BOTH-002-2016 Kelly's Roots TOWN OF ( UEEN I URY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Ct mMUnity Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000002-2016
Tax Map No 309.11-2-24
Permission is hereby granted to: Mike Baird Signs
For property located at: 13 1/2 Luzerne Road
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 tiled and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner blame: WILLIAM E FILERT Sign S11,00
Owner Address: 443 West WEST MOUNTAIN RD Total Value $0.00
Qucensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Mike Baird Signs
414 CORINTH RD
Queensbury,NY 12804
Plans&Specifications
Freestanding sign, 32 s.f,
"Kelly's Roots"
S96.00 PERMi f FEE>PAID-THIS PERMIT EXPIRES: Monday,.January 16,2017
(lf'aa longer period is required„an application for an extension must be made to the code Enforcement Odicer
of theTown of Queensbury before the expiration date.)
Dated at the Town o. Queensb /jridOt. C11 G
SIGNED BY; f"or the`town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of QueenSbtury Building & Cedes
Received:
SIGN PERMIT APPLICATION Tax Map ID: "t l ��-
Permit No.: rm�
_ 6'01000 Z. Zc t�,
Permit Fee: +, no
Date 2 Applicant
Tax Map IDAddress
Zoning
Property Owner Contractor/Agent:
Address Address
ueerw iY.12804
Phone
�..--� -:'�a-���..._..._�,��— Phare
Contact Person for Sign Code Compliance: nay Phone:
Building Street Address: I �/
Site Plan,'variance, or Subdivision Approvals
Location of proposed installation 11L u v
Business Complex/Plaza/Mall name
Business name
Type of Sign proposed
If sign is to be illuminated, indicate internal -;z<external Incandescent —neon other
Do signs currently exist on properly? Yes Y,,No(if yes, list all existing signage)
Change of word/copy From to
Sign Wording l Copy
Sign Size Length TT x Width F- Total sq.ft.
Sign Height(freestanding)
Color&Material to be used
This application creates a change in the flew
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. p
APPL.I'CANT-PRINT NAME I t C ''e r
APPLICANT-SIGNATURE: Date: 1"2.-
C1 S—
Declaration: I hereby authorize the applicant t place a sign on my property or building:
OWNER-PRINT NAME: f ) L L Lc�1,_" tj
OWNER-SIGNATURE: Date:
Town of Queensbury Building&Codes Sign Permit Application 5118_751_8256
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