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2012-078 Cumberland Farms TOWN OF QUEENSBURY 1,*1742 Bay Road,Queensbury,NY 12804-5902 (518)7614201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT PermitNumbe - .Pla22_1711k=_ Application Number:_-_-_JU012007$_-- _ Tax Map No: 523400-303-005-0001-024-000-0000 Permission is hereby granted to: CUMBERLAND FARMS.INC. For property located Be 410 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 Conatructiou Value Owner Address: VSH REALTY INC. sign 100 CROSSING Blvd#9003 Total value FRAMINGHAM,MA 01702-5401 Contractor or Builder's Name/Address Electrical Inspection Agency EMCO CONSTRUCTION Plans&Specifications BP 2012-078 Cumberland Farms 57.75 sq. ft. Wall Sign-Change of Copy ONLY SO,QO PERMIT FEE PAID-THIS PERMIT EXPIRES: Of 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 enab M 'January 28,2013 SIGNED BY or the Town of Queensbury. Director of Building&Code En ement •OFFICE USE ONLY (� � I; r •l U TAX MAP NO. PERMIT N�DI,-©7 <PERMIT FEE.— L/ r l ', : e,/ tin u ��jQ�n� F:1) i= 7 201,2 APPROVALS: DEPOSIT 1`x'4' , • •ITN _ SIGN PERMIT APPLICATION: B ILDINO&CODES 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. OWNER: Cumberland Farms INSTALLER/BUILDER: Emco Construction ADDRESS: 100 Cronin Blvd Fm nmingbam MA ADDRESS: 2050 Western Ave Suite 210 Guilderland NY 12084 PHONE NOS. 508-270-4410 PHONE NOS. 518-456-1853 LOCATION OF PROPOSED INSTALLATION:(LEGAL ADDRESS) 410 Quaker Road BUSINESS COMPLEX f PLAZA/MALL NAME: BUSINESS NAME: Cumberland Farms CONTACT PERSON FOR SIGN CODE COMPLIANCE: Kevin Huntinwjon PHONE: 518456-1853 TYPE OF SIGN PROPOSED: _freestanding S.wail _owing ig _projecting IF SIGN IS TO BE ILLUMINATED,PLEASE INDICATE: X Internal _External _Incandescent _Neon _Other DO SIGNS CURRENTLY EXIST ON THE PROPERTY? "lee _Nom / IF YES,UST ALL EXISTING SIGNAGE: gal ri, rL Pte..�t/A.i '( The application creates a change New I the following existing site _Change In number of signs from to conditions(1W In all applicable _Change In setback for sign from to spaces): Change in size of sign from to _Change in height of sign from to _Change of wording/copy from: / ,� to: Sign Wording/Copy: A� Gro��c! /fA/,st S Sign size: Length/x Width SAP=Total Sq.ft. Air Sign Height(freestanding sign): Color and Material to be used: 62a v LYS 39r/864j 'S So/ Ain in 446 a w.I,CZSet 0.41 / ✓ Provide 2 copies of a scaled drawing or surveyed plot plan with the following Information: we o Location of sign (wale signs: drawing of the facade the sign wAN be located on,Indicate sign on facade) o Height of freestanding sign =EaTIONS? CALL 7e1426e OR EMAIL o Depth of projecting sign codsstilauesnsburv.ne; o Distances from front and aide property lines. VISIT OUR WEBSRE FOR MORE INFORMATION ✓ Provide 2 drawings or photos of sign design. www.aueensburv.net ✓ Provide Applicant and Owner's signature(permission for placement of sign on the property or building). Dedaraaon: To the beet of my knowledge,the statements contei • In the application,together with the plans and ape co sii ons of submitted,Zuni are r true and comp) *vl 1•. ,.,. proposed be shall be complied with,whether d that•all provisions of the Zoning Ordinan•- • � '•specified or noted,and that such `` �'` I er. APPLICANT SIGNATURE: /' DATE: ! .f I hereby authorize the appi --M to • / �T�u"•r building. OWNER SIGNATURE: / I_' DATE: cA,4 • aTown of Queensbury• Community Development Office • 742 Bay Road, Queensbury, NY 12804