23B-015 (15) 1.� 20
�X l S7l,v tj' x 9 » +,
V ILL...*- , u-s16 , )
On Call
URGENT CARE CENTERS
WALK-IN MEDICAL CLINIC
X - RAY
AVAILABLE
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: 1 hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: ° 1 2- 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: 4 ' ' i,�) _c .- St .>
Address: '7 (�Z S i �C�u�t :Z� , C .0i Telephone: 5 )
2. Owner of Property: C L cN'
/
Address: I h" ��� Si , / iJ Cy �` y � it'lct Telephone: L I Y SZ 1 7 Y2
3. Status of Applicant: Owner Contract Purchaser Lessee
■Other(explain):
4. Job Location: (, 1 S) 1 'L-I -P ,
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property: CAc. D < - C--
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary)
t1 S 1 Gr- ti t sT Sb 6 2cvr' --) Si ti S NU -4
7. Attached Plans: Sketch Plan` Site Plan Engineered /Surveyed Plans
8. Has a Special PermitNariance /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 DONT 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: / ,' 516A-)
ON 17 -r 1 c ) L 'j2
Are there any proposed changes to, or additions of, signs intended for the property? YES � NO
IF YES: Describe the size, type and location: AP 0 1Z- 5 i > c Li I " Nom'
S 1 (51\
Page 2 of 3
City of Northampton
+. • ' j � Massachusetts : -,
f � t d ' * ` DEPARTMENT OF BUILDING INSPECTIO 1,s
` ,,,, „ -.. 212 Main Street • Municipal Building
'' -- F : Northampton, MA 01060 Vt
p
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 Inspector Erection ( )
before a permit will be granted. Alteration ( )
Repair ( )
Repainting ( )
Removal ..( )
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 00 C' -u.._ `)Q6 64
1 . Location, Street and No. CO 14 FriC-ts" 91 c""�'t''b1-07`', 0, °G
2. Owner's name 4 P,SN. S c & C bti C � `R , rk-Acs--"
3. Owner's address C : ) ` F l e , 'ST' 3 '-- , , P , e.cGu
4. Maker's name ! 1` l'E S,G"-)
5. Maker's address CON 7_ S i . 1M 1 'r , C ' c (
6. Erector's name ��
7. Erector's address
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated Non - illuminated
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 ins above he public way. Roof
5. Height .J..ft. .ins (24 dth ft..9 Ins Temporary
6. Face area ......sq. . Wall
7. Inner edge wi I 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 2 " S back from the street line.
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 ...if i' ' Face A ^
� - .'�^•
13. Estimated cost $ r co ' °"
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
File # BP- 2013 -0234
APPLICANT /CONTACT PERSON PORCUPINE SIGNS
ADDRESS/PHONE 78 CONZ ST ( #REAR) NORTHAMPTON (413) 584 -4501
PROPERTY LOCATION 6 HATFIELD ST
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 607 e)
Fee Paid
Typeof Construction: ADD TO EXISTING GROUND SIGN - X -RAY AVAILABLE _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
A pproved 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
C74 /14A-----J(' I lq 1 1 ,2,
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 23B Lot015 Zone SI(100)/
Massachusetts Date issued 9/6/2012 0:00:00
Inspector of Buildings Permit # BP- 2013 -0234
Permit Fee$30.00
SIGN PERMIT
Business ON CALL
Address 6 HATFIELD ST
Applicant InstallerPORCUPINE SIGNS
Applicant Installer Address 78 CONZ ST ( #REAR)
Work Description ADD TO EXISTING GROUND SIGN - X -RAY
AVAILABLE
Estimated Cost $100.00
Building Department
Approval by: