SIGN 2014-148 Adirondack Urgent Care TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140148 Application Number: A20140148
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: ADIRONDACK URGENT CARE
For property located at: 959 STATE ROUTE 9
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: RAYMOND HIPPELE
50 ACORN Dr Sign
DIAMOND POINT,NY 12824-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014- ADIRONDACK URGENT CARE
SIGN - 3.3 sq ft panel in Freestanding Sign
$9.00 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 Qu sbu A q Tu a Ma 27,2014
SIGNED BY r for the Town of Queensbury.
Director of Building&Code Enforcement
..-Office=Us�One \\ v
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Town of Queensbury Building & Codes
C e eived:
"\Il\ap IPPR j,SIGN PERMIT APPLICATION . gUK' �� 1.ymit Na.: „ FEN c
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Date V/10 Applicant ilia* J Uq 7-nee.,
Tax Map ID Address 959 Al 9 S;, 0
Zoning // Q"eenShv \f 9 r agb(
Property Owner -2/01hlevel,othn.+t ContractorlAgent: T lbAckier
Address 95�r ,t!/- 9 //Al Address 15 ? id- 7 5k C [l
QV. g c&c77 A /fifty Qve acL,J I1 t al”
Phone 19.— cod.10 / r Phone 5. a
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Contact Person for Sign Code Compliance: Arrlre�.J La ks o Day Phone: -791-04,21
Building Street Address: 951 At 9 Q)€ rta di
Site Plan,Variance,or Subdivision Approvals
Location of proposed installation 9T9 Art 9
Business Complex/Plaza/Mall name Mo„nv- Sri Azo
Business name Ad;,o,cicuCL Urort✓ClT are
Type of Sign proposed
If sign is to be illuminated, indicate _internal _external _Incandescent neon _other
Do signs currently exist on property? _.K Yes No(if yes, list all existing signage)
Change of word/copy From to
Sign Wording/Copy Ad in)aA ck (A nenk Qa re
Sign Size Length rMax Width- =Total sq.ft. 'Yr 3 S/ a
w.
Sign Height(freestanding) sly,r.c(p,a
Color&Material to be used
This application creates a change in the )C New
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 i ct c, A-61 r-
APPLICANT-SIGNATURE: _,_-ifilbiA, Date: yt�8iy
Declaration: I hereby authorize the applicant to place a sign on my property or building: 7
OWNER-PRINT NAME: `{H6 D £ 1.F.R-E
OWNER-SIGNATURE: L Date: 41281141
Town of Queensbury Building&Codes Sign Permit Application 518-761-8256
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Each panel is 8.5" tall it 4' 8" wide. ,,.„...-_,,9,.,.�.
1100 Dix Avenue
Hudson Falls,NY 12839
518.747.5283
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Apt 2 8 2014 1.0
TOWN OF QUEENSBURY
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