2003-1012 Adirondack Dental Implant Center/RO TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20031012 Application Number: A20031012
Tax Map No: 523400-289-015-0001-004-000-0000
Permission is hereby granted to: DR ROBERT SHARP
ADIRONDACK DENTAL IMPLANT CFNTFR/R0
For property located at: 16 HUNTER BROOK Ln
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. Ty
ne of Construction Value
Owner Address: HUNTER BROOK LLC
374 STATE ROUTE 149 SignTotal Value
LAKE GEORGE, NY 12845-0000
Contractor or Builder's Name Address Electrical Inspection Agency
Plans&Specifications
2003-1012 ADIRONDACK DENTAL INPLANT CENTER
28 SQ FT FREE STANDING SIGN
$56.00 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 To,15 d slay, January 21, 2004
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
•
TOWN OF QUEENSBURY Fee Paid �. L
742 Bay Road, Queensbury, NY 12804 Approved By:
(518) 761-8256 Permit #:
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 Hunter Brook, LLC
ADDRESS 16 Hunter Brook Lane, Queensbury, MY TEL. 7093-5995
NAME OF APPLICANT Robert E. Shama, T) D.S. , M.S.D.
ADDRESS 16 Pearl street, Suite 204, Glens Falls TEL. 793-5995
BUSINESS NAME IF DIFFERENT: Adirondack Dental Implant Center
TYPE AND LOCATION I�
Check What Applies: Existing —_ Permanent — Projecting Sign-
Temporary Non-conforming Existing
Free-Standing X Wall New _)�DOV[,
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Location: Tax Map Number 289 . 15- 1 - 4
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Address 16 Hunter Brook Lane , Queansh cy _ C
Proposed Setbacks from Property Line (front) (side)
If sign is to be illuminated, please check appropriate box:
Internal External (x) , Incadescent (x) , Neon Other
Size of Sign: Width 7 ft. Length 4 ft.
Total Square Footage: 28 sq. ft .
Sign Copy: Adirondack Dental Implant Center/Robert E. Sharp, D.D.S. , M.S.D.
Color and Material To Be Used: Green, 0 Gold, Black, White--,Wood and Dense Foam Boax
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Signature: w4fi)
Circe ELL�9 owner, contracto or agent.
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I HEREBY AUTHORIZE APPLICANI PLACE A SIGN ON MY PROPERTY OR BUILDING.
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Signature of Property Owner: IA JPJ �)f all.
ORIGINAL-Office Copy COPY-Applicant
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MAP REFERENCE:
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Land Surveyors
169 Haviland Road Queensbury, New York 12804
"UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY
MAP BEARING A UCENSED LAND SURVEYORS SEAL IS A
VIOLATION OF SECTION 7209, SUB —DIVISION 2, OF THE
NEW YORK STATE EDUCATION LAW."
ONLY COPIES FROM THE OR GINAL OF THIS SURVEY
MARKED WITH AN ORIGINAL OF THE LAND 5URVEYOR5
SEAL SHALL BE CONSIDERED TO BE VAUD TRUE COPIES."
"CERTIFICATIONS INDICATED HEREON SIGNIFY THAT
THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE
TCODE OF PRACTICE FOR AND SURVEYORS ADOPTED
BY
6Y THE HE NEW YORK STATE ASSOCIATION OF PROFESSIONAL
LAND SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY
TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND
ON 415 BEHALF TO THE TITLE COMPANY, GOVERNMENTAL
AGENCY AND ENDING eLENDINGININSTITUMOLISTED HEREON, AND
TO TH[ ASSIGNE[5 OP TH[ LENDING INSTRUTION."
(518) 792-8474 New York Lic. No. 50135
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Map of a Survey made for
HUNTER BROOK, LLC
Town of Queensbury, Warren County, New .York
99.23�
94.81'
3 12-19-03
2 10--IG-03
1 5-13-03
NO. DATE
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SIGN/PARKING LOCATION
FOUNDATION LOCATION
T, P & P. T LOCATIONS
DESCRIPTION
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SHEET 1 OF 1
SHARP C1019
DWG. NO. 03118
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