2009-418 Groundworks Utilities LLC TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
t"NT" ID '"rIFICATE C)IFE7 COMPLI-A-N-
Petmit Number. PZ0090418 Date Issued: Tuesday, September 22, 2009
This is to certify that work requested to be done as shown by Permit Number P20090418
has been completed.
Tax Map Number. 523400-309-017-0001-017-001-0000
Location: 415 BIG BAY Rd
Owner. UPONAHEW FARMS, LLC
Applicant- GROUNDWORKS UTILITIES LLC
This structure maybe occupied as a:
Sign By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the .
property owner of the responsibility for compliance with Site Plan,
Variance or other issues and conditions as a result of approvals b the @"
� pp y Building&Cody E a'amen
Planning Board or Zoning Board of Appeals. Director of
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090418 Application Number. A20090418
Tax Map No: 523400-309-017-0001-017-001-0000
Permission is hereby granted to: GROUNDWORKS UTILITIES LLC
For property located at: 415 BIG 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: UPONAHEW FARMS, LLC
76 POTASH Rd sign
LAKE LUZERNE,NY 12846-0000 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans&Specifications
2009-418
28.8 sq ft freestanding sign to read "GROUNDWORKS UTILITIES LLC UNDERGROUND UTILITY
CONTRACTOR"
$57.60 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,September 22,2010
(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 T wn of/ een} uO / ue,,Rgdda September 22,2009
"ram d for the Town of Queensbury.
SIGNED BY �`�' QL1e urY
Director of Building&Code Enforcement
CASHIER'S DEPARTMENT - TOWN OF OUEENSBURY
BUILDING&CODES
Code No. title Fee Fee Reason for Refund Staff
Collected Refunded Initials
01-51570(210) Demolition Permit
01-52122(211) Sewer Variance
01-52555(212) Building Permit
01-52655(212) Sign Permit F
01-52555(212) Septic Permit
10-30(213) Temporary Sign
Deposit
10-30(213) Temporary C/O
Deposit
01-52655(230) Miscellaneous
PLANNING&ZONING
01.52110 (220) Zoning Fees
01-62115(221) Planning Fees
01-62115(221) Site Plan Review
01-52116(221) Subdivision
01-380 (222) Technical Assistance
Invoice#
01-52655(223) Miscellaneous
Revenue
01-62002-0061 Recreation
(224) Assessments
FIRE MARSHAL
01.51660(190) Public Safety
01-52655(230) Minor Sales
NAME&ADDRESS OF CUSTOMER/RESIDENT PROJECT NAME i NUMBER
✓ OFFICE USE ONLY
CASH CHECK TOTAL FEE(S) TOTAL FEE(S)
NO. �. , COLLECTED: $ REFUNDED: $
TOWN CLERK/ Date: ..
DEPUTY'S SIGNATURE: t ;�
Prepared by: Building &Codes ❑ Planning ❑ Zoning ❑ Fire Marshal
Original Mown Clerk) Canary(Town Clerk) Pink(Customer) Gold(Return to Dept.checked above)
—__________..______________ ____._______/
OFFICE USE ONLY
TAX MAP NOC I. -I'i),t PERMIT NO. // PERMIT FEE e _ 2009
ell'o
Its
APPROVALS: DEPOSIT
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 appearon the+application form.
le
OWNER:� 1 %C k6,Y C( S Y^1 1 L- 1 11,' INSTALLER/BUILDER:
ADDRESS:�� cc sy 1 IR6• kt ILC. t UZ 6('kW ADDRESS:
PHONE NOS. C—C( Cr 5-c-( 0 F] PHONE NOS. t,
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS)``I I ; Ts(G
BUSINESS COMPLEX/PLAZA/MALL NAME: I
BUSINESS NAME:_ C- r f It_J�)c`L w('- �3 �{ -
r
CONTACT PERSON FOR SIGN CODE COMPLIANCE: i r.4 -t 1 V,c. kl <_- PHONE:-
TYPE OF SIGN PROPOSED: freestanding wail _awning _projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: —internal ^External _Incandescent _Neon !Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? Yes 4 No
IF YES,LIST ALL EXISTING SIGNAGE:
The application creates a change 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: to:
Sign Wording/Copy:I 1 V t , S t
Sign size: Length x Width�_=Total Sq. ft. �-Q Sign Height(freestanding sign): .5, G
Color and Material to be used:
✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
o Location of sign (walls signs: drawing of the fagade
the sign will be located on,indicate sign on fagade) QUESTIONS? CALL 761-8256 OR EMAIL
o Height of freestanding sign codes(aagueensbury.net
o Depth of projecting sign
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. vvww.gueensburv.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 SIGNATURA� A_,_ DATE: s Cs
I hereby authorize the appli nt Pplasig on y rop or uilding.
OWNER SIGNATURE: DATE: L t�o C-
Town of Qtteensbury • Comfntolity Development Office • 742 Bay Road, Queensbury, NY 12804
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