2001-483 / T TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010483 Application Number: A20010483
Tax Map No: 523400-288-012-0001-015-000-0000
Permission is hereby granted to: DOMINO'S PIZZA
For property located at: 1498 STATE ROUTE 9 - DUNHAM SHOES
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: LAKE GEORGE ASSOCIATES Temporary Sign
50 STATE ST. 4TH FLOOR Total Value
ALBANY,NY 12207
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2001-483 DOMINO'S PIZZA
30 SQ FT TEMPORARY SIGN AS PER APPLICATION\
SIGN TO RUN FROM 7/1/01 TO 9/1/01
$50.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,July-06T2002 `/ --/-®/
(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 of Queensbury; Friday,July 06,2001
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
. ,
. TEMPORARY SIGN PERMIT APPLICATION
RECEIVPD ni ,LIg 3
TOWN OF QUEENSBURY - PERMIT NUMBER:;.:
Queensbury,New YOrk-12864 TOWN OF QUEENSBURY Deposit Paid: .
BUILDING AND CODE
Important Notice:
Temporary Sign Permits are issued for a period of 12 calendar days not to exceed 60 calendar days per year
per applicant.. Exception-political signs(see attached Local Law).
DATE-placententorsig,T- -/- 0 bATE -removatofsign7 I 767/ - -
Applicant Name(individual or business name): 10 / A90 lPaZ-A
Mailing Address: /1/1 S;--4-re Ip q Telephone No. (98-) 793—- (//
/.4.-4tL " oti •
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Exact Location/Placement of Sign:,S.:0417A 0/-4 Si Pt &114,0/4/
Tax Map Number: Section , Block • Lot
Type of Sign: (only one [1] sign allowed per permit-exception)
Political Signs ONLY (to be placed 60 days prior to event)
Sign Copy for Political Sign:
Wall Sign (not to exceed 32 square feet) Sign Copy: 4046 6-Lice
Freestanding Sign(not to exceed 16 square feet) Sign Copy:
SIZE OF SIGN: /0 x _ ? = 30 sq. ft.
signa u e of applicant i ture property ow r if
di erent from applicant name
Failure to remove sign at expiration may result in forfeiture of deposit as per the
Code of the Town of Queensbury, Section 140, Subsection 140-4 (Local Law No. 11, 1993).
Send Refund-deposit to: