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• 11/ 1 REVISIONS ■
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•
The Commonwealth of Massachusetts
..„1
Department of Industrial Accidents
Print Form j
Office of Investigations
t
`•:::::. ';-:. lv , i ;.', 1 Congress Street, Suite 100
Boston, MA 02114-2017
WWW.mass.gov/dia
... ,. .
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
,-----, ,
Name (Business/Organization/Individual):
0 IQ, ei A ,7„ l'ot
(-)
..,..._, A , t
Address: i e ..,1 I
City/State/Zip: ' i'-''' - ■ 1 1. 1'j_ ... _ . ,.',is.,' - '0'' i 1 Phone #: - 7 ' ) - Li1Pti;-' ',—..
_
Areyou an employer? Check the appropriate box: Type of project (required):
1. 161 I am a employer with oR 4. 0 I am a general contractor and I
employees (MI and/or part-time).* have hired the sub-contractors 6. 0 New construction
2. 0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have s. 0 Demolition
working for me in any capacity. employees and have workers'
. 9. 0 Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. [I] We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t e. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers compensation policy infatuation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1 Contractors that check this box must attached an additional sheet showing the name of the and state whether or not those entities have
employees. If the sub-contractors have employees, they must provide their workers: comp, policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. , ...„
Insurance Company Name: . 1 - \( '.., ■ „ . .
Policy # or Self-ins. Lie. #: (.141..A.366(.-.. ,, Expiration Date: – 7 }
....
Job Site Address: 0 17\ I 'A ), CIR ( '1' , City/State/Zip: A/or it 1 0 ) , 1
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
. . . .,,,,..... „ ..... ...... „.....„ .....„.
/ do herebketre--tify rt he pains an . enclitics of perjury that the information ptovided above is true and correct.
. — f ....,...._.
Signature: . a Date:
Phone #: Lt ( 3 - 7 . 7 ( -1 - C (c) ( c) 3
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
I
...
Page 2 cf 3
1. INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
• 1 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
C \
Building Height
Bldg Square 1 1;3
L t, 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 accura to the best
of my knowledge.
DATE: J /61 IV APPLICANT'S SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicants 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
Pagel f 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
I . Name of Applicant: r D 097.3 7
Address: 1c `J '� "' . Mb "� - C j� �f L Telephone: ` J C1
2. Owner of Property. ( per. -e41L 5 fI -t; S T30-- `.
Address: �Irt s4 D J Telephone: -7 7 Y'
3. Status of Applicant: _Owner Contract Z Purrchaser Lessee
Other(explain): /61 �Yl 74Fq -4 Y'
n -:
4. Job Location: •
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 UseNVork/Project/Occupation: (Use additional sheets if necessary)
7. Attached Plans: V 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
10. Do any signs exist on the property? YES NO X
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: /L k"1 r l 0 -beef 46 the �'-
1e./7V-e" S
RECEIVED z __ lit
OCT I8
O OF DIN INSPECTION S
Tag of P'a>~tttain rtaat
I C : assartrNAi li * 4 k f n
� ' DEPARTMENT OF BL ILDI_VG INSPECTIONS r
t''''t
212 'rlain S #ree #. • Municipal Building ;'`i'?v a ,0 '
Northampton, MA 01 {)fii)
reF'rc',r()x Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee A p / 3 L f6 9
(Application to be filled out M ink or typewritten) Number
Plans must be filed with the Buildino Inspector Erection ( )
before a permit will be granted. Alteration ( )
Repair z ( )
Repainting ( )
Removal ( )
FEE PAGE PLOT
Northampton, Mass. 20....,
To the Building Commissioner.
Application for a permit to place or maintain a si or other advertising device, or marquee.
BUSINESS NAME C. i 1) 67 i � &s i`
1. Location, Street and Na. 3 j 5-
2. Owner's name T ✓1 P t,et4 S.F v l frt S ;vk l<
red 3. Owner's address 6 41 e -e-r ( 5 i dC
4. Maker's name
U 71-1 S1i
5. Maker's address I�''t ..304-6-04-e_. C�
6. Erector's name f1 �
7. Erector's address
SIGN / KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated V Non - illuminated
2. Will sign obstruct a fire escape, window or door? Marquee
3. Lower edge will be .i -.ft 0 ins above the public way. Projecting
4. Upper edge wi))I be / `7 ft. . 1... ins above the public way. Roof
5. Height .2...ft.lr ..ins Width . q:.ft.. .ins Temporary
6. Face areasq. Wall XA
7. Inner edge will be . .ins from the building or pole. Ground '
8. Outer edge will be l...ins from the building or pole. Other
9. Face of building or pole isfi..ins back from the street line.
10. Sign will project .......ins beyond the street line.
11. Sign will extend ..11...ft ins above the building or qI Jf� .
12. Of what material will sign be constructed? Frame ..I/V,J(.Jit(W4. Face....r `'l...
13. Estimated cost $ ;fir"..` Oro
The undersigned certifies th the above statements ar: . : • best of his kn.wl • ge . d belief.
0
, ature.f•wn- r a
f 1
File # BP- 2013 -0469
APPLICANT /CONTACT PERSON HALE CUSTOM SIGNS C
ADDRESS/PHONE 74 Montague City Road GREENFIELD (413) 774 -5663 ()
2-
PROPERTY LOCATION 327 KING ST 3
MAP 24B PARCEL 038 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /8-75- 3G
Fee Paid
Typeof Construction: ERECT ILLUM REAR WALL SIGN - GREENFIELD SAVINGS BANK
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
INFORMATIONPRSENTED:
Approved 1/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: R: § 3 '� r. *a-(M) £Kc6E SS
Finding Special Permit ✓ Variance* J
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
td--4"'"Q _ /6/24
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.
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55
4., \ The Commonwealth of Massachusetts
v,i1A.• . +
; _ +
. . Department of Industrial Accidents
Print Form
1 Office of investigations
7 ,=.
: 1 Congress Street, Suite 100
•:-:::,.,---- , ,..-...,,
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
. ---,
Name (Business/Organization/Individuall. ""\ Li k... II , \
(-1 .
4 . 5
Address: -- IA Id ,) 0 i,,i 11.1 k 6
. ,
I....,
City/State/Zip: — . ',)-\ -: ;AI Phone #: - 1
Areyou an employer? Check the appropriate box: Type of project (required):
I. 2 I am a employer with c.: 4. 0 I am a general contractor and I
6. 0 New construction
.
employees (full and/or part-time).* have hired the sub-contractors
2. 0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
4 9. 0 Building addition
[No workers' comp. insurance comp. insurance.'
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11.0 Plumbing repairs or additions
3.0 I am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] T C. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
1. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
IContractors that check this box must attached an additional sheet showing the name of the s and state whether or not those entities have
employees. If the sub-contractors have employees, they must provide their workers; comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. - c
)
f
Insurance Company Name:
sr 4 , -
Policy # or Self-ins. Lic. #:
C-4D3EGR ?. ,-; ,):J., ' Expiration Date: - 7 j
4
Job Site Address: i:.) 7\ ,1 1 ' nR t, '1' , City/State/Zip: MY-I friri)(4 (--10._
Attach a copy of the workers' comWnsation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb ,' he pains an enalties of perjury that the information +vide d above is true and iorrec f.
l
, .... I --
Signature: - '.-- . _ . Date: Ii' I 5 1.
Phone #: C4 ( 3 - - 7 7 (--(
- - cto 3 —
Official use only. Do not write in this area, to be completed by city or town officiaL I,
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Page 1 f 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: („ " e, �(}�J �'1 S ( S
Address: ' 7 (- / m C7 qi, Telephone: - 77 (( '-56 C
2. Owner of Property: / f7�
Address: Telephone:
3. Status of Applicant: Owner _Contract Purchaser Lessee
__Other(explain): 5 1 C An�t.' vIF� -e -• ) , ,
n
4. Job Location:__ .. M
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 UseMlork/ProjectlOccupation_ (Use additional sheets if necessary)
7. Attached Plans: k7 Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special PeimitNariance/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
10. Do any signs exist on the property? YES NO X
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;] /� v 14 A. /1,1 'A4f C( .' 'F�
^2 15 V 7145 / ith — Zh 9
Page 2 3
' 1 NF .:TION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
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 3.5 *a'
Bldg Square
Footage 1/35 SS
% Open Space:
(Lot area minus bldg and
Paved parking)
# of Parking Spaces
# of Loading Docks
Fill: (volume & locator')
13. Certification: I hereby certify that the information contained herein is true and a curate to the best
of my knowledge.
DATE: lel (it\ APPLICANTS 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
i
D1EPT. OF BUILDI
{2ttl� iTi N1trt�Fttti�l't�OrYt No�u+P ion Ns.
1
, ttssarintselis . p X ,
,'k DEPART.d�E_1� OF BUILDING INSPECTIONS' i.
212, Main Street •Municipal Building °'`'ir '''
Northampton, WA 01061)
I \,H -,E ToR Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee IA p\--3q6,-7
(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 advertisin device, or marquee.
BUSINESS NAME .. 1 I
1. Location, Street and No. 3 2-- ` ■ 5 -- _ .
r" 2. Owner's name , ... , 5 3
( 3. Owner's address . Of) E r ''' `` l C" ' ( s 4 & J - 4 7 '4- d / 3e /
4. Maker's name ........ .5. 0" C U S-4 Yt ' / b ?$ ,
— 1 Le rill t'y1 - t� -- = C 41 �; =i-k.. i m 4-.
5. Maker's address J�� /'
6. Erector's name A9 le C ( /-Pv (57 e S `
7. Erector's address S ! I r i `t C
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated /Non- illuminated
2. Will sign obstruct a fir escape, window or door? Marquee
3. Lower edge will be 4 ..ft i ins above the public way. Projecting
4. Upper edge will " i 3.ft b irri�s above the public way. Roof
.
5. Height ..ft...iOifs Width .. ...ft... .ins Tempora
6. Face area 5iq. ft Wall ........ ,...(AterYti. . .
7. Inner edge will be ..q . from the building or pole. Ground
8. Outer edge will be /. I ...ins from the building or pole. Other
9. Face of building or pole I `j..ins back from the street line.
10. Sign will project u ins IV ..ins
the street line.
11. Sign will extend ..(.;...ft ins above the building o �
12. Of what material will sig be constructed? Frame M � Face.... R 1 b c
13. Estimated cost $..& .
I
The undersigned certifies that the above stateme , are t - - e - best of hi o edge and • -
`k- - • e o 0 . P er or ' gent)
File # BP- 2013 -0467
APPLICANT /CONTACT PERSON HALE CUSTOM SIGNS
ADDRESS/PHONE 74 Montague City Road GREENFIELD
PROPERTY LOCATION 327 KING ST
MAP 24B PARCEL 038 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 016-
Fee Paid
Typeof Construction: ERECT ILLUM FRONT WALL SIGN - GREENFIELD SAVINGS BANK
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
INFQRMATION PRESENTED:
L/ 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.
C 1
ity of Northampton Map 24B Lot038 Zone
Massachusetts Date issued 10/25/2012 0:00:00
Inspector of Buildings Permit # BP- 2013 -0467
Permit Fee$30.00
SIGN PERMIT
Business GREENFIELD SAVINGS BANK
Address 327 KING ST
Applicant InstallerHALE CUSTOM SIGNS
Applicant Installer Address 74 Montague City Road
Work Description ERECT ILLUM FRONT WALL SIGN - GREENFIELD
SAVINGS BANK
Estimated Cost $6400.00
Building Department
Approval by:
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s., \ The Commonwealth of Massachusetts
,.....,-..-,
7 Department of Industrial Accidents
Print Form
Office of Investigations . ,. .
I
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
,-,
Name (Business/Organization/Individual: CI e ( :AI) ', e':., V 1 al.:.
Address:
C ,... ,
— 14 ' i-- '--
, i`- cl \ A- i , c.,', LA k., LA hi
,--, .., ,,,
City/State/Zip: ( tA J 1 ,-e i ei :'-. ' 1) (:) ,7:,(,)1 Phone #: / /1
Areyou an employer? Check the appropriate box: Type of project (required):
1. g I am a employer with
4. 0 I am a general contractor and I
oR
employees (full and/or part-time).* have hired the sub-contractors - 6. 0 New construction
2. 0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have R. 0 Demolition
working for me in any capacity. employees and have workers'
9. 0 Building addition
[No workers' comp. insurance comp. insurance::
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] C. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
1. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the and state whether or not those entities have
employees. If the sub-comractors have employees, they must provide their workers; comp, policy number.
I am an entployer that is providing workers' compensation insurance for my ensployees. Below is the policy and job site
information.
Insurance Company Name: 1 e \(.--(
Policy # or Self-ins. Lic. #: 01-LuEGI-..H ,....,,..)„...:;4.-.. Expiration Date: ---/ 1 i )
i e
Job Site Address: t'-) /\ 1 k nR k) , citv!StateZip:My4 itinio-011 iLk
,
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb Is 'U he pains an enalties of perjury that the informal +willed abO Ve iS triii and corr. ect.
-owl" ....._..
Signaturc: . t ' . Date: 1:I / S/ / 1
Phone #: 4 ( 3 — - 7 7 c( Slc (:, 3
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Page 1 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:_ CI 7, / V ` C `
Address: Telephone: f 7 I t “ 3
2. Owner of Property:_ LS I L,c ' ( f - t G t Ot -fl--L,1,4, 5,' " C J
Address: Telephone: - 1-7,5, - 3j ' (7 (
3. Status of Applicant: __Owner Contract Purchaser _Lessee
__Other(explain)_ / b M r �' y�? v "lZo\r
�[
4. Job Location: --/*; 2'1 ,c i vn (• :S •
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)
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 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
10. Do any signs exist on the property? YES_ NO 1(
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: 2 s -� //v mot, ,,,44--,4
„ , 3 r÷ , Le-0 0 oil
1 Vii/Iii
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
Frontage
Front:
Setbacks:
Side: L: R: L: R:
Rear:
Building Height 7 4'
Bldg Square V
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.
q ��
DATE: 1 A 1 T7' (v. APPLICANT'S SIGNATUR' �-IL
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
N� s
j City of Nortltttmtrton � OCT / 8 �.._. 7
`& .tl 4 . F
tassartrusrtts . ein
s . i a ' - P LN G finis ECTI
DEPAXTME_VT OF MARINO INSPECTIONS
� ' ��; '' _' .' oN '�or N8
212 Main Street • Municipal Building $ ?.).'\�
Northampton, MA 01060
IN p i:( To p Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee P /�
(Application to be filled out in ink or typewritten) Number .. �S
t
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 .6 '.l� -2. x!1. — S. ' ‘Y1E.S. C..? G"
1. Location, Street and No. 32-1 V iv\ - 6T
2. Owner's nam ' E it S 2 ✓t
^
3. Owner's address 1 14. C' " L' --'l 9 t 4.S �`""
fi. Mk .0 (
4. Maker's name . l.L.G C(,),S1 Vvvk sv.6TII -_‘'g.\c, , y�
5. Maker's address 4 ` A 0 ,- 4 6- te. C- \- ( G- f Lb IAA--
6. Erector's name S `A vV
7. Erector's address -S
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated X Non - illuminated
2. Will sign obstruct a fir?�ieescaRe, window or door? ./.1/.:O.. Marquee
3. Lower edge will be ./..ft Le' ins above the public way. Projecting
4. Upper edge will be .1.aft.. :7...ins abov the public way. Roof ,. .
5. Height , i -..ft..(v .ins Width 9...ft... . ins Tempory
6. Face area2.�...$q. ft. Wall ... ......
7. Inner edge will be ..?.ins from the building or pole. Ground
8. Outer edge will be .g ....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.
11. Sign will extend ft — ins above the building or pole.
12. Of what material will sign be constructed? Frame .6.Y.MICiIta, Face 1 —ex 7/4
13. Estimated cost $...Z.. T A Lt.
The undersigned certifies that the above statements are tru- = • - • - • no :. .1- and belief.
‚A'...
(Sig - ur- . :., er or Agent)
File # BP- 2013 -0468
APPLICANT /CONTACT PERSON HALE CUSTOM SIGNS
ADDRESS/PHONE 74 Montague City Road GREENFIELD
PROPERTY LOCATION 327 KING ST
MAP 24B PARCEL 038 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid �Q C/
Typeof Construction: ERECT ILLUM SIDE WALL SIGN - GREENFIELD SAVINGS BANK
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
INFQRMATION 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
/4
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 24B Lot038 Zone
Massachusetts Date issued 10/25/2012 0:00:00
Inspector of Buildings Permit # BP- 2013 -0468
Permit Fee$30.00
SIGN PERMIT
Business GREENFIELD SAVINGS BANK
Address 327 KING ST
Applicant InstallerHALE CUSTOM SIGNS
Applicant Installer Address 74 Montague City Road
Work Description ERECT ILLUM SIDE WALL SIGN - GREENFIELD
SAVINGS BANK
Estimated Cost $2200.00
Building Department
Approval by: