2001-610 Champion Sign Craft TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
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Permit Number: P20010610 Application Number: A20010610
Tax Map No: 523400-296-017-0001-051-000-0000
Permission is hereby granted to: ALEXANDER POTENZA
For property located at: 876 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 the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: ALEXANDER POTENZA
FRANK BORK Sign
403 GLEN-St Total Value
GLENS FALLS,NY 12801
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans & Specifications
2001-610 CHAMPION SIGN CRAFT
12 SQ FT WALL SIGN AS PER APPLICATION
(CUSTOM CARVED SIGNS)
$24.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,August 23,2002
(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 To n of eens T y,August 23,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code nforcement
'., Fee Paid: d'L-P
TOWN OF QL EENSBURY L
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761 8256 Permit #:o/l3)1-O D
SIGN PERMIT APPLICATION RECOVED
THE FOLLOWING INFORMATION IS REQUIRED:
1. Detailed drawing or photo of sign. AUG 0 9 2001
2. Plot plan of location of sign. TOWN OFQUEENSBURY
3. Written consent of the owner of the building or land. BUILDING AND CODE
OWNER OF PROPERTY L,ih.1N 967-6-1\17-/A,
ADDRESS i C1( 3 G1n) S'1, TEL.
NAME OF APPLICANT LCAA,L A, gi oy\) c_Ls -1
ADDRESS 7 8 CzVz.- WS orw/ TEL. '7 2 `Oriel
BUSINESS NAME IF DIFFERENT: GL471/3\in 'Job'J s-kf5r3 CdL101
TYPE AND LOCATION
Check What Applies: Existing —_ Permanent Projecting Sign __
Temporary Non-conforming Existing
Free-Standing — Wall 1Z New
Location: Tax Map Number
Address
Proposed Setbacks from Property Line (front) (side)
If sign is to be illuminated, please check appropriate box:
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Internal ( ) , External ( ) , Incadescent ( ) , Neon ( ) , Other ( )
,
Size of Sign: Width 3 ft. Length y ft.
Total Square Footage: ( �
Sign Copy: COS+ G/J 0 S le; ,5
Color and Material To B U 5 Fo1Y - — Ov1L4--0)NY3Ll
Signature: i�,
Circle, n : ica owner, contractor or agent.
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN 0 PROPERTY OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant
, ( RECEIVED
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