2005-009 CSEA TOWN OF QUEENSBURY
742 Bap Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050009 Application Number: A20050009
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: C'SF.A
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 Cons ruction Value
Owner Address: GUIDO PASSARELLI
465 LAKE Ave Sign
Total Value
LAKE LUZERNE, NY 12846-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-009 CSEA Mount Royal Plaza, Space N, upstairs office
32 SQ FT WALL SIGN
$64.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town,o� ueensbu T S ay, January 20, 2005
SIGNED BY for the Town of Queensbury.
Director of Building& ode En rcement
TOWN OF QUEENSBURY Fee Paid: ,
Bay at Haviland Road, Q~Sbury, NY 12804-9725-518-792-5832 Approved By:
Permit #:
SIGN PERMIT APPLICATION
R ED
THE FOLLOWING INFORMATION IS REQUIRED:
1.- Detailed drawing or photo of sign.
2. Plot plan of location of sign. TOWN] - t °,JSOURY
3. Written consent of the owner of the building or land. BG'tLr ' CODE
OWNER OF PROPERTY tln Raazzzx1�
ADDRESS � y l 1 �/,1 TEL.
NAME OF APPLICANT
ADDRESS y TEL.
BUSINESS NAME IF DIFFERENT:
TYPE AND LOCATION /
Check What Applies: Existing Permanent +f Projecting Sign
Temporary Non-conforming Pisting
Free-Standing Wall y' New
Location: Tax Map Number, t -I ----�"- 1 �
Address
Proposed Setbacks from Property Line (front) Al A (side) N 4
If sign is to be i7, External
Ited, please check appropriate box:
Internal ( ), Incadescent ( ), Neon ( ) , Other ( )
Size of Sign: Width ft. Length ft. ,
Total Square Footage:
Sign Copy: _$� CAS-I&Llr
Color and Material To Be Used: Sl6N C�BlN � — /QC2f L,1 f=/�c
�+ Signature: 62,i J.
Circle One: Applicant, owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY OR BUILDING.
pl Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant ,
'1 rvRb`i�' •,6.w .'.E. -".:e».L'sdL
n
77
A�CEIVED
% . BOX 3321 OLL-kB FAQ LS9 MY 12801 0 `J
A RRirN couNr r L OCA i