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39A-020 AGNOLI SIGN COMPANY, INC. • 7"22 \V'C)I: I I IIN(, LON ti II<LL I SI'KINGIIELI), NIA (111(15 • ILL. ( —}13) 7',2 —5111 • FAX \X (� }1;1 7I)7 -2"1(f 1-:41 :..; IF - IN Baystare Medical Pracl ces NOW ACCEPTG 4 '. Baystar NOW Hetb Mea cat Praames N W PATIENTS "^, A CE 3 7.7. ... (.M 11413 -381 4100 ....,.. W ATIENTS . �..,.._r- .�..a.. . �.. e. ._ <... , M.. - -. / 613 38] A100 .. ow y Baystate LPL. Medical Practices Pioneer Valley Family Medicine NOW ACCEPTING NEW PATIENTS Call 413 -387 -4100 3' X 8' BANNER W /SHADOW BLUE COPY CUSTOMER: BAYSTATE HEALTH LOCATION ° 118 CONZ ST CONTACT: DRAWING CODE BAYSTATEMED /2007/118 CONZ.PLT OR G. 5-7-10 REV. 0-0-00 280 CHESTNUT ST NORTHAMPTON, MA SALESPERSON: PETER DRAWN BY INIT DRAWN BY INIT SCALE MS SPFL DRAWN ., MA DRAWN BY LANCE REV 0 - 0 - 0f REV. AOrao o DRAWN BY em «aA a go ALL vrs BAYSTAE /2005 -2007 118 CONZ.CDR 0 - 0 0 INIT DRAWN BY MIT. TO rs USE OR REPRODUCTION ARE RESERVED : : 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: APPLICANT'S SIGNATURE 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 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: \ \nr.) V, 5 n ( ■t». Address: C) 0`=X Ir.,S: i 'r �f1C F4. ()A In,5, Telephone: 1 -113 - 13 - 511 2. Owner of Property: bn 4 e Ile() 1 4h Address: air) (' .4)01 A• SPr,(Ya i; pCl, (11q Telephone: ull : " ( 4 1 .4 6o 5 n 3. Status of Applicant: Owner /Contract Purchaser Lessee _Other(explain): 4. Job Location: 1 i% Cora 3 Mre e r 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) ( cr hnncpc c per f3Yp Ch • 7. Attached Plans: f 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 f 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 r 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 • City of Northampton M assac h use tt s ,4 4 5 , . , .+c cr 3 ' „s PA ( DEPARTMENT OF BUILDING INSPECTIONS a1 212 Main Street • Municipal Building 'XA .I t' - .,,- ' Northampton, MA 01060 s ~ S" � �� Application for a Permit to Place or Maintain a Sign INSPECTOR pp g Or other Advertising Device, or Marquee P1v o/( (Applicat._i .to b pait iropk r. pewritten) Number , t vi 4 t' Plans must be filed with the Building Inspector J _= ^_ — Erection ( ) before a permit will be granted. Alteration ( ) Reair MAY 2 2.010 ,'• Repainting ( ) �_-1 Removal ( ) fr r r'( FJ FEE PAGE PLOT Northampton, Mass. .20..... To the Building Commissioner: Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME . -ES Q4e,...CicaA...PCO a ces.. . 'tacleP.c...q jPi...raritl.i.. 1. Location, Street and No. I .I: b .....Coni.... .5\ r.eQ 4 2. Owner's name S q.54.31e....r QO I +h ((�} f, 3. Owner's address .. o....0 - nOk...5.kce Q t ..... .r.�. t' Rd. MA 4. Maker's name Pty.ICAt. .3.8.0 C. i 0C. (? 5. Maker's address . .dol....k. h�n4 rar .A-. n : .. .. C....eRX ..ID5S.... .irn..�,.el8a..fa:1.0110l low 6. Erector's name n j f (k7.li...3 Cc...4.oc • 7. Erector's address - .4. aa.. I ... 451 -..... Pc . eox. ..IIJ.: .r. S.... c i Q Id,.p(I.R .Q.i.loi :.1055 SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated Non - illuminated 2. Will sign obstruct a fire escape, window or door? .1.0 ... 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 ..,3..ft...c>. ins Width ...$.ft... b ins Temporary..../ 6. Face area .d!k.sq. ft. Wall 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 .WA .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 $ ,,,.c:?. .it,0 The undersigned certifies that the above statements are true to the best of his knowledge and belief. (Signature of Owner or Agent) Page 1 of 3 r ' File # BP- 2010 -1045 APPLICANT /CONTACT PERSON AGNOLI SIGN CO INC ADDRESS/PHONE P 0 BOX 1055 SPRINGFIELD (413) 732 -5111 PROPERTY '1 �. ,90` % rxf MAi P EL 020 001 ZONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 603 Fee Paid Typeof Construction: ERECT 3 X 8 TEMPORARY BANNER - NOW ACCEPTING NEW PATIENTS 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 Approved V 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* ✓ -7 ' -T ()(2') 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 SIZR) I 0 Signature of Building Of is al 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.