2005-954 Outback Steakhouse TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050954 Application Number: A20050954
Tax Map No: 523400-296-013-0001-017-000-0000
Permission is hereby granted to: OUTBACK STRAKHOIJSF
For property located at: 931 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 die Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: NASREEN KHURSHID
15 NEEDLE Park Sign
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/AddressElectrical Inspection Agency
COLOR AD SIGN CORP.
615 LANSING ST
IJTTCA_ NY
Plans&Specifications
2005-954 OUTBACK STEAKHOUSE
35 SQ FT WALL SIGN i
sandyk - 12/27/2005 9:13:39 AM
i
$70.00 PERMIT FEE PAID-THIS PERMIT EXPIRES:
i
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queens) efore the rxpiration da e
Dated at the Tow of Q e y, January 09, 2006
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
...........a -------------
OFFICE USE ONLY
TAX MAP N0._p� - PERMIT NO. t''- S'9 Sq_
r ,
PERMIT FEE:----.APPROVALS—__ S
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SIGN PERMIT A.I'I'LICA7d 01NT,
A permit must be obtained be'forie installation of your permanent sign. All appllcants'
spaces on this application must be completed and must appear on the application form-
OWNS ,: S��Cd Y�_1I S�TALLEA UILDER: b x-PUI(LL`1'1t711,
ADDRESS: _�aL ADDRESS:_ i
PHONE NOS. 1� --� PHONE NOS.-• l5� SS -J I �l5 -_U�D
LOCATION OF PRO OSE� IRSTALL4Ti N: (LEGAL ADDRESS)
b r 1��RE
-� — - c
BUSINESS COMPLEX/PLAZA/MALL NAME, ,
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BUSINESS NAME: '`�4Y�T�Y�(.� �� c��t;�uS-P-- TnIA�n. Ul-
CONTACT PERSON FOR SIGN CODE COMPLIANCES y�fl \ VJfa ►�l(1?HONE'��1�
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TYPE OF SIGN PROPOSED: _fre W n , if�v �VII awning projecting
l�t�l ti
IF SIGN IS TO BE ILLUMINATED, C1�„s ..
�I�os� � 04
PLEASE INDICATE: _Internal _External —incandescent 1�eon Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY! _Yes 'No
�-�ra�nUtiY
YES,LIST ALL EXISTING SIGNAGE:� _ CG�`Jt`tS`L` tr_,LOPV4c t1"1
clu
he application creates a _New '��
Ohl g in the following ____Change In number of signs from,` to ��05
g site conditions (fill in _Change in setback for sign from to ^
ap lic ble spaces): Change In size of sign from to
Change in hoight of sign from
Change of wording/copy from: to: a&C
Sjgn Wording/C py:
1 n,IL -. .,...
i siz ength� x Width'ti'1. _=:TotsihSq' #t n Height (freestanding sign): O
Ca and Material to be used: 4 �
✓ 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,indigo:
sign on fagade)
o Height of freestanding sign ou>=s�loNs 7 CALL 7e+-s25s OR EMAIL
o Depth of projecting sign
o Distances from front and side property lines. codes%queensbury:n�t
VISIT OUR WERSIrE FOR MORE INFORMAno�J/
✓ Provide 2. drawings or photos of sign design. www.aueensbury,neY
f 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 wit,
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 �;-oa,
authorized by the owner.
APPLICANT SIGNATUR ATE:
I hereby authorize t e applicant to place a sign on my property or building;
QWNER SIGNAT � DATA,
Town of Qiceensbury- Com7nun'ity.Developrtzeaat Office- 742 Bay Road, Queensbury,NY 12804
yUOi ;Otl�j u:aWdOTaa.90 SaTunsMOD 001 Ll f-f SfJL BTS XVJ CT:CT gal
`lETTER,OFAUTHORIZATION .
- - - - - -------� -,
TO WHOM IT MAY CONCERN:
This letter serves as authorization for UNITED SIGN SYSTEMS or it's agents to
obtain any permits or variances required to erect signage on the following property:
Owner Signature Telephone Number
Owner Name and Address:
TOWN OF QUEENSBURY
COMMUNITY DEVELOPMENT
DEC 6 - 2005
. State of �vtr/v/d-`t ACO ZONING
e&c PLtit.NINIG— �~
FM EXEC,DR.-
County of
Before me appeared 11r 0i, w this 01ay of
2005 being personally known of having produced
.:t�a as identification and who executed the foregoing
instrument, and acknowl d to and before.me that he/she executed said
instrument for thwourposes therein expressed.
MICHAEL S.60RGOS.
a"Public.sm Of New Mkt
Warren county
RevNotary Public Eon�ss(oNo.
ExpirescJa 2uary3.�2 �
My commission expires: