SIGN 2007-178 Anthem Health ServicesTOWN OF QUEENSBURY
742 Bay Road, Queensbury, Nl' 12804-5902 (518) 761-8201
Community Development -Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070178
Application Number. A20070178
Tax Map No: 523400-296-013-0001-018-000-0000
Permission is hereby granted to: ANTHEM HEALTH SERVICES
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 incompliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. ~e of Construction
Owner Address: RAYMOND HIPPELE
50 ACORN Dr Sign
DIAMOND POINT, NY 12824-0000 Total value
Contractor or Builder s Name /Address
MIKE BAIRD SIGNS
414 CORINTH ROAD
QUEENSBURY, NY
Electrical Inspection Agency
Value
Plans & Specifications
-178
SQ FT WALL SIGN TO READ "ANTHEM HEALTH SERVICES"
564.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, June 18, 2008
(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 Tq~ o eens ry;,~ o~tla June 18, 2007
SIGNED BY ` w~~ ~,/~ `~° for the Town of Queensbury.
Director of Building & Code Enforcement
' OFFICE USE """"' '""""""'-"
~6`~3_ ~ l0 ONLY --"-_-_--_"_"-
, ;
TAX MAP NO. PERMIT NO. D~pERMIT FEE ~ c~0 ,
APPROVALS ~ ;
DEPOSIT FEE ~ ~ , ~ ,
SI GN PERMIT APPLI CATION. T~ ~ ~ ~ ~' - ~,~.~R~ - _ _
BOIL ° ~i~ COUE
A permit must be obtained before installation of your permanent sign. All applicants'
spaces onpthis a'plplication must be completed and must appear on the application form.
OWNER: _ R ik~ H" ~ PPGI{. INSTALLEwBUILDER: ~ ~ ~' BA~R.4 S; ~s-
ADDRESS: Q S9 INT. 9 t~SduaNi ~Y
~2-~`f ADDRESS: _ COQ. lNT?f R1~ ' ®u~,tt'e4~~
PHONE NOS. w ~4'- ,L3~'0 PHONE NOS.- 'I `j2- ' 6`Z.~f ~
LOCATION OF PROPOSED INSTALLATION: (LEGAL ADDRESS)
M.cx{.a ~ 20 H fi-c. Puft.k ; 959 leo~crf" 9 '. Q~~S 6k,k-~/ ~cJ y / 2- ~o ~-F
BUSINESS COMPLEX /PLAZA /MALL NAME: /"I Oct ~/ T /Q p yam,. /~~.-~ ~„
BUSINESS NAME: ~ ~
iC
CONTACT PERSON FOR SIGN CODE COMPLIANCE: PHONE:
TYPE OF SIGN PROPOSED: freestanding wall awning pro ectin
J 9
IF SIGN IS TO BE ILLUMINATED,
PLEASE INDICATE: ~ Internal -External _incandescent -Neon -Other __
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? -Yes _No
IF YES, LIST ALL EXISTING SIGNAGE:
The application creates a
change in the following
existing site conditions (fill in
all applicable spaces):
Change of wording/copy from:
Sign Wording/Copy:
,~ New
Change in number of signs from to
Change in setback for sign from to
Change in size of sign from to
Change in height of sign from to
to:
Sign size: Length ~ ~ x Width ~= Total S ft.
q• ~~ Sign Height (freestanding sign):
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)
o Height of freestanding sign
o Depth of projecting sign QUESTIONS ? CALL 761.8256 OR EMAIL
o Distances from front and side property lines. codesCa7gueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATIO
/ Provide 2 drawings or photos of sign design. www.aueensburv.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 vtiork shall be complied with, whether specified or noted, and that such work is
authorized by the owner. ~ ~
APPLICANT SIGNATURE: 1,~~ ~"• DATE: U'~/ f 9l0
T
I hereby
SIGNATURE:
~s-^; __~
a sign on my property or building:
DATE:
B 6-LGL 11-OS
ry • Comircunity L7evelopment Office • 742 Bay Road, Queertsbury, NY 12804
PR-19-2007 01:23 PM ZIM DE'JELOPMENT CO. 518 644 2350
P. 01
Aor. 19. 1001 1:31PM ANTHEM HITH GF OFC 7~3~O110 Na,1937 P, I
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i TAX MME NO. PfiRMIT NO. pEq~T p~~~~.. ~ , ~
~ APPROVALS ~ ; ~ ; ~ •~ ~ ,~ r .
SIGN PERMIT APPLICA,T',t'ON:
A wane nluat ba obtalnad baibre inafa~iaaa, of your penlanan! alpn, al applbana'
•p~ae one!~_ wpplbatlon rnuat be compNtad and mwt appMr on !M Applllee~.ttlbonn tarn.
OWNlIt RM ~ ;~--,--s~N~YAI.~ENBUILOR~R; 1~1 f4 B~t'r~.0 ~~'nyr
ADDRESS Q 59 QT_ q ~~irpy ~ ~: CO R / N 71i IQ,~ ' Q f .~.~.~t f'B ee ~ ~/
PMOnts Noe._ G Y+t- ~.3So PHONE NOS._ ? 9 i ~ 6~. y~~
LOCATION Of PROI~p M~IlIITALLATIOIW (LE4AL ADl?R!!~)
Mawr ReMM. Pw~k ~ 95~.kr~ ~..,~_ Q~!.~5.,,,,Au~,a~ I y
suslNESS coi~lix rPL~zAr ~ w-I~: Mom N r ,~P,Q y hL Pl..t-~.4•
61181NRt3E NAMt: _ i~ Alr~}'~}~ ~!°Shs,r'r~t ~E1~1/r CCS'
CONTACT PlRSON POR 810N CODE OOMPLIANCE: PHONE:
TYPE OR atGN PROf~p: ~ haMtandinp wall y awrrnp _. Pml~ane9
IF 8K>+N 18 TO 9E HATED,
PLEASE INDIGATEInNrnd ,,,_ 6xearnal ~IneandasoK:1 ~~ `~ _
no o1oNS cuaasNnr e~asT oN THE PROPERTY? _Ya _Mo
IF Yae, usr AUr ~oBTING lIONAOE;
Tf N ~IIOMO~ 01'Mh/ Y ,~ (fir
DSO COlldl(tOM (fM In ~ b nu;ev d Aarn p
aA appNCable apaoaa~ -~~ N Ib~ Npn from Ip ~~~~
,..,CMnpe d wadh:ploopy from: ~;
81pn
Blpn ~: L.orplh ~ x Width ~^ Tolal 8q, fl ~~ Slpn No1pfR (~tandlnB algn): __..__
Color and MaMrlsi to ba ueed:
/ Provide Z ooplee of a actaNd drawhp or etwsyed plol alen wNh Un foNewM~g InlomNttbn:
° i~q~d~s) (o~Ma WpM: dmWnp of tha fa0ada the Npn wIA ba tooalod on. hdlaata
o H~eIpIN of (~e~ndlrw algn
o ~ of projp{trp ~ ou~arloNa 7 Cµ1.7M~I on uIAM.
o Olegew>sa from ftoni and aide PSVPesb Anne.
/ Provide 2 vwtr oun rraaette eon MoNi ~
drewNtBa or phoboa of Npn dgipn, ~YIIN~iI~~
~ P~ovlde APONOwri and Owner's elptlwhar (Pan+rwbn I'or plaoamanr et
Y), slpn on (ha proparpr or
~ To Uts baq o1 mf' ~ the Ssllttemsnb oorSEakt.d In 1M appNcedan, toysther wMh
apeoMoatiorsa wlbn;llNd, ~ a flue ane oornplele Wfwriant el all
done on 11n d.aaribed v~l•.e and @a;! eA proNalone of tlta zortkp ordk~enos,~ ~a
pero~~ to +~ plovaed eitell be oompAed with, whelhvr apaclnad ~ twEod, end that auon work le
eutliorized by tl:e owr+ar.
nrRIGwT lXINATIM!!:: A
~_ a-rE; ~' o~
1 hsraby aWl,orisa a:. a my prop.ny or DuNdinp:
OWNER aIONATIMiX; t]pTis:
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Totm~ oJ(~i~~*Y' C~~ SKr 0,~'ra • 7!2 Bay Road, Q~erittbuy, lVl' iZeW
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