SIGN 2014-183 Queensbury Family Chiropractic TOWN OF QUEENSBURY
/04,1742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140183 Application Number: A20140183
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: OUEENSBURY FAMILY CHIROPRACTIC
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 Sign
50 ACORN Dr Total Value
DIAMOND POINT,NY 12824-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014-183 QUEENSBURY FAMILY CHIROPRACTIC
SIGN wall sign 16.5 sq ft
$48.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tow of Que sbu , Th• s/ ,June 19,2014
SIGNED BY / � for the Town of Queensbury.
Director of Building& Code Enforcement
OFFICE USE ONLY
TAX MAP NO. PERMIT NCr J4' L1' y
ERMIT FEE (.D I" 'S T . I i
APPROVALS DEPOSIT FEE t
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BUILDINGVCSD1�g__._,_,_.J
SIGN PERMIT APPLICATION
➢ A separate application is required for each sign.
A permit must be obtained before installation of your permanent sign.
All spaces on this form must be completed.
APPLICANT: 1DYI/([._ (5ki11 INSTALLER/BUILDER: V 11, E - l R.0 c$ [ Com-KIJ
ADDRESS: q S ► ?JprkSIV- r ADDRESS: r� r L
PHONE NOS. 55T'7elr I t t I (� PHONE NOS. `1 Q �- - L9 (;___ f
LOCATION OF PROPOSED INSTALLATION: (LEGAL ADDRESS)
NAME OF BUSINESS COMPLE PLA a / MALL: 1\1176UV1+ KU N
Gil OI GIS
NAME OF BUSINESS: 4Qtyil` /Y et/ I)/jp,�
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CONTACT PERSON FOR SIGN CODE COMPLIANC : jenI Q 1 PHONE: 51 r-7i r--- , I f
TYPE OF SIGN PROPOSED: freestanding X wall awning projecting
IF SIGN IS TO BE ILLUMINATED, PLEASE INDICATE:
yInternal External Incandescent Neon Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? x Yes No
IF YES, LIST ALL EXISTING SIGNAGE:
The application creates a X New
change in the following Change in number of signs from to
existing site conditions (fill in Change in setback for sign from ' to
all applicable spaces): Change in size of sign from to
Change in height of sign from to
Change of wording/copy from: to:
Sign Wording/Copy: L o a p 01.1\;_ y
1, J �
Sign size: Length x Width 3 = Total Sq. ft. Wo SIS Sign Height (freestanding sign):
Color and Material to be used: --3(u -4 N.sk" L a.Cr° In wt. u„u u wrEa
1. Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
a. Location of sign (walls signs: drawing of the facade the sign will be located on, indicate sign on
facade)
b. Height of freestanding sign
c. Depth of projectingsign QUESTIONS? CALL 761-8256 OR EMAIL
P 9 codesqueensbury.net
d. Distances from front and side property lines.
VISIT OUR WEBSITE FOR MORE INFORMATION
2. Provide 2 drawings or photos of sign design. www.queensbury.net
3. Provide Applicant & 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 , whether specified or noted, and that such work is authorized by the
owner. \
APPLICANT SIGNATURE: _ DATE 5/i Ski
I hereby authorize the applicant to pl. ce a si/ o m .roperty or building:
OWNER SIGNATURE: 2J/A A/4. . DATE: .��f/i4
'1 '
Revised 02/18/2010
'�,' Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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Sign Design is appred-canfmg
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MOUNT ROYAL PLAZA
959 State Route 9, Queensbury, NY 12804
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