2012-588 Community, Work, & Independence 6111- �
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OFFICE USE ONLY C- ' •
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TAX MAP N0..7c�o),g_i_ i !PERMIT NO. /c.)'5 O PER ��i/ 4, •
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DEPOSIT L /'Viii l%4 ,Aro ,/ ' •
APPROVALS: I�I�� , ••,,,__ EC._ ,(,± 2012
SIGN PERMIT APPLICATION: AL-S ''
A permit must be obtained before installation of your permanent sign. All applicants'spaces on this application must
be completed and must appearfon the application form. (e ��u�
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OWNER: 0 . 0A&4 v�0r1 tV'l - , W
INSTALLER/BUILDER: tyris �f } /
ADDRESS: CR Qio"� S�• 6 v ` ADDRESS: I 0 0 1 I X ilut_ ..5,,t fT UJ N/ / ,�i
PHONE NOS. SIR —�Y5 V gag( PHONE NOS. -Sig--74-1 — S 3 t
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) / EVx is Am, 0J s ivy/ Zop
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BUSINESS COMPLEX/PLAZA/MALL NAME: s lal--I_q j
BUSINESS NAME: C, (<J
CONTACT PERSON FOR SIGN CODE COMPLIANCE: AOl CO A Lie S1 PHONE: 1 7"Sags
TYPE OF SIGN PROPOSED: X freestanding _wall _awning projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: _Internal _External _Incandescent _Neon _Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? LYes _No � ,
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IF YES,LIST ALL EXISTING SIGNAGE:
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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): ..X—Change in size of sign from .21/soi f'a-, to `f Ostie4,
Change in height of sign from to
Change of wording/copy from: C li-J 1 to: COnil.1{`)"i 1"'- 4,0 '4C
Sign Wording/Copy: 3-fi J� �L/Alf'
Sign size: Length Width .< =Total Sq. ft. Wil/ Sign Height(freestanding sign):
Color and Material to be used: Uk I�¢ `� IS1Lx 1 A l L/A`,(1''r' `i- A)/ (`. �c'}"�
✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following informatidn:
o Location of sign (walls signs: drawing of the facade
the sign will be located on,indicate sign on facade) QUESTIONS? CALL 761-8256 OR EMAIL
o Height of freestanding sign codes(u�queensburv.net
o Depth of projecting sign
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. www.queensburv.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' authorized by the owner. (L
APPLICANT SIGNATURE: ,
b /J f DATE: / //01--
I hereby authorize the applint to plac a sign on my property or building.
OWNER SIGNATURE: liVL ll
DATE: 0
eb Town of Queensbury - Community Development Office . 742 Bay Road, Queensbury, NY 12804
TOWN OF QUEENSBURY
742 Kay Road,Queensbury,NY 12804-5942 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120588 Application Number: A20120588
Tax Map No: 523400-302-012-0001-044-000-0000
Permission is hereby granted to: COMMUNITY WORKSHOP RESOURCES CORP
For property located at: 37 EVERTS Ave
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: COMMUNITY WORKSHOP RESOL Sign
PO BOX 771 Total Value
GLENS FALLS,NY 12801-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
WEST SIGNS
1100 DIX Ave
HUDSON FALLS.NY 12839-0000
Plans&Specifications
2012-588 Community, Work& Independence,Inc.-
Freestanding Sign 24 sq. ft. change of copy only (old sign permit 88-1068)
$0.00 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; Wednesday,January 23,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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,� Queensbury Web Map
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PERMI-- f----)1"°1-PLAN A
I HAVE PERSONALLY MEASURED THE DISTANCE
FROM T/PROPERTY LINES TO THE ,
PROP*�p STe URE(S)OR SIGN(S)
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Map is for GENERAL REFERENCE ONLY.
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