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18D-071 (4) ACORO® DATE(MANDDrmrY) `,-� CERTIFICATE OF LIABILITY INSURANCE 10/10/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Sara Scrivner, CIC Crimmins/Graveline Insurance Agency, Inc. PHONE No.Fxtl (413)283-8378 (AIC,No):(413)283-2556 1382 Main St. ADDARESS:sscrivner @cgins.com P 0 Box 905 INSURER(S)AFFORDING COVERAGE NAIC# Palmer MA 01069 INSURER A:Peerless Insurance 24198 INSURED INSURER B:Excelsior Insurance 11045 Ace Signs Inc, INSURER CA.I.M. Mutual Insurance Co. P 0 Box 3374 INSURERD: INSURER E: Springfield MA 01104 INSURER F: COVERAGES CERTIFICATE NUMBER:2013 Ren Pack, BA, Cu, WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tLTR TYPE OF INSURANCE INSR SUER POLICY NUMBER (MMIDDY/YYYY) (MM/DDY/YYYY) UMITS LTR INSR WVD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) A CLAIMS-MADE X OCCUR CBP6078955 4/1/2013 4/1/2014 MED EXP(Any one person) $ 15,00G PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- $ POLICY n JFCT LOC AUTOMOBILE LIABILITY (Ea accidentSINGLE LIMIT $ 1,000,000 ) BODILY INJURY(Per person) $ B ANY AUTO ALL OWNED X SCHEDULED BA6078952 4/1/2013 4/1/2014 BODILY INJURY(Per accident) $ AUTOS NONAWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) _ Underinsured motorist BI split $ 20,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 X DED RETENTION$ 10,000 CU8847344 4/1/2013 4/1/2014 $ C WORKERS COMPENSATION II WC ' O I TORY I IMITS ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 4/1/2013 4/1/2014 (Mandatory in NH) WMZ8002951022013 E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIM17, $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11-fE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE T Gravelin CPCU/CRISS ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025OntnnA1 m The Af`riPr1 nomo,nri Inns mro ronicforeri mmr4¢of Srf1Rn LETTER OF AUTHORIZATION Property Owner/Agent Information Site Address Information Company Name: ()O.M1 /nor(vegfikril Mailing Address: D PDX .1 �� _�� . u 1-&-Et -at s j',I )16 VT- Con tact: Contact: Tel: Tel: CM- 3a5-Z-LATil Fax: / ^ Fax: L�2:of_(to Amt/91.,z e7fie i)k i 64 mail: 1,PLEASE PRINT NAME)(1.9-kef 1 (bik /(J2/. ,owner/agent of (Location Site) ,(4.4213 pT k12Ttifi(y 19%7)4 hot dealer name or code) property,give PA7TISONSIGN GROUP authorization to install signage at the above mentioned property. This letter shall also serve to authorize PATTISON SIGN GROUP to act as our agent when applying for the necessary municipal approvals and permits. Date: I / . / Signature of Property Owner/Agent: �f_/��� '11" Or Legal description of property: Page 2 of 3 11. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 12. This column to be tied in by the Budding Department Existing Proposed Required by Zoning Lot Size a , a A G s M L Frontage S /h Front: Setbacks: Slide. L: R: L: R: Rear: Building Height a f " S4rn 67, Bldg Square l 8 • lita/ $r S,-m` Footage %Open Space: (Lot area minus bldg and Paved parking) #of Parking Spaces a / 6 CA-/'r)e #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. // �,I 42/41 DATE: /0 "/ "/3 APPLICANT'S SIGNATURE w / 74274 11 / 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 /PLEEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: / Z4T (VaoO/ 013/<fr//S /Q n AvtO/nOM/ RS 4L7{I1f Address:a '0140e-661 ! M/ a)012 t;/kM Q(6a-s Telephone: 57)o ' ''73 3 �- 2. Owner of Property: 1 /}7o'TI f i1 Ro-�L.ry L 1 (C/4ki-1 Address: q O f U..55c S T / /40 1-6:1(m/11 691°Telephone: 4/3-3 c. 3 f'cy 3. Status of Applicant:✓Owner Contract Purchaser Lessee �Other(explain): // /¢G 'r Porgy OGd/vt , 4. Job Location: 3(o / Az t R_2 S I Parcel ID: Zoning Map# l gr2, Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) f/ 5. Existing Use of Structure/Property:re/Property: / L)7T) 0E7a-L S!f I P�y02Tttffi/1P7 /t) ✓ee 4 v 6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary) /' 6/200/vi Si6,v all /4' 5'Y1 78:6 0. (-0 (? fs&Ttmot 0 7• p 8 A L G a Z/d A-p l 6 l 1 L 1 g r 9 '7 . " x /6" /9' N c i7//- a t (3, Lobo/ezi p c l/./6, 1 7. Attached Plans: ketch Plan ite 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 'r- 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: Are there any proposed changes to,or additions of,signs intended for the property? YES NO IF YES: Describe the size,type and location: 3_g- — v (� _ D r cn m D w m p = I I I I I U) u II: — CES<C �1 040011111111111 n .p ' - _ - CC -CC D 11 ---I ''t, FT 1 iiE9 10- 4111 < M D m 0 m z m z f v rn N G _ m r S rr r rn r - T a,,,,,,,,,,,.. raw p `Y - , III D Fri m in J - ` - - = C\ N_ Z = CL _, �" �_ T 11 �� _n_ m �_, r T - m I. 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Ta c„s , .J L0\3 `tg\ Vt N rtiµmptVn / . ? is \ ■ _�S,... Si• fi ,c I. ----- _ Alassttrlfusrtts *” `� `l l ' WI, m, _ DEPARTMENT OF BUILDING INSPECTIONS y06 ca` ' ;,� 212 Main Street • Municipal Building sfP .°To`�° Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee p/[/ter (Application to be filled out in ink or typewritten) Number .i Plans must be filed with the Building Inspector Erection ( ) before a permit will be granted. Alteration ( ) Repair ( ) Repainting ( ) Removal /RP ( ) FEE PAGE o PLOT OS./ 490 /e) / Northampton, Mass. � 20.I,3 - To the Building Commissioner. Application for a permit to place or maintain a sign or other advertising device,or marquee. BUSINESS NAME /1/0277/41)200/1.) tJo626 S WA-6OA) 1. Location, Street and No. 36. ! 1 -//06/0G S 2. Owner's name .,'�..1.7-4) /►'I PT/Li /76794-7--y L P (ce2(--", CASE/(,/z!) 3. Owner's address .Y b R U 55ELG ST_ 1-641dLE y /hill C/4735— 4. Maker's name Pnw^ SON S le R) 620(,i° 5. Maker's address ...5.55- 67-/--&-$171 - / iW dP-CW `D 0,(3714,e/,C i¢aa,/ 6. Erector's name �CE stews x-tt)c /� y� 7. Erector's address 17/77 C-0 `/ I66 ST J/"/ehfug F/fit) / �/14 ©/l0 y SIGN KIND OF SIGN (Designate) 1. Sign will be(check one) illuminated Non-illuminated 2. Will sign obstruct a fire escape,window or door? .Ala. Marquee 3. Lower edge will be .b".ft ins above the public way. Projecting 4. Upper edge will be .P .ft ins above the public way. Roof 5. Height .3..ft.9%gins Width ft ins Temporary 6. Face area ll./ sq.ft. Wall V S6-2. 7. Inner edge will be . ins from the building or pole. Ground 8. Outer edge will be //.34ns 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 ..0.ft ins above the building or pole. 12. Of what material will sign be constructed? Frame At Um Face /12/2'U L- 13. Estimated cost $....3 0 4 0.ex? The undersigned certifies that the above statements are true to the best of his knowledge and belief. ( ignature of Owner or Agent) File#BP-2014-0458 APPLICANT/CONTACT PERSON HAZEL WOOD HOPKINS ADDRESS/PHONE 2 PHOEBE WAY WORCESTER (508) 856-7332() PROPERTY LOCATION 361 KING ST-NORTHAMPTON VOLKSWAGEN MAP 18D PARCEL 071 001 ZONE HB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out s/ `t g a Fee Paid / `l b Typeof Construction: ERECT ILLUM WALL SIGN-NORTHAMPTON VOLKSWAGEN 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: § SSG `?` Z (AA) 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 )0117/1) Signa f 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.