2012-309 TOWN OF QUEENSBURY
' .. / :-
742 Bay Road,Queensbury,NY 12804-5902 (518)761-S201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120309 Application Number: A20120309
Tax Map No: 523400-296-020-0001-055-000-0000
Permission is hereby granted to: SEAN BERGER
For property located at 351 BAY 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: SEAN BERGER
175 BROAD St Suite 314 Sign
GLENS FALLS,NY 12801-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
K.D.WHEELER SIGNS
Plans&Specifications
2012-309
Wall Sign 4 x 3 for Adirondack Retirement Specialists
$36.00 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 Queensbury before the expiration date.)
Dated at the Town of Q eensb • , - •i 12
SIGNED BY N for the Town of Queensbury.
Director of Building&Code Enforcement
45P1 ptc
OFFICE USE ONLY
62-0
TAX MAP NO. cq(p,a(J"I SPERMIT NOZ– 3D PERMIT FEE a
APPROVALS: DEPOSIT
JUN . R 2012
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 appear on the application form. �p
OWNER: SEA 6.3 �c �- INSTALLER/BUILDER: ie b , wrIEEL.-tX e.4J STOP Slay lS
ADDRESS: 3 5 // 3 A/ /�-b . 6)rS ADDRESS: /(D R r CI-144A lS�P--)P--) S! Q r3 V
PHONE NOS. `7 l0/ - (p/ `T PHONE NOS. %AB- c�(' od
LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) 3 5 I /3 Ay "/2. •
BUSINESS COMPLEX/PLAZA/MALL NAME: (�
BUSINESS NAME: / p P-Cr-�7AC� R 1 (ZEI�L� T %. Pee/F'1/-is i 5
CONTACT PERSON FOR SIGN CODE COMPLIANCE: P-01-1-7 y (,J N i ELt'7 - PHONE: 713- '
TYPE OF SIGN PROPOSED: freestanding ��wall awning projecting
IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: _Internal "External _Incandescent _Neon _Other
DO SIGNS CURRENTLY EXIST ON THE PROPERTY? ✓S'es _No
IF YES, LIST ALL EXISTING SIGNAGE: I JVe(_ rwp �Q /DQA. R2U) 20 1 (cA
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: A1(ato Acis. E7rrSPrejA,..,s 775Sign size: Length 4 x Width 3 = Total Sq. ft. ►2- Sign Height(freestanding sign): —
Color and Material to be used: Hi) – 3 Ire_o_1
✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
o Location of sign (walls signs: drawing of the facade
the sign will be located on,indicate sign on facade)
o Height of freestanding sign QUESTIONS? CALL 761-8256 OR EMAIL
o Depth of projecting sign codesqueensbury.net
o Distances from front and side property lines. VISIT OUR WEBSITE FOR MORE INFORMATION
✓ Provide 2 drawings or photos of sign design. www.queensburv.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 hat such work is authorized by the owner./ �
APPLICANT SIGNATUR �(. ;Jt . A14..e .Q,L.. DATE: 9,7?4,y1,P--
I
hereby authorize the applicant to place a sign on my propert .r building.
OWNER SIGNATURE: DATE:
alrei
IP
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
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•
JUN 28 2012
______
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351 Bay Road l ilWND,, CR
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Y;\Adirondack Retirement Specialists\C-1 Siteplan.dwg Mon Nov 29 13:32:15 2010
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