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2015-004 Stewart's
OA TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 t41131 Community Development- Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20150004 Application Number: a20150004 Tax Map No: 523400-303-019-0001-061-000-0000 Permission is hereby granted to: STEWARTS SHOPS CORP. For property located at: 777 QUAKER 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. Type of Construction Value Owner Address: STEWARTS SHOPS CORP. P.O. BOX 435 Sign SARATOGA SPRINGS,NY 12866-0 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2015-004 Stewart's Shops SIGN wall sign 27 sq.ft. South Elevation-this is a change of copy and decrease in sign size from 30 sq. ft. to 27 sq. ft. Cross Ref. BP 2007-470 21 sq. ft. wall sign(original size measured incorrectly) $0.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbu before the iration dat-. / Dated at the Tow of Q b ;4 iii :!I ay,April 02,2015 V \ SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement dC iltL V/7 tjtil Nii161/ S'..t& . ice %Town of Queensbury Building & Codes 'r D5 1015 SIGN PERMIT APPLICATION T. D: - Pe No . Ooy/ ^ 1"1 .'I' Per 't Fe OeU — e_era 1 4_. / Date { 0 ; Applicant c O ►ev' " Tax Map ID f'S Address .i gl2 Zoning .. 0 & 1 7 Sr _ tel- 3 Property Own Or (5 c c C 'O tractor/Agent: Owner- 0644179,6) O/ Address i �I 5 . 1 ddress �4a g . Waft* i i ►�� Phone 5 —l 0 r LI , r Contact Person for Sign Code Complianceqr-dirct-le(--a00. Day Phone:��''" 0.0i y. 441 Building Street Address: u .'�� _ Site Plan,Variance,or Subdivision Approvals Location of proposed installation l ,r).9 )LL- SC 5)-1,(7-* 4.8410 Business Complex/Plaza/Mall name Business name )a - S Type of Sign proposed I v If sign is to be illuminated,indicate rntemal external Incandescent neon other Do signs currently exist on property? le/Yes No(if yes li t all existing signage) 5 • Change of word/copy From ) to Ii . /L_i "1 C Sign Wording/Copy N a- Sign Sign Size Length x Width =Total sq.ft $r Sign Height(freestanding) / V Color&Material to be used m croon tDh`k )- .xai')This a lication creates a chane in the New PP g following existing site conditions(fill in all Change in number of signs from to applicable spaces) Change in setback for sign from to Change in size from to Change in height of sign from to 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 work is authorized by the owner. APPLICANT-PRINT NAME APPLICANT-SIGNATURE: Date: Declaration: I hereby authorize the applicant to pl..- a sign/ / on my p operty or building: l,J C n/ ( � L I OWNER-PRINT NAME: i rip I OWNER-SIGNATURE: ,,.4 4j f ' Mall d Date: Town of Queensbury Building&Codes Sign Permit Application 518-761-8256 N.c ,�'""p"1 OP ID: NW ACCT O DDIYYYY) �� CERTIFICATE OF LIABILITY IN t nil r x:114 IftTHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N t H •o t , C R W'C/ 9 yR. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER toOVERAGE AFFORDED BY & PDLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B ^II THEI UIfNI INSLU R S HORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. !} U IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be en.!ll i . . If SUBROGATION IS WAI k D, subject to the terms and conditions of the policy, certain policies may require an endorsement A stater ent o ' ...'....,.-1,, i r rights to the certificate holder in lieu of such endorsement(s). TOWN ,� M'�a j /� CONTACT UIl.L)114IG<Ot CEDES PRODUCER 518-587-1342 NAME: J __, *.x« Marshall 8r Sterling Upstate 518-587-1348 (AHC No,Ext): (AIC,No): 125 High Rock Avenue Suite 206 EMAIL Saratoga Springs,NY 12866 PRODUCER Harry D Bucciferro CUSTOMER IDs:STEWA-7 I INSURER(S)AFFORDING COVERAGE NAIC# INSURED Stewart's Shops Corp INSURERA:Liberty Mutual Fire Ins Co P 0 Box 435 INSURER B: Saratoga Springs, NY 12866 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF POLICY EXPM1LIMITS (MDD/YYW) (MMIODIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X EB2611260852034 01/01/14 01/01/15 DREAMMISEAGE S((EaRENTEDoccurrence) $ 100,000 P CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJJRY $ 1,000,000 i GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJJRY(Per acadent) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 9,000,000 X , EXCESS LIAB CLAIMS-MADEAGGREGATE $ B — NXG389176K 01/01/14 01/01/15 — DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUl1VE NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below -E.L.DISEASE-POLICY LIME $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Town of Queensbury is provided Additional Insured status when required by signed written contract or agreement with respect to sign, under the General Liability policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Queensbury ACCORDANCE WITH THE POLICY PROVISIONS. 742 Bay Rd -- Queensbury, NY 12804 AUTHORIZED REPRESENTATIVE 7� - 4 - ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ti i - STATE OF NEW YORK > _ Cal _ ! - WORKERS'COMPENSATION BOARD G NSAT3 ON s e:*�• 328 State Steel - = : Schenectady,NY 12305 ANDREW M.CUOMO ROBERT E.BELOTEN GOVERNOR (518)402-0247 CHAR JEFFREY FENSTER FYFCI I1VE DIRECTOR Compliance With Disability Benefits Law Pursuant To Section 220,Subd. 8 of the Disability Benefits Law Employer: Stewart's Shops Corp. WUB Carrier ID leo.: B843134 Federal Employer Idenacation No.: 14-1323607 Self Insurance Qualification Date: 3/9/1994 Location Of Operations: New York State .There are documents on file with the Workers' Compensation Board indicating that the above named employer has complied with the Disability Benefits Law with respect to all of his or her employees, in the following manner: By approved self-insurance pursuant to Section 211, subdivision 3 of the _. Disability Benefits Law. The status of the employer as a self-insurer was effective as noted above and remains in fall force. Status Confirmed By 2/20/2014 DB-155 5/1t2013 THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION N, STATE OF NEW YORK WORKERS' ``"; ^;' WORKERS'COMPENSATION BOARD t. COMPENSATION .1.:--"i'� 328 State Street µ. r _, I-t Schenectady, NY 12305 W ;OSI) ANDREW M.CUOMO ROBERT E.BELOTEN GOVERNOR (518)402-0247 CHAIR JEFFREY FENSTER EXECUTIVE DIRECTOR Office of the Secretary Compliance With Workers' Compensation Law I,Kim McCarroll, Secretary for the Workers' Compensation Board,DO HEREBY Certify that. Name: Stewart's Shops Corp. WCB#: W630503 Tax ID #: 14-1323607 Qual Date: 1/1/1992 - has secured compensation to its employees as a self-insurer in the following manner: Pursuant to Section 50, subdivision 3 of the Workers' Compensation Law. The status of the self-insurer was effective as noted above and remains in full force. IN WITNESS WHEREOF,I have hereunto set my hand and affixed the seal of the Workers' Compensation Board this 20th day of February 2014. ,E / 17 . / .ff �- , KIM MCCARROLL SECRETARY Status Confirmed By 0 v co,-; t fj' 2/20/2014 SI-12 8/1/2012 THIS AGENCY EMPLOYS AND SERVES PEOPLE WITH DISABILITIES WITHOUT DISCRIMINATION sp ,10, 009 540. „... EX w W.rr. Sr.i6 V Sa.Fr oum+e SIME1.11.9170SION Ste ;!'',i Stt uTtt'tt , ill ' = ==_ =_==-==_' __===_== ==-====