2005-286 A Mirror's Image TOWN OF QUEENSBURY
(2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050286 Application Number: A20050286
Tax Map No: 523400-303-016-0001-061-000-0000
Permission is hereby granted to: A MIRROR'S IMAGE
For property located at: 438 DIX Ave 932391
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: 11PLEWOOD ICE CO., INC.
#32�391 Sign
PO BOX 62 Total Value
WHrI`HAAU,NY 12887-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2005-286 A MIRROR'S IMAGE
32 SQ FT FREE STANDING SIGN
$64.00 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 own Que bum;4T rsday, May 19, 2005
SIGNED BY �V/ for the Town of Queensbury.
Director of Building&Code Enforcement
Building&Codes Office-Department of Community Development-Town of Queensbury PERMIT NUMBER 0
742 Bay Road,Queensbury,NY 12804
Dave Hatin,Director c6des@aueensbury.net FEE PAID
Phone: (518)761-8256 FAX: (518)745-4437
Sign Permit Application
Application & plans are subiect to review before issuance of a valid permit for placement of a sign.
Instructions: 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. f
Applicant/Business Owner: LI'd If' Le l Co.,. ..
Address: Address:
f
Home Phone: -/ - Home Phone:
Email Address: Email Address:
Cell Phone: 'y /_ Z{ Cell Phone:
FAX Phone: FAX Phone:
Person responsible for supervision of work with respect to Sign Code compliance:
Name:
Address: Phone
Email Address:
<
Location of proposed installation: Legal Address: 43 9 J�ix �`('���-� Suite No.
Business Complex/Plaza/Mall Name: /v(C c /3Lrs"�ntsses
i
Business Name: i f r�r 5 . Tmaw - 9f 0� RECEIVED
Tax Map Number: �U 3.��°�� -�{
MAY 4 UN5
Type of sign proposed: '
freestanding wall awning pro
TOWN OF QU EtAb%9
If sign is to be illuminated, please indicate: L-Internal _External _Incandescentd d NO
_
Do signs currently exist on the property?)—(Yes / _No If YES, list all existing signage:
The application creates a change in the following existing site conditions: fill in all applicable spaces
New
Change in number of signs from to
Change in setback for sign from to
Change in size of sign from to
Change in height of sign from to
Change of wgqr�din /copy from �r�j�h, 5r �.� to j fl7�l'S h1�9 e
1llLLW G�LcS,-Z'
Sign Wording/Copy:
Sign size: Length x Width t=Total Sq. ft. / Sign Height (freestanding sign)
Color and Material to be used:
Provide 2 copies of a scaled drawing or surveyed plot plan with the following information:
location of sign (walls signs: drawing of the facade the sign will be located on, indicate sign on fag-ade)
' height of freestanding sign
(; depth of projecting sign
y distances from front and side property lines.
P v' 2 drawings or photos.of sign design.
Provide Applicant and Owner's signature (permission for placement of sign on the property or building).
Declaration: Please sign below after you have carefully read the statement:
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 SIGNATURE: DATE:
hereby authorize the applicant to place a sign on my property or building.
OWNER SIGNATURE: , DATE:
L:\Sue Hemingway\Building.Permit. s\Sign Permit Application.doc
V: 1/6/2005
C' �Y
Town of Queensburyj ,c j
Fire Marshal's Office
742 Bay Road
Queensbury, NY 12804
Phone (518) 761-8205 Fax(518) 745-4437
Fire Marshal's Inspect'o sport F r
Request SCHEDULE Received: Permit# INSPECTION ON: J'" -7
Name: (1� y
��r c�`�('�:� ��n�,� I� � PM ANYTIME
Location: LfJ
APPROVED
N/A YES NO COMMENTS
EXIT ACCESS _
EXIT ENCLOSURELA EXIT DISCHARGE �w ���`'` �T t� t
MAIN AISLE WIDTH 1
SECONDARY AISLE WIDTH
EXIT SIGN-NORMAL
EXIT SIGN-BATTERY
EMERGENCY LIGHTING
FIRE EXTINGUISHER HUNG
FIRE EXTINGUISHER
INSPECTION ►`�"`
FIRE EXTINGUISHER HYDRO _
FIRE ALARM SYSTEM
FIRE ALARM -FAN SHUTDOWN
FIRE SPRINKLER SYSTEM �--�
FIRE SUPPRESSION-KITCHEN
FIRE SUPPRESSION-GAS 4-iT
ISLAND
HOOD INSTALLATION
INTERIOR FINISHES
STORAGE
COMPRESSED GAS i v
CLEARANCE TO SPRINKLERS
CLEARANCE TO ELECTRICAL
ELECTRIC WIRING ENCLOSED
COMBUSTIBLE WASTE
VEHICLE IMPACT PROTECTION —�
FIRE LANE
F.D.SIGNAGE-UTILITY ROOMS
NO SMOKING SIGNS
MAXIMUM OCCUPANCY SIGN
EMERGENCY EVAC PLAN'
l
OK THIS DATE K F R CO NOT OK
INSP CTED BY
COMDEVICHRISJIWORD/LETTERS2001/FIREMARSHALINSPECTIONRE PORT11022001
WHITE-BUILDING DEPARTMENT COPY YELLOW-OCCUPANT COPY
RECEIVED
TOWN OF GUEENSBURY
SUILDtNG AND CODE � '
NOV 17 1999
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r� 2$ .51 t:-N
RECEIVE
MAY 0 4 7_005
TOWN OF QUEENSBURY
BUILDING AND CODE
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