31B-038 Pal 2 of 3
11. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
12 Tlvs column to be Wed in by
(he Etdilc:r12 E.terlaww91,
Existing Proposed Required by
Zoning
Lot Size
Frontage
Fi ont:
Setbacks:
Side:
L: R: L: R:
Rear
--
Budding 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: APPLICANTS SIGNATURE
NO iL: 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
I /6
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT AlL INVORMANuN
1. Name of Applicant:, 0,19,er.),C Y/c/
• z r-, -7
Address: 4 /,-,.//,2, Aroc-W ,/ cow— y c.6-stO Of.-lephone:
2. Owner of Property & A #
/O e.< S/41 • 9i V27
Mdress " 'fr" 14. Alf 22,4? 4/,92),,Xelephone:
3. Status of Applicant: Owner Zs-onlract Purchaser Lessee
X 0 0
4 ob Location: / /
Parcel ID: Zoning Map # Parcel # DistrictIs:
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: 37.9 7
rne-.6
6. Description of Proposed UsetWor'K/Proct/Occupation: (Use additional sheets ff necessary)
, 5)9-92 - (Ls' 17N c7 6:2 X
'Pie/ z-/ G At' (5
(
7_ Attached Plans: )Sketch Plan X Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON1 KNOW_X 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: it Al 7 A I 3.4, 4)C 06L.C,..
CF P,9 Al cv A/ ei42 ( 2
Pe/ .6 L s' 6 • / .z.f nz-6
Are there any proposed changes to or additions of, signs Intended for the property? YES X NO
j y °,
IF YES: Describe the size, type and location: A/ c.5" ,
tiiN 6 e S 62D /-& *C-c, (-
hi D Z)/ (W4LOPY.
.. .
RECEIVED
SEP i 9 Ile
(gill.; if N't
. t
DEPT OF B ' 41 NG INS.Ere NS
r- ....k
Ali l i t
) ffi assi ur IT u s eti5
DEPARTAIENT OF BUILDING INSPECTIONS :
,'::.i r.t i * 'Aunic-p,.11 P
\ tiluim: N'.4 :II tio0 4-I.
Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee ,4 / - — —
L' (3
(Appilcabbn to be ftilod out in ink or typ.:nrritten) Number. 4 - i / , i
el /
Plans must be iiie0 with the Buikiino Ins23ctor Erection...„... ....,....><)
before a permit will be granted. Alteration... ..,... ..( )
Repair
Repainting..___
Removal...
FEE .. _PAGE. ... PLOT . _. _
(2_... /i
Northampton, Mass. ......./.,..../ .f........20,41—
To the Building Commissioner:
Application for a permit to place or maintain a sign or other adverysing device, or marquee.
BUSINESS NAME ...a.:
1 2
6 Sree-7,6
1, Location, Street and No.../..s. tr/A/ _ . -.. . /
2. Owner c name .e.:-.t.i./7- _...
,, , , „,.., ,,,,, ,,_,, 2 , ,...7,,
3. Owner's ackiress./...C._,(.7. 4 VD fel;(..d .--7;,"1 /1/2 .46/t7-' --, i ----
,
4. Maker's name .. .crE /....,' ..///5/7H 7
_/ ,a,
_ 44 „....„.
5. Maker's address /....6-477-1(// /1 V/ .--, 7.7( e7 t__ /eTY----
c i / i c-
6. Erector's name /V/7 L- ‘-7ic./ \...
7. Erector's address 4?0,4 .._...... .4.._, teig,_,,e...e.'iiSta:244Pe..:
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated ./.. Non-illuminated .......
2. Will sign obstruct a fire escape, window or door? Ar.O., Marquee ...............
3. Lower edge will bel67..ft...Y,...ins above the public way. V- Projecting ..............
(7.
4. Upper edge wit be/./...ft...(e...ins above the public way. e
5. Height .... _,4? ins Width .L.ft... Temporary .,..........
6. Face area /1..sq. ft. Wall ......i.c._.__.....
7_ Inner edge will be ins from the building or pole, A///9 Ground ................
B. Outer edge will be .......ins from the building or pole./1///9 Other ..........,......_.„..,
9. Face of building or pole is __ins back from the street line. _,(5, j,'4 .:.'", v,'
10. Sign will project ..Q..ins bAyond the street line. .L:?..
11. Sign will extend ..z)ft ...Y..ins above the building or pole. ,
12, Of what material will sift) bconstructed? Frame eq.).. Face.t . ..... C.
13. Estimated cost
The undersigned certifies that the above statements are t : to the bes of his k ••w14.... - an. belief.
. / /
1
'
(Signatur. of Owner or Agent)
File P BP-2013-0313
APPLICANT/CONTACT PERSON CAROLYN A PARKER CONSULTING
ADDRESS/PHONE. 3 LORTON AVE WORCESTER (508) $f 167
PROPERTY LOCATION 138 KING ST - CUMBERLAND FARMS
MAP 31B PARCEL 038 001 ZONE lif3,(190)/
. .
TiilS SEC! ION FOR °FP 1CIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM HI LED °Ill
Fee Paid
i3uilding Filled out /94 >
Fee Paid
TypeolConstruc.tion: REMOVE PRICE SIGN FROM POLE & INSTALL LED PRICE ON CANOPY
New Consrruction
Non Structural tritoz rcrictvattOns
Addttion to
Accessory Stricture
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 ! ,RESENTED:
Approved i..! 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 Penult With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: § . 350 — — 1 ... 2......(t) il.
Finding_ Special Permit I., 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 hoard of Health
Permit from Conservation Commission Permit from C13 Architecture Committee
_ Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
212 - 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 sLandards of M.61, 40A. Contact Office or
Planning & Development for mite information.