2002-692 HHHN TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERT IFICATE OF COMPLIANCE
Permit Number: P20020692 Date Issued;, Wednesday,August 21,2002
This is to certi£ that work requested to be done as shown-by Permit Number. P20020692
has been completed.
Tax Map Number: 523400-301-008-0001.028-000-0000
Location: 14 MANOR Dr
Owner: BARBARA JONES -
HUDSON HEADWATERS HEALTH NETWORK
This structure may be occupied as a:
By Order of Town Board
Sign TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256_
BUILDING PERMIT
Permit Number: P20020692 Application Number: A20020692
Tax Map No: 523400-301-008-0001-028-000-0000
Permission is hereby granted to: WDSON HEADWATERS ITFALTH NETWORK
For property located at 14 MANOR Dr
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: BARBARA JONES Sign
8 SWEETBRIAR Ln Total Value
QUEENSBURY,NY 12904
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
2002-692
Permanent 15 sq ft wall sign
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Sign copy: H H Queensbury Family Health
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$30.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 21,2003
(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 own ue u h ay,August 21,2002 1 gp
PIT
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
n
Fee Paid:
TOW"''N OF QUEENSBURY
4 '742 Bay Road, Queensbury, NY 12804 Approved By: "L(U0G'~"�:ctZ.
(518) 761-8256 Permit #:
SIGN PERMIT APPLICATION
THE FOLLOWING INFORMATION IS REQUI 1, `
s
"/1. Detailed drawing or photo of sign. AUG
✓2. Plot plan of location of sign. Tt71��,�; ^ �nl
,/3. Written consent of the owner of the building orati .", ,vecy
•gin - ����f' �
OWNER OF PROPERTYi�4l7 tAt�-A
ADDRESS Jk,-�AAK)VeL YJamlrti- a oa&,kw, J,i -/� rJ TEL. - 101
t�Lt�c� -�c�.4�1G3�`Tz=•�S i��/�U�zf fid�.:'%Zc t�tc"
NAME OF APPLICANT _ C.�[[=4=/US 'l a A�till - PL=-AL71—H
ADDRESS 14 P1Adt?k M,4 ' OuL%2=,�1d �{t2 � TEL.:519 ?616 60
BIJSINESS NAME IF DIFFERENT:
TYPE AND LOCATION
Check What Applies: Existing Permanent Projecting Sign
Temporary Non-conforming Existing
Free-Standing Wa11 _ New .
Location: Tax Map Number
.Address
Proposed Setbacks from Property Line (front) (side) 1197
If sign is to be illuminated, please check appropriate box:
Internal ( ) , External ( ) , Incadescent ( ) , Neon { ) , Other { )
Size of Sign: Width P ft. Length _ ��' ft.
Total Square Footage:
Sign Copy u-
A t 6 LAK i UA,
Color and Matal To B d: e60 is (, t�c� (f ' ?
Signature: �'----�'_."" --- sl Lilo
Circle One: Applican owner, contractor or agent,-
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY ,OR` BUILDING.
Signature of Property Owner: �^ (
ORIGINAL-Office Copy COPY-Applicant
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