2005-540 Upstate Black and White TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050540 Application Number: A20050540
Tax Map No: 523400-302-006-0001-009-000-0000
Permission is hereby granted to: i IPSTATF BLACK AND WHITF. SERVICES
For property located at: 707 GLEN St
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 ui compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: FRANK J PARILLO
215 BALLARD Rd Sign
Total Value
GANSEVOORT, NY 12831
Contractor or Builder's Name / Address Electrical Inspection Agency
Plans&Specifications
2005-540 UPSTATE BLACK&WHITE
10 SQ FT AWNING SIGN
$20.00 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 T Quee ury ay, July 27, 2005
SIGNED BY nesd for the Town of Queensbury.
Director of Building&Code nforcement
Building&Codes Office-Department of Community Development-Town of Queensbury PERMIT NUMBE �J TO
742 Bay Road,Queensbury,NY 12804
Dave Hatin,Director codes@aueensbury.net FEE PAID g
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 l)_t0.6-*- Owner: _ 1r' n V, PA'fi" llli b
Address: . Z- Address: Z
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Home Phone: _ 1b2 T_ Home Phone:
Email Address: s !C� wla -Wld+il Address:
Cell Phone: 'i 4 t. 3 Cell Phone:
FAX Phone: 1 Z 3 C)Z 3 FAX Phone: Sg t - y am
Person responsible for supervision of work with respect to Sign Code compliance:
Name: Byck l._.a,,rsov,
Address: "10 U -QV- ¢ Phone '?!Z-3 O(o
Email Address: -2 V141 V1 8 W A., e.lA e.i Ce avt a tM a .co wt
Location of proposed installation: Legal Address: 01 Upmr Glen . Suite No. Z
Business Complex/Plaza/Mall Name:
Business Names
Tax Map Number: L.f1�C /) J ,,
Type of sign proposed: freestanding wall awning J) protectin
If sign is to be illuminated, please indicate: _ Internal _External _Incandescent �g{f�tjci 4r �-
Do signs currently exist on the property? XYes / _No If YES, list all existing signage:
The application creates a change in the following existing site conditions: fill in all applicable spaces
New
Change in number of signs from to Z.
Change in setback for sign from to
Change in size of sign from to
Change in height of sign from to
Change of wordin /c py from f to
U p s "a�e. t31 ae 4� -�. , c
Sign Wording/Copy: C cn 0-e-itzI--
t r
Sign size: Length x Width 2. =Total Sq. ft.1O / Sign Height (freestanding sign)
Color and Material to be used:
V
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 fa(;ade)
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, whether specified or noted, and that such work is authorized by the owner.
APPLICANT SIGNATURE: "-- 1 DATE: S I O
I hereby authorize the applicant to pia a sign on my property or building.
OWNER SIGNATURE: CA-'`SC DATE:
L:\Sue Hemingway\Building.Permit.FORMS\Sign Permit Appiication.doc
V: 1/6/2005
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Client: BUCK LARSON
Salesperson: TONYA
T A NDUSTI Date: 5/1 8/05
32 Eal Aby Me PO Bm 618 Wmat L B/33
29-M-SM WD-Z2-=S Ux 29'M'SM Rendering by: JH
ww -ter ICA: BUCK LARSON Concept Drawing Not to Scale