SIGN-000217-2017 TOWN OF QUEENTSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Zoning Department (518)761-8256
SIGN PERMIT
Permit Number: SIGN-000217-2017
Tax Map No: 302.6-1-63
Permission is hereby granted to: Merrie Lynn Towle
For property located at: 68 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
Owner Name: Petroski&Fisher LLC Sign-Temporary $0.00
Owner Address: 68 Quaker RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans&Specifications
Temporary Banner 12 sq.ft.
for a period of 60 calendar days.
May 4,2017 thru July 3,2017
$100.00 PERMIT FEE PAID Monday,July 3,2017
Dated at the Town of Queensbugv, Friday,May 26,2017
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SIGNED BY: for the Town of Queensbury.
Zoning Administrator
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TEMPORARY SIGN PERMIT , �'� c"""" c k � �r I g Deposit Paid To,00
Chapter 140 Signs;Section 140-4 Temporary Signs and Section 140-5 General Standard gilations A Request#�of 5 allowed
t ..� k 88q Sign Dates
Filing Fees: $10 for up to and including 12 consecutive days with p 6 from ii to
a refundable deposit of$50. -1 Ott`; :Ku z>,, a� Office Notes:
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GENERAL INFORMATION: Only one active,temporary sign F rtt�el�a
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Applicant Name(person` ponsible for placing and removing sign) Prorerty Owner Name
Street/koad/PO Box (mailing address) Street/Road/PO Box (mailing address)
City/State/Zip Code City State/Zip Code
Email Addre�-���P
is Phone Number Emai Address Phone Number
IS PROPOSED SIGN"OFF PREMISES"? Yes / No
LOCATION OF SIGN: R4�1_ TAX MAP NUMBER: j C.}�2/L
BUSINESS/EVENT NAME: SIGN COPY/WORDING:c-, ry)t,e lva&('a
RF SIGN REQUESTED: (check one)estandin Si (ground sign)—limit 16 s .ft. all Si n—limit 32 s . ft.
ary, double-sided,freestanding sign must be placed a minimum of porary wall sign must be placedflush against
rom the front property line. If the front property line cannot be t e wall of a building and may not project more than
determined, the following setbacks shall apply: four(4)inches from the surface of the wall to which
a.) Forty(40)feet from the center line of a two-lane road they are attached.
b.) Forty-Five(45)feet from the center line of roads with 3 or more lanes.
Include a rendering of the sign. Include a site plan
Include a rendering of the sign; indicate dimension from grade to top of clearly showing the location of the sign in relation to
sign. Include a site plan clearly showing the location of the sign in relation property lines and roadway/driveways. Show sight
to property lines and roadway/driveways. Show sight distances. distances.
The installed sign must remain secure and taut while on display. The installed sign must remain secure and taut while
on display
AREA OF TEMPORARY SIGN: (feet and inches)
Height of Sign Surface ! ; Width of Sign Surface Total Square Footage:
Height from Grade to Top of Sign: (freestanding/ground sign only)
DATES OF USE: From: kA 1�-�101 ? To:
NUMBER OF SIGNS PER CALENDAR YEAR: Temporary Sign Request No./"5 of 5 &0 d"XS
Number of Temporary Sign Permits Allowed: 1
I) Five (5) Temporary Sign Permits per applicant for a total of 60 days per calendar year.
2.) Only one active, temporary sign permit per applicant.
REFUND: The$50.00 Deposit will be processed upon receipt of a letter from the applicant stating that the sign been removed. The Sign must be
removed upon expiration of the permit. Failure of the permit holder to remove the sign,the Zoning Administrator will issue a written notice directing
that the sign be removed within 24 hours. Failure to comply with this notice within 24 hours shall result in forfeiture of the cash deposit.
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Applicant's Signature Date Property Owner's Signature Date
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