2011-349 Family Dentistry TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110349 Date Issued: Tuesday, August 09, 2011
This is to certify that work requested to be done as shown by Permit Number P20110349
has been completed.
Tax Map Number: 523400-301-008-0001-035-000-0000
Location: . 365 AVIATION'RdRd
Owner: 365 AVIATION, LLC
Applicant: JESSICA.SHIN.DI)S
This structure may occupied as a:
Sign
By Order of Towh Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Cd e En1kcernent
Planning Board or Zoning Board.of Appeals.
TOWN OF QUEENSBURY
742 Bay Road;Queensbury,NY 12804-5902 (518)761-8201
Community Development'-Building&Codes (518)761-8256 .
BUILDING PERMIT:
Permit.Number: P20110349 Application Number: A20110349
Tax Map No: 523400-301-008-0001-035-000-0000
Permission is hereby granted to: JESSICA SHIN DDS
For property located at. - -3,65 AVIATION Rd
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. Tyke of.Construction Value
Owner Address: 365 AVIATION,LLC Sign
365 AVIATION Rd" Total Value'
QUEENSBURY,NY,- 12804-0000
Contractor or Builder's Name-/Address Electrical Inspection Agency
K.D. WHEELER CUSTOM SIGNS
16 RICHARDSON STREET -
OUEENSBURY,NY
Plans&Specifications.
2011-349
22.5 sq ft sign to read"Jessica Shin, DDS Family Dentistry"
$67.�0 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,August 09,2012
(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 Quee bury TuaA°Yigust 09,2011
SIGNE)BY , for the Town of Queensbury.
Director of Building&:Code Enforcement:
•------------------------------------------------------------------
OFFICE USE ONLYD - -8-
TAX MAP NO. PERMIT NO. PERMIT FEE
JUL 2 Q 2011 0
i APPROVALS: DEPOSIT i
� '�LTIjEEi43 '
SIGN PERMIT APPLICATION: BUILDING P. CODES
A permit must be obtained before installation of your permanent sign. Ali applicants'spaces on this application must
be completed and must appear on the application form.
OWNER:_Je S S i CA S i-I I"i r 1>DS INSTALLER/BUILDER: k• 72. 1t)NEE LG P p6U S-11 M S/Cr/-)s
ADDRESS: 3tP 5 A V f A-n O,3 ZI -D i3`/ ADDRESS: 1(p ►R 1 Cr I DS d/J
PHONE NOS. —1 q R` Me 91!p PHONE NOS. 12 3-,2(P-2�
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) �3 h S A1/r ATI 6 nj -P-D. g Y
BUSINESS COMPLEX/PLAZA/MALL NAME:
BUSINESS NAME: I-J ESS(CA SN 1rJ� / DJS F,41-1IL`/ _C)EIJT/STP_`/
CONTACT PERSON FOR-SIGN CODE COMPLIANCE:- - PHONE: -713
TYPE OF SIGN PROPOSED: freestanding _wall _:awning _projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: _internal K.-External _incandescent _Neon _Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? kYes 4,No
IF YES,LIST ALL EXISTING SIGNAGE: __fkni n,11A_V-W
The application creates a change ✓New
in the following existing site Change in number of signs from to
conditions(fill in all applicable Change 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 Wording/Copy: FA-M I ty �F.►JTIS'T1� /Ess1 cr4 LSHra) 17 r] S
Sign size: Length 72 x Width =Total Sq.ft. Sign Height(freestanding sign):
Color and Material to be used: ALL i Q tt,5 (.AWN rTi= / 143>V_
✓ 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 QUESTIONS? CALL 761-8256 OR EMAIL
o Depth of projecting sign codesCaD-aueensbury.net
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. www.aueensbury.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 work shall be complied with,whether
specified or noted,and that such ork is authorized by the owner.
APPLICANT SIGNATUR DATE:
I hereby authorize the ap 1 nt to p ace sign on_my property or building. /
OWNER SIGNATURE: G DATE: _ I Tt/—r
Town of Queensbu ■ Community Development Office ■ 742 Bay Road, Queensbury, NY 12804
. 72.2 in �
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36S -
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S 18-798-S696
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Jessica Shin, DD S a
50.1 in
Client: Shin Famlly Dentisrty
• Drawing#:6/20/11
CUSTOM ;SIGNS Date:
Approved by: f
n ome'or.on rt+e vyHeeuMn,wr;r oweu�wo. A signature Is required before any work can be Initiated. W
to a�6TN o.' Hwv tma/
This design Is copyrighted and Is the exclusive property of The Wheeler Art Group,Inc,
it Is not to be copied or reproduced In any way until approved and accepted through purchase
by the client or their agent.
& SIEVES
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