2013-139 00/14 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130139 Application Number: A20130139
Tax Map No: 523400-296-019-0001-029-000-0000
Permission is hereby granted to: ALLSTATE- KEVIN CROSBY
For property located at: 357 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. Type of Construction Value
Owner Address: OLD SCHOOL HOUSE L.L.C.
Sign
ATTN: JOHN& DIANE MATTHEW: Total Value
2546 STATE ROUTE 9L
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2013-139 ALLSTATE- Suite 2
w/"good hands" logo
wall sign Change of Copy and increase in sign size from
1.34 sq. ft. to 2 sq. ft.
$3.00 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 f Que bu Th d,i +ril 11,2013
i
SIGNED BY \ for the Town of Queensbury.
Director of Building&Code Enforcement
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OFFICE USEONLY
TAX MAP NO' - r -a9 PERMIT NO.13 43 PERMIT FEE 3 APR 1 0 2013
APPROVALS: DEPOSIT J
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. _
O'ER: KC-Nit N (;e0>(y 10-A- + � � ' INSTALLER/DUO:5.ER: t\C�'C��- '3Ita (,z++kPA!vi/ LL .
ADDRESS: 3S1 v( 4 D ) X ( 2� Cl+LI 'J"Jf7''7J.~ ADDRESS:_327(p (ZI v'ii- R.b-/ RCN.-SCLA t=/IL. ALJ 1 Vy
PHONE NOS. 51r> '7'--ISPHONE NOS. 3j _LIT --c754,0 ' 1,,*1-87DO
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) 357 L?4 get)
Sit ke GYu ft�ltis47-c:y •Ai /Z'1V'
BUSINESS COMPLEX/PLAZA I MALL NAME: Al rA ! �J
BUSINESS NAME: IN 12o..Y,/ Arc
CONTACT PERSON FOR SIGN CODE COMPLIANCE: Cx/1/4A1 S t3 PHONE: S 13 --HS:-
TYPE
— `{jTYPE OF SIGN PROPOSED: freestanding ' wall 4/,6.4 _a Hing projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICA . _Intern. _ -rnal _Incandescent _Neon Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? _Yes No
IF YES,LIST ALL EXISTING SIGNAGE: VlU + -' S P(i-- SG Ste- 'JZ-
The application creates a change v/ 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: Q L t.s,a to: v�y
Sign Wording/Copy: r
+.t !l _ . V-7) Sf
Sign size: Length a`� x Width =Total Sq. 1.3�{(ak Sign Height(freestanding sign):
Color and Material to be used: f k C(
✓ 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) QUESTIONS? CALL 761-8256 OR EMAIL
o Height of freestanding sign
o Depth of projecting sign codesqueensbury.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: 1 LGA---" DATE: C - / 3
I hereby authorize the applicant to place a sign on my property or building.
OWNER SIGNATURE: DATE:
121C-SS pvo ,AFPPO-m 11 k` ll e .krThct t;z-a . (� _
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
03/14/2613 14:03 5187922910 ALLSTATE PAGE 61
PHLADELPHIAS GN
"^,.-;:•' etttNflt,rt'. tN: WORLD'S CIRANnS 7Q IIFF
Re: S'itel.UNYCSO
jCevlir Crarby
357 Bay Rd e9�,sS''i
Sure 2
24eensbury, NY 12804'
A.UT.H.ORIZATION AND CONSENT leO M
By my signature below,I hereby represent that I am the owner of the property indicated above or otherwise
duly authorized by the Lease to grant authorization for Philadelphia Sign Company andlor their sub
contractor to apply for permits and install new swage at the above referenced location.
LANDLORD APPROVAL
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Signature '- •L �� Print Name
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Return Form to:
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or FAX to: 856-829-5549 attn:Helene Getthold
ox email to: bgotthold@phibutelphiasign.com
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is PHILADELPHIA 3 I G N 02.20.13 AFR Revised E02 and updated hours CREATED BY PHILADELPHIA
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