32C-016 (10) Lorence Signworks
55 Willow Brook Drive
Berlin, Ct 06037
(860) 829 -9999
Date,
To:
Thank you for your request on behalf of V
Located at
If you could kindly have both the land owner /property management group and / or the lease holder sign and
date this form stating they are allowing Lorence Signworks, llc. To file a permit on their behalf, it would be
most appreciated.
I approve plans for (� ��� , located at
I allow a representative from Lorence Sign
works, llc. To apply for and complete said work in a timely fashion. I further understand that Lorence Sign
works, llc will carry out work in a professional manner and carry all necessary insurance and will list the
customer as additional insured, if requested.
If any changes are to be made (Form/Content) an additional form and plans will be sent.
Plan File Number
Landowner a6 1 1
Tenant `
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
,.1./02/7.010
RObuCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFOR
fate Fal:m Insurance MATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
91.3 Silas Deana Hwy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ocky Hill., Cl' 06067 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
ED NAIC #
SUR
Dxence Signworks 1,I.0 INSURERA:State Par.m Fire rind Casualty Company 251,43 ?5143
5 Willow Brook Dr. INSURER B:Stato Farm Mutual Auto Insurance Company 251.7£1 251_'78
orlin, CT 06031 INSURER C:
INSURER D:
INSURER E:
OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L POLICY EFFECTIVE POLICY EXPIRATION
R INSRO TYPE OF INSURANCE POLICY NUMBER DATE MMIDDlYY DATE MM/ODh'Y LIMITS
` X GENERAL LIABILITY 97 - BF - 2798 - 8 1.1/01/201.0 '11, /0:1, /207..1. 7EX RRENCE $ "00 0, 000
k 1 X COMMERCIAL GENERAL LIABILITY - �
a occurrence $ 300, 000
i CLAIMS MADE OCCUR
I ono ersan $ 5 , 0 0 0
ADV INJURY $ 1 , 00 D, 000
GREGATE $ 2. 000,000
GENLAGGREGATELIMITAPPLIESPER
I PRO - PRODUCTS - COMP(OP AGG $ 2, 000, 0 0 0
POLICY X 'EC; X LOC
AUTOMOBILE LIABILITY 039 - 97911 F.01 - 07 11/01/201.0 05/01./2011
COMBINED SINGLE LIMIT
X
ANY AUTO 034 - 4977- N01. -07 11/01/ 2010 05/01./2011 (Ea accident) $ 1., 000, 000
034 - 4976- E01, -07 11/01 /2010 05/011 2011
ALL OWNED AUTOS 034- 4975- E01 -07 11./0112010 05/01/201.1 BODILY INJURY
SC14EOULEDAUTOS 034 - 55994101. - 07 1/101/2010 05/01/2011 (Per person) $ 1,000,000
X HIRED AUTOS 034 - 5598- r01 -0'7 111011201,0 05/01,/201.1. BODILY INJURY $ .7_, D00, 000
X NON -OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
,( (Per accident) 1, 000, 000
1 a
GARAGE UASIUTY AUTO ONLY - EA ACCIDENT $
i
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY:
1 AGG $
EXCESSIUMBRELLA LIABILITY 97- BA - E556 -8 1. 1. /07./2010 1.1/0.1./2011. EACH OCCURRENCE $ 5, 0 00, DDO
f X OCCUR aCLAIMS MADE AGGREGATE $
,.� DEDUCTIBLE
$
3 RETENTION $ $
WORKERS COMPENSATION AND 97- BS- 15 ?_6 -3 1.1./0]./201.0 17.101/207.7 Y, ORYLIMITS ER
I EMPLOYERS' LIABILITY
ANY PROPRIETOPJPARTNERJEXECUTIVE E.L. EACH ACCIDENT $ 100, 0 00
OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100, 000
It es, describe sunder
SP ECIAL PROVISIONS below E.L. DISEASE - LIMIT $ 500, 0 0 0
OTHER
CRIPTION OF OPERATIONS i LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
signing and Fabricating signs
Willow Brook D.r.
�nsington, CT 06037
RTIFICATE HOLDER CANCELLATION
ditional Insured: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
entity Solutions, Tnc. and its subsidiaries and DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
ageCare Maintenance Services I,1,C NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TODO$0SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
3. REPRESENTATIVES.
1 j! AUTHORIZED REPRESENTATIVE
1 Sara I.. Masi.s (Offi.c ;e Mana(jer)
h e registration no ices M Ica a owners Ip OT Ine mars by th eir respective owners 9 )ACUND CORPORA T N
849 03 -13 -2007 All rights reserved
v�s
ri
METHOD OF FASTENI
a
F asteners TBD in f ield,
Brick Typical Lag & Shield of appropriate size and grade, wedge anchors, Tapcon
wedge bolts or Hilt! "blue" masonry screw if applicable
Block Typical Thru-Bolt preferred - threaded rod of appropriate size & grade,
toggle bolts if applicable for light load signage. Solid or cast block, wedge bolt,
quick hit exp. anchors or tapcon appropriate for channel letter fastening - light load only
Drivit Construction
Type 1- 2 layers exterior wall board /metal studs 16" - 24" on center.
' A)Toggle bolts to be used unless inappropriate for install
B)Threaded rod with proper wood (2 "x4" nominal) bracing to carry
load across structural member
Type 2 - Mastic /Foam over plywood or particle board
A)Screws of approprate length and grade shall be used.
B)Threaded rod with washer and nut to complete mechanical fastening.
Proper wood blocking if necessary to be installed to structural,
"i or UNI -Strut if applicable.
Wood Fascia; Attachment shall be made with 2 "x2" Commercial Shoes
(Wall Brackets - 3/16" Hot Dipped Galv, Steel).
Mechanical fasteners shall be grade 5 or better.
Wall attachment shall be made with lags of proper size and grade
and shall penetrate to a structural member.
Sign attachment shall be made with self tapping "TEK" screws #12x1.5"
ALL WALL PENETRATIONS SHALL BE CAULKED AND MADE WEATHER PROOF!
a
ALL FASTENING METHODS WILL ADHERE TO BOCA & LOCAL BUILDING CODES
TIONS AT HIS /HER DISCRETION
HJ HAS AUTHORITY TO CHANGE OR MODIFY THESE RECOMMENDA
�k
4
1
°s
�.�.
w
w
o• � N d
�a
co
'Sly
o
o� v
s 00 C
z o o
G+ ® N
3 N �
®R o0
lk CIO
lk
m � �
w
ccn
p � O
0
N
N
a �
O,
s W
J
'S
7 p O
y
y 9 m m <`g m
m
O
�Q ro c
0
O
TZ
n H
3$ e
,
CD
2 — <
CD
%a %
. �
n \ _
\
z to « <
\ \
� 77 �
� § j
cn P-3
\ co
� C4
1 =�
9[ §[2
� � |
- \ |(
k ®
# ] |
/) 7 k
CI
GGGGGk .
� ;qg
{ � ... .
: m
0
mmommow
£�- a
2
}� � �
r
�
� »
. � .
n \
k% kk
e 0
£
ca §
7 ` CD
§O
2z_;!! �
! %5maa
}£f]
\CL
- / | \
\mDa \ /o \
CD CD cz CD k} �
M ; �2�A �\
� \zR
�
Cj )/
2 � \
■�- %
§ �
% \�\
/� �
i
m N i
A N c a
3. �q Co o
3 m 0
m �
m
3 0
9 -o
So m
� o
x.
9
C
F
o
o
�u o
0
0
�Gn
10. Do any signs exist on the property? YES —_ NO
IF YES, describe size, type and location: 6" ±0A ^c La=�&� �
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) o� acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Dep artment
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
Open Space: (lot area
minus building Et paved
parking
# of Parking Spaces
# of Loading Docks
Hit:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicant's Signature
NOTE: Is. uance 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,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W:ADocuments\ FORMS \original \Building- InspectorA Zoning - Permit- Application- passive.doc 8/4/2004
File No.
ZONING PERMIT APPLICATION ( §l 0.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City of Northampton
1. Name of Applicant: L-0fXA GL <�s Iii\) W UP-1 J
Address: ` � .1 t l l ��lC_ Telephone: U 2 � " 9 19 9
2. Owner of Property: i t
Address: Q t Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: q0 ai a �'�"1
Parcel i Id: Zoning'Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED 1N BY THE "BUILDING DEPARTMENT)
5. Existing Use of Structure/ Property: Q.R J�a, A.
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
GCS Q� z o _ - a (- 0 - C
It 4f cane -g S; '�-
G ✓ i R yw , �0�` i Uh
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:
(Form Continues On Other Side)
W: \Documents \FORA4S\ original \Building- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004
..�,e - -,.� P
,.�
#�
b
__ ..�
City of Northampton
r = Massachusetts�"C�
DSPARTNEW OF 8>TILDXNG INSPECTIONS `
212 Main street • Municipal Building rb
Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee
(Application to be filled out in ink or typewritten) Number .....................
Plans must be filed with the Building In Erection ..................( )
before a permit will be granted. El ED Alteration .................( )
Repair .....................( )
s ..8 Repainting ...............( )
Removal ..................( )
OF 81ptDING INSPECl10NS FEE........ PAGE........ PLOT.......
NpR7�{AMPTON. MA 01060
To the Building Commissioner: Northampton, Mass . ....... ........................20.....
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME ...... .4!.S ....... ..I..IQ �C (.�. ................ ...............................
1. Location, Street and No....1 Q .... ................ ...............................
2. Owner's name ... X .... fl jvl a� ................................ ...............................
3. Owner's address io .... Hai,, ..... eci ...................... ...............................
4. Maker's name ... ► `C' 1 1 ..... ). � Lo ( rk ............. ...............................
5. Maker's address ... : 5 W .(.� 1 EE � I A
CT . 6. Erector's name ..................... .. K .�..`. �1, . *........ CT. .......... .f�. � .............
7. Erector's address ....................................................................... ...............................
-- P --V KIND OF SIGN
CVV (Designate)
1. Sign will be (check one) illuminated .... Non - illuminated .......
2. Will sign obstruct a fire escape, window or door? ..lC p. 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 .........x.......
7. Inner edge will be ......ins from the building or pole. Ground ................
8. Outer edge will be .......ins from the building or pole. Other
. ...................
9. Face of building or pole is .......ins back from the street line.
10. Sign will project .......ins beyond the street line. (( Y -,S' 4 oA
11. Sign will extend .......ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame ........................ Face...
13. Estimated cost $ ... It.b()U..........
The undersigned certifies that the above statements are true to the be of his knowledge and belief.
.......A.A ............................
(Signature of Owner or Agent)
Page 1 of 3
File # BP- 2012 -0242
APPLICANT /CONTACT PERSON LORENCE SIGNWORKS LLC
ADDRESS/PHONE 55 WILLOW BROOK DR BERLIN (860) 829 -9999
PROPERTY LOCATION 90 MAIN ST - CVS
MAP 32C PARCEL 016 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE SIGN FACES - CVS
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION 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.
°a
City of Northampton Map 32C Lot016 Zone CB(100)/
Massachusetts Date issued 9/16/20110:00:00
Inspector of Buildings Permit # BP- 2012 -0242
Permit Fee$30.00
SIGN PERMIT
Business CVS
Address 90 MAIN ST - CVS
Applicant InstallerLORENCE SIGNWORKS LLC
Applicant Installer Address 55 WILLOW BROOK DR
Work Description REPLACE SIGN FACES - CVS
Estimated Cost $1000.00
Buildinp, Department
Approval bv: