22B-041 (27) 11. ALL INFORMATION MUST BE COMPLETED,• PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
12, This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage
Front:
Setbacks:
Side: L: R. L: R:
Rear:
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus bldg and
Paved parking)
#of Parking Spaces
#of Loading Docks
Fill: (volume&location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 16"'t APPLICANT'S SIGNATUR
Applicant's Email Address (required)
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
Requirements and obtain all required permits from the Board of Health, Conservation Commission,
Department of Public Works and other applicable permit granting authorities.
Page 3 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: Telephone:
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):
4. Job Location:
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary)
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: Enter: Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES: Has a permit been,or need to be,obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
10. Do any signs exist on the property? YES NO
IF YES: Describe the size,type and location:
Are there any proposed changes to,or additions of,signs intended for the property? YES NO
IF YES: Describe the size,type and location:
Page 2 of 3
- Tit1j of Xortam ton
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` � � �� .+.)dlttssttrlfusptts F��5 "�-
DEPARTMENT OF BUILDING INSPECTIONS %
212 Main Street • Municipal Buildings
_ Northampton, MA 01060
JN-�PE(70u Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device
(Application��� writte ) Number .....................
Plans must be filed with the Buildin Ins ecto Erection..................( )
before a permit will be granted. Alteration.................( )
NOV 2 7 2018 Repair.....................( )
Repainting....... ....( )
9r�l-)Wd �go moval........�{.j....( ) I
1LDING INSPECTIONS ,�//
DEPT OE au I .......PAGE ....PLOT.......
NORTHAMPTON•P.1A 01060
To the Building Commissioner: Northampton, Mass. ...............................20.....
Application for a permit to place or maintain
-a signorother advertising device, or marquee.
BUSINESS NAME .UA....K..int�E ....L!- .F .......................................................
1. Location, Street and No. 06.. ....k\stere. ...1 .... ...
2. Owner's name )ck 1Qd ......c x��n.... y� .................................................
3. Owner's address . .... SJuC�i,US. ....J.-TW?..... 1.�... .... ��Q .....
« ���4. Maker's name ............ ........ ....... .... .. .....................................................................
`lS 1/2-... _
5. Maker's address ........... .l3C.y.(Dy.....5�'.r... � /lu �O✓C3!'1....../V( ....��62. �.....
6. Erector's name ..........................................................................................................
7. Erector's address .......................................................................................................
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated ....... Non-
illu inJated .......
2. Will sign obstruct a fire escape, window or door? .. . .. Marquee ...............
3. Lower edge will be ......ft........ins above the public way. Projecting ..............
4. Upper edge will be ......ft........ins above the public way. Roof .....................
5. Height ......ft......ins Width ......ft......ins Temporary.............
6. Face area .......sq. ft. Wall .....................
7. Inner edge will be ......ins from the building or pole. Sidewalk....................,,
8. Outer edge will be .......ins from the building or pole. Other...... ,t��^ �` /
9. Face of building or pole is .......ins back from the street line. 5.
10. Sign will project .......ins beyond the street line.
11. Sign will extend .......ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame ........................ Face.......................
13. Estimated cost $........................
The undersigned certifies that the above statements are true to the besYbf bis knowledge and belief.
.... ..... .. . ..
(Signat of Owner or Agent)
r'
Page 1 of 3
File#BP-2019-0637
APPLICANT/CONTACT PERSON PUFFER SIGN
ADDRESS/PHONE 45 UNION ST EASTHAMPTON (413)527-1069
PROPERTY LOCATION 176 PINE ST
MAP 22B PARCEL 041 001 ZONE NBU901/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid CHAN To
Typeof Construction: NON ILLUMLATED N T TM RET CAFE MIX
New Construction
Non Structural interior renovations
Addition to Existing
-
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FgtLOWING ACTION HAS BEEN
TAKEN ON THIS APPLICATION BASED ON
INF94MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
—Demolition Delay
Signature of Building Official Date
Note:issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
City of Northampton Map 22B Lot041 Zone NB(100)/
Massachusetts Date issued 11/30/2018 0:00:00
Inspector of Buildings Permit # BP-2019-0637
Permit Fee$100.00
SIGN PERMIT
Business
Address 176 PINE ST
Applicant InstallerPUFFER SIGN
Applicant Installer Address 45 UNION ST
Work Description NON ILLUMIATED GROUND SIGN - UN ARRET
CAFE - NO CHANGE TO FRAMEWORK- REFACE ONLY
Estimated Cost $733.00
Building Department
ARproval__by:
Sands
LLO'Woll
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