2005-173 Shindigs TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050173 Application Number: A20050173
Tax Flap No: 523400-295-008-0001-002-000-0000
Permission is hereby granted to: SHTNDI S
For property located at: 1161 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: MITCHELL A COHEN
PO BOX 21 Sign
Total Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-173 SHINDIG'S 1161 STATE ROUTE 9
96 SQ FT WALL SIGN (Shindig's 2 Pizzas 2-2Lt $22 [Call for Delivery] 518 798-1918 [Karaoke& Live
Music] small changeable panel
$192.00 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 To ueens , April 20, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Building&Codes Office-Department of Community Development-Town of Queensbury PERMIT NUMBER 0
742 Bay Road,Queensbury,NY 12804 �Op
Dave Hatin,Director codes@aueensbury.net FEE PAID
Phone: (518)761-8256 FAX: (518)745-4437
Sign Permit Application
Application & plans are subiect to review before issuance of a valid permit for placement of a sign.
Instructions: A permit must be obtained before installation of your permanent sign. All applicants' spaces on this
application must be completed and must appear on the application form.
Applicant/Business /kCV"' 4714c A)S, 1-Che'"I ff 1-r-4j Owner: /W WCAe 11,4 6 4e, US
Address: P0 B6h 2Z Address: O 6-AC Z/
Home Phone: 7! Iv-to q1_e Home Phone: -7 ' D 20-5-
Email Address: --S-00166- 47V 42 Email Address:
Cell Phone: S 8 , 3o 8/ _ Cell Phone:
FAX Phone: SG • !o`FZ 8 /3 FAX Phone:
Person responsible for supervision of work with respect to Sign Code compliance: w
Name:
Address: Phone VAFZ
Email Address: "y
a TQWN
Location of proposed installation: Legal Address: //�o ell /
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Business Complex/Plaza/Mall Name: CDOF y
Business Name:
Tax Map Number: _ 2—
Type of sign proposed: freestanding kl'�`w all awning projecting
If sign is to be illuminated, please indicate: _Internal 'External _Incandescent _Neon _Other
Do signs currently exist on the property? -'es / _No If YES, list all existing signage: / ,
The applic ion creates a change in the following existing site conditions: fill in all applicable spaces
New
Change in number of signs from to 1;L 151A 1 Sij
Change in setback for sign from � � to
Change in size of sign from to
Change in height of sign from to
Change of wording/copy from to
Sign Wording/Copy: 51A 6 s (LAD t
Sign size: Length 8 `x Width =Total Sq. ft. �� / Sign Height (freestanding sign)
Color and Material to be used: rSA ;F44gE ac fz - 44-77/H4
Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
location of sign (walls signs: drawing of the facade the sign will be located on, indicate sign on facade)
height of freestanding sign
depth of projecting sign
distances from front and side property lines.
Provide 2 drawings or photos of sign design.
Provide Applicant and Owner's signature (permission for placement of sign on the property or building).
Declaration: Please sign below after you have carefully read the statement:
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,wheth spgcifie or noted, and that such work is authoriz d b�/the owner.
APPLICANT SIGNATURE: ,// DATE:
i
I hereby authorize the app*cant t pla/e a sign on my property or building.
OWNER SIGNATURE:- DATE: ✓'� ��
L:\Sue Hemingway\Building.Permit.FORM S\Sign Permit Application.doc
V: 1/6/2005