2004-367 Jack's American Bistro T TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040367 Application Number: A20040367
Tax Map No: 523400-302-006-0001-054-000-0000
Permission is hereby granted to: JACK'S AMERTC;AN BTSTRO
For property located at: 730 STATE ROUTE 9
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: DECOGLEN LP
25 CORPORATE Cir Sign
Total Value
ALBANY, NY 12203
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2004-367 JACK'S AMERICAN BISTRO
21 SQ FT FREESTANDING SIGN
$42.00 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 T f Queen ury r' ay, June 04, 2004
SIGNED BY 9 f for the Town of Queensbury.
Director of Building&Code nforcement
Fee Paid: -J
ILI TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804 Approved By:
Permit #:
9
..t
(518) 761-8256
SIGN PERMIT APPLICATION
THE FOLLOWING INFORMATION IS REQUIRED:
1. Detailed drawing or photo of sign.
2. Plot plan- of location of sign.
3. Written consent of the owner of the building or land.
OWNER OF PROPERTY
ADDRESS -1 3v �P�e(- \cry S-4'sef� Q�•.tear� r�Y TEL. I g�761-12
NAME OF APPLICANT C(X in i �
.ADDRESS � VL (5 TEL.
BUSINESS NAME IF DIFFERENT: Q Vvtl
TYPE AND LOCATION RECE,_DIVED
Check What Applies: Existing X Permanent Projecting Sign
- Temporary _J Nan-conforming Existing wi is f 2004
Free-Standing Wall __ New !_
;�'� TOWN OF C�UEENSBURY
;�� - ,� BUILDING AND CODE
Location: Tax Map Number r
Address73v S¢�.
Proposed Setbacks from Property Line (front) �_ e{side)
If sign is to be illuminated, please check appropriate boW ,pl"
Internal External ( ) , Incadescent { ) , Neon ( ) , Other { )
Size of Sign: Width ft. Length ft.
oo
Total Sqare Footage: _off J V ��
u
Sign Copy: Q,C S Zrr I C_cy C
Cam.C (00,VV14LO
Cal irL
Color and Material To Be Used: �� DC 1/L
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Signature: Cq'Zq
Circle One• Applicant; owner, contractor. or a en
I HEREBY AUTHORIZE APPLICANT TO PLACE A SIGN ON MY PROPERTY- OR BUILDING.
Signature of Property Owner:
ORIGINAL-Office Copy COPY-Applicant'
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