2012-549 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120549 Application Number: A20120549
Tax Map No: 523400-296-019-0001-032-000-0000
Permission is hereby granted to: PROVIDENT BAY ROAD. LLC
For property located at: 375 BAY 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. Tyne of Construction Value
Owner address: 375 BAY ROAD LLC
6 INDUSTRY Rd Sign
Total Value
WATERFORD NY 12188-0000
Contractor or Builders Name/address Electrical Inspection Agency
JERSEN CONSTRUCTION GROUP
518-233-0600
6 INDUSTRY Dr
WATERFORD NY 12188-0000
Plans&Specifications
2012-549 "375" with 16 spaces for tenant IDs
Freestanding Sign at Bay Road; size increasing from current 30 sq.ft.to 60 sq. ft.
$90.00 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; Tuesday,November 27, 2012
SIGNED BY for the Town of Queensbury_
Director of Building&Code Enforcement
OFFICE USE ONLY
CO
TAX MAP N r(� , Ici /r�P NIT NO. ) S'/ RMIT FEE / V NOV 1 e 2012
APPROVALS: DEPOSIT
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 thelapplication form.
OWNER: 7.� LAS / Iii/ c L INSTALLER/BUILDER: J// e rse n 67,s/. �rvu,,
r / /,/ / n /} �e4,-/ )) L,a/ 4 N /Z/�'a
ADDRESS: h in ✓S�i-y l�� /N�i 42�4,-- / . / ADDRESS: �(
PHONE NOS. Sri P-Z 3 ? - °era0 PHONE NOS. -S-/I- Z 3 ?- d6(-Gd
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) 3 7.S /3ti 7 )Zl oe,--c ue-y
BUSINESS COMPLEX/PLAZA/MALL NAME: Sq nl Le
BUSINESS NAME: fri,J/f%A/ }e"M h T S
CONTACT PERSON FOR SIGN CODE COMPLIANCE: I)s v it/ 3e%S e'I PHONE: 17 cP ` ‘7 f- D 9 S eP
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? XYes No
IF YES,LIST ALL EXISTING SIGNAGE: / 7/ c r /716-i J:h< l aIt / i� I e-r Uzi n1.-7/ 494-- Z,--''//f
The application creates a chang �S (r New 1
in the following existing site cxr Change in setback for sign from to Change in number of signs from to
conditions(fill in all applicable <1
O //
spaces): '� ,c Change in size of sign from 30 S to > [D J` r.,
etChang in height of sign from_ to
Change of wording/copy from: ��� � Oh(7 to:
Sign Wording/Copy: i? 3 1-�� U:a 01) fe /( ceJ 10.- A h 4,, /Pi
Sign size: Length 6 x Width-7z S =Total Sq. ft. al- Sign Height(freestanding sign): vr, Zo
Color and Material to be used: 13 ure s r74r741i/4i iIte ()n 4/ve CI
0.-- 6.',ll f i.-'7 1,A.
sr Provide 2 copies of a scaled drawing or s rveyed 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(@,queensbury.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 that such work is authorized by the owner.
APPLICANT SIGNATURE: / C' DATE:_ 7/7 0
I hereby authorize the applic
ant place a sign on my property or building.
/ 7-----t---7.----,
OWNER SIGNATURE: /�i(��: DATE: /f /7/!
Town of Qneensburt, • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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