2013-527 Berkshire Bank Oek TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130527 Application Number: A20130527
Tax Map No: 523400-296-019-0001-043-000-0000
Permission is hereby granted to: BERKSHIRE BANK
For property located at: 183 QUAKER 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: BERKSHIRE BANK
24 NORTH St Sign
PITTSFIELD, MA 01201-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
AGNOLI SIGN CO., INC.
CHRISTINA MOREAU 413-221-6298
722 WORTHINGTON St
PO BOX 1055
SPRINGFIELD MA 01101-1055
Plans&Specifications
2013-527 Berkshire Bank
SIGN freestanding Cross Ref. SV 18-2014 Approved 2/19/2014
$99.00 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 ue sbury A We, es;ay, March 05,2014
/
SIGNED BY V 4 for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received: _
SIGN PERMIT APPLICATION NC\ 1Tix ID: off` lio,r_9-1—'`/..3
Permit No.: /3— S eR7
Permit Fee: S_ q 9 00
Date 1/ / i ": Applicant AGNOLI SIGN CO., iNC.
Tax Map ID - Address
X22 Worthington St
Zoning P. 0. Box 1055 -
T ---- Ing ' -1055
Ai
Property Owner (i (' r I S 6i r ON ve4-44 f L Contractor/Agent: AGNOLI
Address . '{ i() v e T-/-/ - 7 . Address 722 Worthington St
Cr rr /=f G /4 4 P. O. Box 1055
Phone -u( 3 --.a 34- -- 3/ 01 Phone Springfield,MA 01101.1055
Contact Person for Sign Code Compliance: . ,til(-1 TIP ! i.--c,-- r•- t c:i _ Day Phone: V/ ' -D--)-/-(-37.f•
Building Street Address: I S.:" (..) if r< - „c.,J , 0 C.L'\i-,5--{-ivi,.•-.�)C4CJiioL''Sig'-
Site Plan, Variance, or Subdivision Approvals �- , cosi
Location of proposed installation I & :3 QLi ./1- Ick tc /e o
Business Complex/Plaza/Mall name -
Business name i - r / S --(,.-A--( (5 -y`?(L
Type of Sign proposed c1 ( iv i G _
If sign is to be illuminated. indicate : /internal —eternal _Incandescent _neon _other
Do signs currently exist on property? /Yes _ No(if yes, list all existing signage)
Change of word/copy From j /-?-i LL u-j- /� to /->.-= tics /.-( ;feL 11-- .4 A.)(<-..
Sign Wording I Copy
Sign Size Length - x Width '7 = Total sq. ft. ;�3
Sign Height (freestanding) k_f 5 72-; nJ -. /
Color& Material to be used /ex-, et--"1,k 14-7,---f_. _ on
This application creates a change in the New ,v c c it c&- --
- following existing site conditions (fill in all Change in number of signs from to
. . • applicable spaces) Change in setback for sign from to
- • Change in size from _to
.. - 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 (k0-70( s-r7 N A' 0 te /1-U
(A- (--A-'CA---l/ 'CA-- /``,(�J ‘A----'.------- Date: /'/ 7 ' ,
Declaration: I hereby authorize the applicant to place a sign on my property or building:
OWNER-PRINT NAME: (I /(/C 6,-- < A
OWNER-SIGNATURE: Date:
TAUm of fli iaanchiin/LL iilriinn R(`.nriae Cinn Parrot Annlirafinn Clft_7Fi1_frAF
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America's Most Exciting Bank
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New York State Insurance Fund
Workers'Compensation&Disability Benefits Specialists Since 1914
105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS,NEW YORK 10604-3814
Phone:(914)253-4871
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAA 041017411
AGNOLI SIGN COMPANY(A MA CORP)
PO BOX 1055
SPRINGFIELD MA 01101
POLICYHOLDER CERTIFICATE HOLDER
AGNOLI SIGN COMPANY(A MA CORP) TOWN OF QUEENSBURY
I PO BOX 1055 742 BAY ROAD
SPRINGFIELD MA 01101 QUEENSBURY NY 12804
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE I DATE
W 2093 426-1 829348 02/12/2013 TO 02/12/2014 10/25/2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO.2093 426-1 UNTIL 02/12/2014, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER
FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW' YORK, TO THE POLICYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/12/2014 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW
YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
DONALD AGNOLI,PRESIDENT AND SOLE
OFFICER/OWNER OF AGNOLI SIGN
COMPANY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECTOR,INSURANCE FUND UNDERWRITING
This certificate can be validated on our web site at https://www.nysif.com/certicertval.asp or by calling (888)875-5790
VALIDATION NUMBER: 397675704
•
STATE OF NEW YORK
WORKERS'COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1, To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier
la. Legal Nance and Address of Insured(Use street address only) lb.Business Telephone Ntuuber of Insured
AGNOLI SIGN COMPANY INC (413) 732-5111
722 WORTHINGTON STREET • ic.NYS Unemployment Illsurance Employer Registration
PO BOX 1055 Number of Insured
SPRINGFIELD, MA 01101
Id.Federal Employer Identification Ntnnber of Insured or
Social Security Number
041-01-7411
2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier
Coverage(Entity Being Listed as the Certificate Holder) NEW YORK STATE INSURANCE FUND
Town of Queensbury
742 Bay Road • 3b.Policy Number of entity listed in box"la":
Queensbury, NY 12804 DBL 5900 86 - 6
3c,pplicy effective period:
03/02/2013 to 03/02/2014
4.Policy covers:
a_ D33 All of the employer's employees eligible raider the New York Disability Benefits Law
• b. ❑ Only the following class or classes of the employer's employees:
Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above
and that the named insured has NYS Disability Benefits insurance coverage as described above.
-70tDate Signed 10/25/2013 By
— Joseph J J. M asi
(Signature of insurance m rrier's authorized represertatue of NYS Lice reed irsura ace Agent of that insurance ca rrier)
Telephone Number (866) 697-4332 Title Director of Disability Benefits Insurance
• IMPORTANT: If box"aa"is checked.and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Arent of that
carrier,this certificate is COMPLETE. Mini it directly to the certificate bolder.
If box"4b'is checked.this certificate is NOT COMPLETE for purposes of Section 220.Subd.S of tate Disability Benefits Law. It must be mailed for
completion to the Workers'Compensation Board.DB Plans Acceptance Unit.20 Pari:Street.Albany.New York 1220'.
PART 2.To be completed by NYS Workers'Compensation Board (Only if box"4b"of Part 1 has been checked)
State Of New York
Workers'Compensation Board
According to information maintained by the NYS Workers'Compensation Board.the above-named employer has complied with the NYS
Disability Benefits Law with respect to all of his.'lter employees_
Date Signedd ____ By
(Signature of NYS Workers'Compensation Board Employee)
Telephone Number Title
Please Note:Only insurance caniers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of
those insurance carriers are authorized to issue Fonu DB-120.1. Insurance brokers are NOT authorized to issue this form.
DB-120.1 (5-06) Certificate Number 232895
•
• Additional Instructions for Form DB-120.1
By signing this form, the insurance carrier identified in box"3" on this form is certifying that it is insuring the business referenced in
box"la"for disability benefits under the New York State Disability Benefits Law.The Insurance Carrier or its licensed agent tivill send
this Certificate of Insurance to the entity listed as the certificate holder in box "2". This Certificate is valid for the earlier of one yew
after this form is approved by the insurance carrier or its licensed agent,or the polio'expiration date listed 111 box "3c",
Please Note:Upon the cancellation of the disability benefits policy indicated on this form,if the business continues to be named on a permit,license o:
contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of ICYS Disability Benefits Coverage.o:
other authorized proof that the business is compying with the mandatory coverage requirements of the New York State Disability Benefits Law.
DISABILITY BENEFITS LAW
§220. Subd. 8
(a) The head of a state or municipal department, board, commission or office authorized or required by law ti
issue any permit for or in connection with any work involvins the employment of employees in employment a!
defined in this article, and not withstanding any general or special statute requiting or authorizing the issue 0:
such permits. shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in
form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as
provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such
state or municipal department, board, commission or office to pay any disability benefits to any such employe(
if so employed,
(b) The head of a state or municipal department, board, commission or office authorized or required by law tc
enter into any contract for or in connection with any work involving the employment of employees ii
employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing
any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is
produced in a form satisfactory to the chair. that the payment of disability benefits for all employees has beet
secured as provided by this article.
DB-120A (5-06)Reverse
BERKSHIRE BANK
183 QUAKER RD
QUEENSBURY
EXISTING SIGNAGE
NEW PROPOSED SIGNAGE
NEW DOUBLE FACED SIGN CABINET WITH WHITE GE SOLARGRADE
LEXAN FACES, 3M HOLLY GREEN TRANSLUCENT VINYL BACKGROUND
WITH 3M GOLD NUGGET TRANSLUCENT VINYL OVERLAY FOR LOGO ELEMENTS
INSTALL NEW SIGN CABINET ON EXISTING POLE AND BASE.
PAINT SIGN CABINET PMS 349 GREEN
PAINT POLE AND BASE BLACK
N
CUSTOMER: BERKSHIRE BANK
LOCATION: BERKSHIRE BANK
STORE:
CONTACT: PETER MERWIN
24 North ST.
183 QUAKER RD
SALESPERSON: MARIANNE
DRAWING CODE:
ORIG. 8-9-13
REV. 10 17-13
SCALE 3/8" - 1' - 0"
Plttsfield,Ma
QUEENSBURY
DRAWN BY: MARIANNE
QUEENSBURYPLT BERKSHIRE
/ KHIRE BANK / BOA CHANGEOVER
DRAWN BY:
DRAWN BY:
QUAKER RD QUEENSBURYCDR/BOA CHANGEOVER/BERKSHIRE BANK
REV. 0-0-11
REV. 0-0-11
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DRAWN BY:
DRAWN BY:
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