BOTH-00088-2016 St. Peters Health Partners i
TOWN OF QUEENSBURY
4iL 742 Bay Road,Queensbury,14Y 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000088-2016
Tax Map No: 302.7-1-44
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Permission is hereby granted to: AJ Signs
For property located at: 154 QUAKER RD
In the Town of Queensbury,to construct or place at the above location in ac ordance with application together
with plot plans and other information hereto filed and approved and in comf liance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of C nstruction
Owner Name: Michael Kajdasz Sign $0.00
Owner Address: PO Box 268 Total Value $0.00
Cleverdale,NY 12820
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Contractor or Builder's Name/Address Electrical Inspection Agency
AJ Signs
842 Saratoga RD
Burnt Hills,NY 12027
Plans&Specifications
New Wall Sign 9 sq.ft. Sign Copy: St Peter's Health Partners Albany A sociates in Cardiology.
This is the same business as Primecare Physicaians,PLLC,however,a n e change. This wall sign is NEW and not a
replacement sign.
PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,March 4,2017
(If a longer period is required,an application for an extension must be mad to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of Qu Vj�edne ,2016
SIGNED BY: �d/ for the Town of Queensbury.
Director of Building&Code Enforcement
302.7-1 -77 BOTH-088-2016
St Peter's Health Partners...
9 sq.ft.wall sign (new)
Town of Queensbury Building & Codes 156 Quaker Road
FES 17 010 Tax P,lac - -
—-—
SIGN PERMIT APPLICATION --- --
Perm!t+Nc
' f
Permit Fee: 3 _
Date Applicant _
Tax Map ID 5-2,3' 100 —I —4/' Address -,
Zoning 1 1�
� —
Property Owner --A t c.•►mot E L Contract jr/Agent
Address _ Address
Phone I�'� (�St _ 3tt`�_____. Phone
Contact Person for Sign Code Compliance: Day Phone:
Building Street Address: ���c,��°�� F ���.,,ti F {�;t� '� r 7 u
r,
Site Plan,Variance, or Subdivision Approvals
Location of proposed installation ;�S
j Business Complex/PlazaiMall name j
, Business name
Type of Sign proposed
if sign, is to be illuminated indicate c-interral _external _Ircardescent _neon _ether
I Do signs currently exist on property? Yes —Ne(if yes. list ail existing sigr,age)
Change of'Ncrdicopy I From to
Sign Wording 1 Copy
I Sign Size Length t = x Width,!�=Total sq ft. �
Sign Height freestanding)
Color& Material to be used ll u«„nucn �I k
This application creates a change in the New
fcl!cwirg existing site conditcrs,fill in ail Change in numberrof signs from to
applicable spaces) Change in setbackifor sign from to
Change in size frorl to
Change it height sign from tc
Declarattcr: To the best of my k%viledge. the statements cortaired tre 3ppiicatcr. tcgetrer �,vith the piars and spec,ficar.ors
sJbr,itted are 3 tr:ie and complete statement of all proposed �Nork to be re or the cescr:bed premises and ;hat all provisions of the
Zonirg Ordirarce and all other laws certairirg to the proposed 'Mork 3hail be compliec 'Nit^ M ether specif'ed or rcted ark' that such
work is aLthcr,zed by the owner
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APPLICANT•PRINT NAME
APPLICANT-SIGNATURE _ Date
eclarat:cr. i ^ereby at.,ror`za:re 3cv;cart:c ciacc 3 31g- iC I�cer r ,,r
OWNER-PRINT NAME
OWNER-SIGNATURE
:.-ces Sig.- =?. ,'t 'ccicar;", A-'146