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32C-140 (30) s ,! �_ � , ,. ". } .,.. ,. x�t� �r� �� � � ��� fi .. • � � � ' � l ;� . .x,. ��► f �� �; �R �`� ��� a ' l Oq-�IUVaPTO 6 =� �� �a<sasrhasrtla m DEPARTMENT OF BUILDrXG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WOM ER'S CONAPENSATION INSURANCE AFFIDAVIT (li censer:/permi tire) -vvith a principal place of business/residence at-. (Stre—c Um ty/5tatcjZ1 P) do hereby certify, under the pains and penalties of pegury, that: O I am an employer providing the following worker's compensation coverage for my employees worming on this job: (insurance Company) (Policy Number) (Expiration Date) (vj/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 Contactor) (Insumnc;, Company/PoLicy Number) (Exp rm ion Date) (Flame of CoutTacior) Omamc-_ CompanyPoLicy Number) (Expiration Date) (Name of Contractor) (lnairanc . Company/Policy Number) (Expiration Date) (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (mach additional shed if noon ry to inch he iufermiiioo pc tniaing W all c�fradon) (") r am a sole proprietor and have no one woridng for me. ( ) I am a home owner performing ail the work myself. NOTE:please be aware that whilo hcmeoxvm Abo employ periom w do muinuaaneS c=at ctioe ar rr,pair work on a dwelling of n.ot moco than thr"trne,in which the homeowner resides or on the grounds apVjexnarrt th t,c arc no(grncrgily oomidcmd to be employers under the a oompc soon Act(GLI52,sa t(5))�,application by a homeowner for a license or permit may evidcace the lepil ctaLra of an employer under the Wa$or'a Compomation Act I undccsLaad that a oopy of this statement may be fomvxY icd to the Dcpart�of Industrial Aocidmts'moo of Irrsuramoe for tba covaxge verificadoo and that fidure to secure covai p under soctioa 25A of MGL 152 can lord to the iMPOSAioa of-imiasl penalties ooasistiug of a fine of up to S 1,500.00 aadlor imprison of tip to one year and civil perultiel in the form of a Step W Order and a fmo of S 100.00 a day tgaimi tnc_ For dcpa¢tnaaatal usa only Permit Number MaP# Lot# Si�taturt;of LiccnscxlPcrmittcc Zed ° � u� Zo `3- l Z p i rb Q Z CL ui m ► V t� L1. s . 0 OC V LLJ m �SYWfp�, Oy Erection.----------...........( ) Alteration........._........... ( ) Repair______...___ .( ) Plans must be filed with the Building Inspector, Repair Repainting before a permit will be granted, Removal-....................... ( ) Tits aaf wart amptila, jnmi i. Application for a Permit to Place or Maintain a Sign or other .Advertising Device (Application to be filled out in ink or typewritten) FFl . PAGF_ PLOT.......... Northampton, Mass.,. . ...............................:.:........4........19......... ... To the Building Commissioner: Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME.... C L J..,.Cie t--G__ 1. LOCATION, STREET and No. .............. ....................................._..._.._......................_....... ....................................... 2. Owner's name................1 ' `t!...... 4.6t� _............................_----------....................................................................................._.......... 3. Owner's address....._.........351.... .1 S ...:....................M...t� � . 4 ..................... 4. Maker's name............. t? ............�:�`-................................ v`{= ..................................... 5. iMaker's address.................... ........ ............................ 6. Erector's name.__.._ ...... _......__._. ................................. 7. L'rector s adaz-ess. .._..... _........ ............. ...........__._..........._.............._...._.........................................._...... ................................ SIGN KIND OF SIGN (DC51�'71a t(.) L Sign will be, (check one) illuminated..................non-illuminated......_. 2. Will sign obstruct fire escape, window or door?...1�..r._. Marquee...................................... . 3. Lower edge will be....._...........ft. ..................ins. above th Projecting................................ . e ;� y. 4. Upper edge will be....__..........ft. ..................ins. above the 5. Height_.................ft. f/-� Temporary................................. ..................zns. Width..........._.....ft---.�!�_.....ins. // 6. Face areaJ.VA2. 7 s q. ft. wall.................V ................ Ground............................._.......... 7. 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. 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....._..�'`�°3'�.-...-.......... Face.............��_. 13. Estimate cost..��11�!`.a The,undersigned certifies that the above statements are true to the best of his knowledge and belief. (Signature of Owner or Agent) NOTE I11 order that this application may be accepted, the data called for above must be set forth CLEARLY and FULLY. c 10. Do any signs ebst on the property? YES v/' NO IF YES,describe size,type and location:_ Are there any proposed changes to or additions of signs intended for the property?YES V NO IF YE/S',describe size,type and location:_ 1J�% 22� ���� SkCiy 11. ALL INFORMATION MUST BE COMPLE'T'ED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This colama to be filled in by the Bailding Department Required I 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 &pax,ed parking) # of -Parking spaces f 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. DAVE: q'w '�c APPLICANT's SIGNATURE_ NOTE: issuanoe of a zoning permit does not relieve an applioant's burden to oom wlt ~ zoning requirements and obtain all required PIY Ip .pll q permits from the Board of Health. Conservation Commission. Department of Publio Works and other applioeble permit granting authorities. FILE # File No. � r ZONING PEST APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: � �- Address: �L C�r'z S�• i�cr�k ^1�`Z"� _Telephone: GV y�f 2. Owner of Property: Address: 3S1 �� 5 -i ST +3L2!Lt QyJ Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain): w1(9rJ t r?,2�CA`ZT'_ 4. Job Location: 3 l Parcel Id: Zoning Map# a Parcel#,1 er*'C District(s): � (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property Dr �—�C 5 / A,c�✓ - Z 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 0 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 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: (FORM CONTINUES ON OTHER SIDE) File#BP-1999-0184 APPLICANT/CONTACT PERSON Porcupine Signs ADDRESS/PHONE 2C Conz St (413)584-4501 PROPERTY LOCATION 351 PLEASANT ST MAP 32C PARCEL 140 ZONE &—5 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid — lwaZ4 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 THE LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based 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 rd�d� oard of Health Well Water Potability Board of Health Permit from Consery io 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. Department: Reference No: 13P-1999-0184 Building, Electrical & Mechanical Permits ......................................................................................... Fee Type: Receipt No: Sign ......................................................................................... R1:C-1999-000377 Paid By: Paid­i'n'F'uT1­0'n:..... Porcupine Signs ................................................................................... Fri Aug 14,1998 .. . ...... ...... ceived By: .Check. . .No:................... Linda Lapointe 1634 ...................................... DEPARTMENT'S COPY Amount: $20.00 ...................... DEPARTMEN"I' 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-1999-0184 $20.00 GIS 4: Map Block: Lot: Address: Zoning: Use Group: Lot Size: 10142 32C 140 001 351 PLEASANT ST GB 0 Contractor: License Type: Insurance: Porcupine Signs Address: License No.: Insurance No.: 2C Conz St LtE State: Zip Code: Phone: NORTHAMPTON MA 01060 (413) 584-4501 Pro iect No: Category of Work: Const. Class: Cost Estimate: JS-1999-0321 signs $340.00 Description of Work: FRONT WALL SIGN GeoTMS@)1997 Des Lauriers&Associates,Inc. Signature: