CALL 761-8256 OR EMAIL
o Depth of projecting sign codes(a.queensburv.net
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. www.queensbury.net
✓ Provide Applicant and Owner's signature(permission
for placement of sign on the property or building).
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 t t such work is authorized by the owner.
APPLICANT SIGNATOR . l DATE: s i s// —
I hereby authorize the applicant to place a sign on my property or building.
OWNER SIGNATURE: AC.o_ DATE:
Qw Town of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804
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LEGEND:
MAP OF A SURVEY OF LANDS OF
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MAURICE M. YAFFEE
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SUPPLY CO., INC.
DATED: NOVEMBER 29, 1978
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LASTAMENDMENT.- AUGUST 9, 1990
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QUAKER COUNTRY CLUB ASSOCIATES, LLC
DATED: APRIL 5, 2004
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LAST REVISED: APRIL 7, 2004
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BY. VAN DUSEN & STEVES
DEED REFERENCE:
ELIZABETH D. YAFFEE, et. al.
TO
YAFFEE FAMILY LIMITED PARTNERSHIP
DATED: OCTOBER 7, 1998
BOOK 1088 PAGE 102
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