2013-526 Berkshire Bank Aek4 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130526 Application Number: A20130526
Tax Map No: 523400-296-019-0001-043-000-0000
Permission is hereby granted to: BERKSHIRE BANK
For property located at: 183 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: FLEET NATIONAL BANK Sign
C/0 BANK OF AMERICAN CORP R Total Value
NC 1-001-03-81
101 N TRYON St
CHARLOTTE,NC 28255-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
AGNOLI SIGN CO.. INC.
CHRISTINA MOREAU 413-221-6298
722 WORTHINGTON St
PO BOX 1055
SPRINGFIELD MA 01101-1055
Plans&Specifications
2013 - 526 Berkshire Bank
SIGN wall sign
$54.00 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 f Que sbu /Alt a t_I_• •mber 23,2013
d'J •1.
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received:
SIGN PERMIT APPLICATION thPaPJ:2013 a 91r,)9-
Permit No.: 7 , -
Permit Fee: $ S.
Date 7// /i Applicant AONOLI SIGN CO., INC.
Tax-IVlap ID — Address 722 Worthington St,
Zoning P. a Dox 1055 -
Springfield,MA 01101.1n5.5
Property Owner j (' r (C S hi re --44 rc Contractor/Agent: I _, _ _, _g•
Address '-( ,Uv C 7-/-t .S i . Address — 722 Worthington St
f' 7,3/-, - o, ,4 4 P. O. Box 1055
Phone L7-7 3 -- . •- , , '-/ Phone Springfield,MA 01101-1055
Contact Person for Sign Code Compliance: f`fr--i c-7l Day Phone:
Building Street Address: I 3 Qu 0
Site Plan,Variance,or Subdivision Approvals_
Location of proposed installation
Business Complex/Plaza/Mall name
Business name ,- (L j (5
Type of Sign proposed
If sign is to be illuminated, indicate : t/intertal _ temal _Incandescent _neon _other
Do signs currently exist on property? /Yes _No(if yes, list all existing signage)
Change of word/copy From /?/4-, o J= 6 i cA to c s r-r " c /4-
Sign
fSign Wording/Copy
Sign Size - Length % x Width : 'G "=Total sq.ft. /
Sign Height(freestanding)
Color&Material to be used
This application creates a change in the New • fa.r /..
• -. 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 workto 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. ,q
APPLICANT-PRINT NAME r //C/ !: h rut r {-�( '3r<�
APPLICANT-SIGNATURE: ( �i,�-(�{;t �-2 %I� ��� Date: / // 7/1 3
/
Declaration: I hereby authorize the applicant to place a sign on my property or building:
OWNER-PRINT NAME:
OWNER-SIGNATURE: Date:
Intim of(Liaonchiart'FLulrfinn R('..nrlcc Cinn Pornif Annlinafinn c1R_7R1_R,)cc
IERKSHIREBANK
America's Most Exciting Bank
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BERKSHIREBANK
America's Most Exciting Bank
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SIF New York State Insurance Fund
Workers'Compensation & Disability Benefits Specialists Since 1914
105 CORPORATE PARK DRIVE SUITE 200,WHITE PLAINS,NEW YORK 10604-3814
Phone:(914)253-4871
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAA 041017411
AGNOLI SIGN COMPANY(A MA CORP)
PO BOX 1055
SPRINGFIELD MA 01101
POLICYHOLDER CERTIFICATE HOLDER
AGNOLI SIGN COMPANY(A MA CORP) TOWN OF QUEENSBURY
PO BOX 1055 742 BAY ROAD
SPRINGFIELD MA 01101 QUEENSBURY NY 12804
POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE
W 2093 426-1 829348 02/12/2013 TO 02/12/2014 10/25/2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO.2093 426-1 UNTIL 02/12/2014, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER
FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUTSIDE OF NEW YORK, TO THE POLICYHOLDERS REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/12/2014 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE.
NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW
YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE.
THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE
INSURED CORPORATION.
DONALD AGNOLI,PRESIDENT AND SOLE
OFFICER/OWNER OF AGNOLI SIGN
COMPANY
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECTOR,INSURANCE FUND UNDERWRITING
This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888)875-5790
VALIDATION NUMBER:397675704
• STATE OF NEW YORK
WORKERS'COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier
la. Legal Name and Address of Insured (Use street address only) lb.Business Telephone Number of Insured
AGNOLI SIGN COMPANY INC (413) 732-5111
722 WORTHINGTON STREET Ic.NYS Unemployment Lsurance Employer Registration
PO BOX 1055 Number of Insured
SPRINGFIELD, MA 01101
Id.Federal Employer Identification Ntnnber of Insured or
Social Security Ntunber
041-01-7411
2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier
Coverage(Entity Being Listed as the Certificate Holder) NEW YORK STATE INSURANCE FUND
Town of Queensbury
742 Bay Road 3b.Policy Number of entity listed in box"la":
Queensbury, NY 12804 DBL 5900 86 - 6
3c.Pplicy effective period:
03/02/2013tQ 03/02/2014
4.Policy covers: -
a.® All of the employer's employees eligible under the New York Disability Benefits Law
b. Only the following class or classes of the employer's employees:
Under penalty of perjury.I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above
and that the named insured has NYS Disability Benefits insurance coverage as described above.
Date Signed 10/25/2013 By, —.�._ Joseph J. M asi
(Signature of insurance rrier'sauthorized represertatue of M'S Licersed ireura rce Agent of that insurance carrier)
Telephone Number (866) 697-4332 Title Director of Disability Benefits Insurance
IMPORTANT: If boa"4a"is checked,and this form is signed by the insurmice carrier's authorized representative or NYS Licensed Insurance Agent of that
carrier,this certificate is COMPLETE. Mail it directly to the certificate bolder.
If box-4b"is checked,this certificate is NOT COMPLETE for purposes of Section 220.Subd.S of the Disability Benefits Law. It must be mailed for
completion to the Workers Compensation Board.DB Plans Acceptance Unit.20 Park Street.Albany.New York 12207.
PART 2.To be completed by NYS Workers'Compensation Board (Only If box"4b"of Part 1 has been checked)
State Of New York
Workers'Compensation Board
According to information nurimtained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS
Disability Benefits Law with respect to all of his ier employees.
Date Signed By
(Signature of NYS Workers'Compensation Board Employee)
Telephone Number Title
Please Note:Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of
those insurance catriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form.
DB-120.1 (5-06) Certificate Number 232895
r ,
Additional Instnictions for Fonn DB-120.1
By signing this form,the insurance carrier identified in box"3" on this form is certifying that it is insuring the business referenced it
box"la"for disability benefits under the New York State Disability Benefits Law.The Insurance Carrier or its licensed agent will send
this Certificate of Insurance to the entity listed as the certificate holder in box "2". This Certificate is valid for the earlier of one tear
after this form is approved by the insurance carrier or its licensed agent,or the policy etpiration date listed in box "3c".
Please Note:Upon the cancellation of the disability benefits policy indicated on this form,if the business continues to be named on a permit,license of
contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage of
other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law.
DISABILITY BENEFITS LAW
§220. Subd. 8
(a) The head of a state or municipal department. board. commission or office authorized or required by law k
issue any permit for or in connection with any work involving the employment of employees in employment a!
defined in this article. and not withstanding any general or special statute requiring or authorizing the issue o:
such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in
form satisfactory to the chair. that the payment of disability benefits for all employees has been secured a!
provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such
state or municipal department. board. commission or office to pay any disability benefits to any such employe(
if so employed.
(b) The head of a state or municipal department, board, commission or office authorized or required by law tc
enter into any contract for or in connection with any work involving the employment of employees it
employment as defined in this article. and notwithstanding any general or special statute requiring or authorizinE,
any such contract. shall not enter into any such contract unless proof duly subscribed by an insurance carrier
produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has beer
secured as provided by this article.
DB-120.1 (5-06)Reverse
BERKSHIRE BANK
183 QUAKER RD
QUEENSBURY
�. 44
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NEW PROPOSED SIGNAGE
NEW INTERNALLY ILLUMINATED SIGN TO BE FABRICATED WITH
SIGN COMP SINGLE FACED BODY AND 1-1/2" HINGEABLE RETAINERS.
1/8" ALUMINUM ROUTED SIGN FACES WITH 3/8" CLEAR PLEXIGLAS PUSH—THRU LETTERS
CUSTOMER: BERKSHIRE BANK
LOCATION: BERKSHIRE BANK
STORE:
CONTACT: PETER MERWIN
DRAWING CODE:
ORIG. 8-9-13
REV. 10-1 7-13
SCALE 3/4" - 1' - 0"
24 North ST,
PiftSfleld,f
183 QUAKER RD
QUEENSBURY
o0o
SALESPERSON: MARIANNE
DRAWN BY: MARIANNE
QUEENSBURY.PLT/BERKSHIRE BANK/BOA CHANGEOVER
QUAKER RD QUEENSBURY.CDR/BOA CHANGEOVER/BERKSHIRE BANK
DRAWN BY:
REV. 0-0-11
DRAWN BY:
DRAWN BY:
REV. 0-0-11
DRAWN BY:
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