32C-140 (29) AUG) 1 4
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m DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COiYLPENSAZTON INSURANCE A + 1 AVTr
(li ccii sec/perms ttee}
%vith a principal place of business/residence at:
2C_ CV-rZ Si•• U z�� pit_ (phone#)
(str�i/city/staiela p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) J (Expiration Date)
(VI I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insuran(—_ Company/Policy Number) (Ex-pimboa Date)
(Name of Contractor) (Insurance Company/Pohu, Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy[Policy Number) (Expiration Date)
(Name of Contractor) (Insumnce Company/Policy Number) (Expiration Date)
(attach additional sheet if n6cr=ary to mch,,dc udcc n uci Q pertaining to all ocatmd r5)
(-�/I am a sole proprietor and have no one working for me..
( ) r am a home owner performing all the work myself.
NOTE:please be award thai whilo homeowners wfio employ perions to do mAa tcaaacr,o=!a tioa or repair work on a dv-1fwg of
not more than throe units in which the homoowncr rrsidca or on the grouad3 appurlcawi the_ o arc not gcocrally comidcrcd to be
cmPloyas under tho workcr`a oomp=u4on pct(GLI52 ss 1(5)},app U ation by a homeowner for a Gcenx or permd may cvidcooc the
legal etahra of an amp loyor under tho Woricees C.ompmaaiion Act
I undcrsUnd thsi x copy of this rb cmcat maybe fom-arded to tho Dcpert co o of I—histrial Anadoa&Offioe of Iasurwxx for the
oovcragc vaificatioo and that failure to scarce covmwp tmcicr soc ioa 25A of MGL 152 can lead to the imposition of criminsi penalties
oomisling of a fine of up to S 1,500.00 aadlor of rip to one yrsr and civil pcnattia in the form of a Stop W ork Ocdcr and a '
firm of 5100.00 0-Y against mc.
For dgnQtrseatal use Only
Permit Number
i r i f C7•�1 t,�api} Lot 41
Signature of-LicenswjPermittim Date
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. 4 ' La , ► ! Erection............-...........( )
Alteration........._...........
( )
Plans must be filed with the Building Inspector,
Repainting........_...........
( )
before a permit will be granted, Removal....._......_...........
( )
Ttt� af 'Wart4amptall, Xa5'�i
Application for a Permit to Place or Maintain a Sign
or other Advertising Device
(Application to be filled out in ink or typewritten)
FEE . _.. PAGE.—.... PLOT..........
Northampton, Mass...................................................................19...........
To the Building Commissioner:
Application fora permit to place or maintain a sign or other advertising device, or marquee.
BUS1NESSNAME...........1 ?�'?�'�'Z-. . SiS3 �..F... !.3.i CtA .
.................................................
1. LOCATION, STREET and No. ........... j�.--....� Y:.._..._ '1...'........ �"T{: ...... ..............................
2. Owner's name............lZc�.1� -...._U'.R-g" .._........... . _..........
.............._............................................................................................
3. Owner's address....._............ r�._1....17�.�' `�! ........5c'................0�! ................................................---
.� .
4. Maker's name....................... � �_ �.�!? ................................................................................
.................................................
q,
5. Afaker's address......................2-...........�'`'z:-.......ST.........�.f?`��:.........:.�?'`.'..,..................:..........._.............................................
;. I�rector's name .-_._ ._. ... .......... ... __.. . ._.__.._
� . erector's adores:; ....... .................................................. .......... ... ._._..... ...... ._..........._................_....._ ........_..........._.......
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuininated..............._.non-illuminated.____.
2. Will sign obstruct a fire escape, or door?.. .
`.... Marquee......................................
3. Lower edge will be............-f Projecting..................................
g t. ........°�_...In". above the public way.
Roof.........................._....................
4. Upper edge will be...........-:...ft. ..................ins. above the public way.
heigh ..................ft � Widt ...... _ . .....� -....is. Temporary............................
1, �� ..._..f .....
6. Face area.S•.a.�._�sq. ft. Wall...............................................
Ground...........
✓............._........�
i. Inner edge will be...............ins from the building or pole.
Other......................._...._...............
8. Outer edge will be..................ins. from the building or pole.
9. Face of building or pole is_...._.._.....ins. back from the street line. SVSJ is
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.... _..W��............- Face........... °..
13. Estimate cost. l99"M
The undersigned certifies that the above statements are true to the
best of his knowledge and belief. -
(Signature of Owner or Agent)
NOTE -ln order that this application may be accepted, the data called for above must be set forth
a CLiI,11 RI,Y and EUL1.Y.
10. Do any signs exist on the property/? YES NO
IF YES,describe size,type and location:_ ?m &G—
Are there any proposed changes to or additions of signs intended for the property?YES ✓ NO
IF YES,describe size,type and location: QaiC_-yL- AQ,R-o-C11kR41_r1j
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col— to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&Paved Parking]
# of -Parking Spaces
f of Loading Docks
Fill:
{vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: �j-l3 ��1� APPLICANT's SIGNATURE �
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oom wit all
zoning requirements and obtain all required Pn M io
q permits from the Board of Health. Conservation
Commission, Department of Publio Works and other appliomble permit granting authorities.
FILE #
i
I I T
AUG 1 � •_,'
File No ,p
r ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 222"uP
Address: )-f-_ Cojz- SIT-, QLHi��-,-z� Telephone: S -y SO)
2. Owner of Property: -i
Address: -3's e--5i• Telephone: S-9,, U75-2–
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s): c f
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property OPF10Es T—
/ ,U� t ��
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
si c ►�� 2,—S��� 562
7. Attached Plans: '� Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNO4ti' -' 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:
(FORM CONTINUES ON OTHER SIDE)
File#BP-1999-0183
APPLICANT/CONTACT PERSON Porcupine Sims
ADDRESS/PHONE 2C Conz St (413)584-4501
PROPERTY LOCATION 351 PLEASANT ST
MAP 32C PARCEL 140 ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presentedibased on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Od of Health Well Water Potability Board of Health
Permit from Conservatio ommissio
-467
Signature of Buildingifffficial 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.
Department: Reference No: BP-1999-0183
.................•.................
Building,Electrical & Mechanical Permits
Fee Receipt No:
Sign REC-1999-000376
Paid.6Y: Paid in Full 0 n
Porcupine Signs Fri Aug 14 1998
............... ......................................................................... ......................................
Received By: Check No:
Linda Lapointe 1634
......................................................................................... .....•..............•.................
DEPARTMENT'S COPY Amount: $20.00
...........................
W!"PARTMENT FILE COPY 351 PLEASANT ST
CITY OF NORTHAMPTON
BUILDING PERMIT
Owner's pulling their own permits or dealing with unregistered contractors for applicable work do
not have access to Guaranty Fund(MGL 142A)
Issued: Permit No: Inspector: Tracking No.: Fee:
BP-1999-0183 $20.00
GIS Map Block: Lot: Address: Zoning: Use Group: Lot Size:
10142 32C 140 001 351 PLEASANT ST G13 0
Contractor: License Type: Insurance:
Porcupine Signs
Address: License No.: Insurance No.:
2C Conz St
Li!n State: Zip Code: Phone:
NORTHAMPTON MA 01060 (413) 584-4501
Project No: Category of Work: Const. Class: Cost Estimate:
JS-1999-0321 signs $199.00
Description of Work:
2 SIDED NON-ILLUM GROUND SIGN
GeoTIVISOD 1997 Des Lauriers&Associates,Inc. Signature: