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Page 2 of 3
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 , Gary 5 ti , -r s
Frontage ► la ' S C.,
Front: Z.° P „ 4.
Setbacks:
Side: IC
Rear: ZC,
Building Height `IC? 1 ( 3sFa• ti� ) <; c,vw�-
(1?,a unt cry. L« )
Bldg Square
Footage 1' ux I , c., n.—._
k-k
Open Space:
(Lot area minus bldg and
Paved parking)
# of Parking Spaces
# of Loading Docks 0
Fill: (volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: I o 1 Iy 1 I I APPLICANT'S SIGNATURE ■ .� . .. ~ -----------------
gip
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.
FILE #
Page 3 of 3
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
//���-,
II PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: CftCc. fl Lear- E i� CDD VA- ` J�.-+i f c -v
Address: 1.0 kk T f -e (..0 5t • t'r 114 O IO tt C elephone: LJ 13 5 - 7
2. Owner of Property: I (:-tr•
vt"..11 110 rf-a LLC..)
Address: N V' A'h t -1 r2 `, h• e,, j W 0/111 1 Telephone: L 13 ' S Es t' " d I I U Z
OI tte C)
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 14 re) z- l - J " NC' 11k 124 1 01C.) >
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT) C �
�e r-
5. Existing Use of Structure/Property: �r4 c n 1 �i�v� �r f � }cr l (1. r' f (A I t +~.i 1 I
0 f
6. Description of Proposed Use/Work /Project /Occupation: (Use additional sheets if necessary)
e6i -c4-1 ha-1(8 C 41 ifitt of c- 'Z kti? hct /
k)) 1 6 4, I-, i 114 ruylka.,„,
L�w.1r��►� s c, tcJ )c rv'
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans / IA i '1‘ ,L
i vt ty.e_
S iiti j s0 6'n • s
8. Has a Special PermitNariance /Finding ever been issued for /on the site? ff
NO DON'T KNOW ,- YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW x YES
IF YES: Enter: Book Page and /or Document #
Nit T ib my
9. Does the site contain a brook, body of water or wetlands? NO X 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 X NO p/� /
IF YES: Describe the size, type and location: 11 IS U. $ctkn tAaic,A b rcI rkovf Si f1
0 ti,} , Yt f v n ` t [ C9 iit-k ad h n h,z m tA..11 d ict - / C. H tux-0
'/ L nu
Are there any proposed changes to, or additions of, signs intended for the property? YES x NO
IF YES: Describe the size, type and location: 11c i S - ' -c u t-'.n; t t/'- ' t
<-4 / 4. St Wit tA,C IA 1 CA i I_ 11'
L I Yt -Lat I D i- t -c v►tiu � t t t� 1/ 1 kx-e
vit4
r-� L C
-C tt 12 a t 1'1`k l e SL!.' n.� v�, ec�
� �t '''�J�t'n� SLr , PCh.j
ri.„. .. 44.
N ,, ` , ,
WI
9 .... _ .. .,
„A�F �' ECEIVED itu of x rt1Tttmpto - �5 _s�
? ° ° s r __ iti, nssarilusetts ti ? _ `�
,�c D.E ARTMENT OF BUILDING INSPECTIONS 0 '; tr
X 12 Main Street • Municipal Building ,; 4.4_ � ���
,;. i Northampton, MA 01060
lli'i';( "roil ' pp Ica Ion -tor a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee '79/04',-37a (Application to be filled out in ink or typewritten) Number ic/
Plans must be filed with the Building Inspector Erection (>C)
before a permit will be granted. Alteration ( )
Repair ( )
Repainting ( )
Removal ( )
FEE PAGE PLOT
i` II, L)
Northampton, Mass. .. ..4 U-Y 1 20.1!
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
l
BUSINESS NAME ) Cc„ k.\ Ukc 'Yi Cc` (5...Y) k /►- 1. Location, Street and No. 1 H 4 0 fi Noi' wnic. \t n mn Ci")c)
2. Owner's name LbLk ti "P i''V-60v Ylt 1). flu-Jr
3. Owner's address IS t+).L l • i\)6 «'Y1) \ 010(.4::0
4. Maker's name L.U tin
5. Maker's address 0 K.)1
6. Erector's name r 1 e- i't - k-- t-'► -N
7. Erector's address ( L k�� 'i IVANU MR_ DLO CO C
6 SIGN (Sa► L.�, c.1� bt,, -ct) KIND OF SIGN
1 l L (Designate)
1. Sign will be (check one) illuminated Non - illuminated �C
2. Will sign obstruct a fire escape, window or door? ..k).t`.. Marquee
3. Lower edge will be ft ins above the public way. Projecting
4. Upper ede will be ft ins above the public way. Roof
5. Height .. .ft..a .ins Width .! ..ft..cl.ins Temporary X
6. Face area . i2..sq. f . f }- Wall
7. Inner edge will be 41^ from the building or pole. Ground ....X.,.
8. Outer edge will be `. ffrgm the building or pole. Other
9. Face of building or pole isiu"t back from the street line.
10. Sign will project ..Q...ins beyond the street line.
11. Sign will extend . 0...ft ...Q..ins above the building or pole
12. Of what material will sign be constructed? Frame r� I Face y' -}v
13. Estimated cost $.... Xl bak4)...Lt►15wy t c' ( l . n $ N -
0 1, -� h Y1�Fl -ks^� Q.. o S c-c
The undersigned certifies that the above statements are true to the b t o his,,knowledge and belief.
s'1h_e k ■ v. (Signature of Swner o Agent)
a e c - v.m E
File # BP- 2012 -0388 i PC°
HOW _ MA''
APPLICANT /CONTACT PERSON ONCALL URGENT CARE CENTER
ADDRESS/PHONE 6 HATFIELD ST NORTHAMPTON (4) 135 -8474 (25304) try - r4F c; AQf"
o -CE D
PROPERTY LOCATION 6 HATFIELD ST 1°11P1
MAP 23B PARCEL 015 001 ZONE SI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out B3"
Cy j,/. �
Fee Paid // 9
Typeof Construction: ERECT TEMPORARY NON -ILLUM GROUND SIGN - ONCALL URGENT CARE
CENTER
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
INFORMATION 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.