SIGN 2012-015 Miracle Ear TOWN OF QUEENSBURY
742 Bay Aoad,Queenebury,NY 12804.5902 (518)761.8201
Community Development-NMI"R do Codes (518)761-UN
BUILDING PERMIT
Permit Number: P20120015 Application Number: A20120015
Tax Map No: 523400-296-013-0001-018-000-M
Permisaion is hereby granted to. MIRACLE EAR- SPACE L
For property located at 959 STATE ROUTE 9
in the Town of Queenebury,to construct or place
at the above location in accordance with application together with plot plane and other information hereto filed
and approved and in compliance with the NYS uniform Building codes and the Queensbuty Zoning
Ordinance. 2b00 of Construction Yallle
Owner Address: RAYMOND HIPPELE gip
50 ACORN Dr Total value
DIAMOND POINT,NY 12824.0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans do Specifications
BP 2011-015 Miracle Ear,Space L
29.61 sq. ft.wall sign
$SSM PERMIT FEE PAID-THIS PERMIT EXPIRES:
(If a longer period b mgWred,an appNoadoo for an extension must be made to the code Enforcement O(Neer
of the Town of Quesosbnq behua dke expirsdon date.)
Dated at the Tows Wetinbs y,January 18,2012
b
SIGNED BY r the Town of Queensbuty.
Director of Building&Code Enforcement
p [ � d [
�3 JAN 17 2012
U
TAX MAP NO. _ ' . �- ``� L t PERMIT FEE
APPROVALS. DEPOSIT ._ TOW► OF QUE_NSSURY
:.................... -------.... -. --- .---- :.. - -SUILDfNG£�OO-DES
SIGN PERMIT APPLICATION:
A permit must be obtained before installation of your permanent sign. All applicants' spaces on this application must
be completed and must'IIp ear on appli at an to r
OVMER. i lsty !1,� `�,,rr�` �' INSTALLERISUILOER.
ADDRESS959-��RJ 9 (lAUuu- 56. A � ADDRESS: �I.Ir_'!ml C r:.A?V?
PHONE NOSQ9I- 463 _-�. PHONE NOSES ij 7_i,/ 4 71 �r
LOCATION OF PROPOSED INSTALLATION.(LEGAL ADDRESS)A l atI i, S C,n IT I:'a
BUSINESS COMPLEX l PLAZA/MALL NAME:- A-- 'S J��'t(% ^u7
BUSINESS NAME. WI,rc ( IP (-,.:/,/-
CONTACT PERSON FOR SIGN CODE COMPLIANCE: _Ti, .. PHONE i 7- /&_)/ AJ;
TYPE OF SIGN PROPOSED: _heesl[Witing K was _awnng _Protecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: X Lntemal _Extema: _Incandescent _Nem Other.
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? _Yes XNo
IF YES.LIST ALL EXISTING SIGNAGE'
The application creates a change New
in the following existing site _Charge in number of signs from to
conditions(Ea in all applicable _Charge in setback for sign from to
spaces): Change in size of sign from to
_Change in height of sign from to
_Change of wording/copy from: to:
Sign WordinglCopy: Lc i?'!r f, ( ic Cats
l 1
Color and Material to be Used:
✓ Provide 2 Copes of a scaled drawing or surveyed plot plan with the following information:
signs: drawing of the lawn
ird.te sign on fayade)
o Height of freestanding Sign /attESTIONS Cal 7614M OREM L
o Depth of projecting sign I �eensbury net
o Distances from front and side property lines. \11lI OUR WEBSITE FOR AI INFORNIM,
Provide 2 dravrings or photos of sign design. ensburv.net _
✓ Provide Applicant and Owner's signature(permission ---
for placement of sign on the properly or building).
Declaration: To the test of my knowledge,the statements contained in the application,together with the plans and
speaf.cations 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 mat such vi is autnorized by the owner.
APPLICANT SIGNATURE: l DATE.
I hereby authorize the apdicant to W n prop Tiding.
OWNER SIGNATURE: DATE: S /
CaTntptr of Quccnsluny• Ctnfruunlih/Dcztcfuymcrt(?f%trc• 742 Itey Rne<i, Qanrrlshury, NY 12304
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