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A Item for ( )
PIP--s must be£led, r�Le Budding Lspea:or, repair ( )
RepaiZting ( )
before a permit wEl be granted, Removat _( )
,Application for a Permit to Place or Nlaintairra Sign
or other Advertising Device
(Application to be filled out in iak or typewritten)
FEE..........//PAGE.......... PLOT..........
Northsmpton, Maw, -g! l z t a 8—19—
To the Building Commissioner:
Application for a perasit to place orrmaintain a sign or other advertising de-ice, or marquee:
13USINESSNAME-4; ..�rt�t a4 . ,..cF !!�cl ............ . . . ° ..�J... ..._.
1. LOCATION, STREET and No.
2-" Owner's n.%=-. h LC.Q a?L C
3. O'wner's address -a e73 �1��_..R�4�—�= ,�A4 � - in t_Q..r,n
4. Maker's nxime ,,,-k
5. Maker's addxeS;� - T.— ._ (.S_ -,'7
6. Erector's name -
7. Erector's addrP-4____
SIGN KINID OF SIGN
I. Sign will be (check one) illuminated ton illuminated (Kest„—ante)
2. Will sign obstruct a fire escape,window or door? 00_ Marquee
T Proj ecti.ng
S. Lower edge wM be--L—ft r- ���,above he public,; ay.
4. Upper edge will be-� ira inc above the public way. Roof
s.
5. Height S ft in Width LJ f# irc
Temporary
-
6. Face arez_5...,.sq. ft. We n
7. Inner edge Will be- 6A ins from the building or pole.
Ground
8- Outer edge w0l be .from the buuding or pole_ Other —
9. Face of building or pole is��back from the street line:
10. Sign wV1 project C --ins.beyond the street line-
11. Sign wC1 extend n ft CD ins,above the building or pole.
12. Of what material will sign be corn r-acted? r-amp LAJakPzC Face_�-
13. Estimate cost..Y���
The unde_*sigz.ed certifies feat the above st,-, to=,its are true to the
best'of his haowledge and belief.
�SL,�?T�3.21Iaf!.of O:vnZf0 r..A �D11.»
yya•
this 87 �iC�i1� i�^c��!`�i�_�CGE�`2d l am' .... 3a ti �`.=:: �. .. ci.'iGI� '
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TOO In ZLZTL9SCTV TVA 90:0T LOOZ/ST/OT
File#BP-2008-1057
APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL INC
ADDRESS/PHONE 30 LOCUST ST NORTHAMPTON (413) 582-2216 O
PROPERTY LOCATION 30 LOCUST ST
MAP 23B PARCEL 046 001 ZONE M
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction:_ERECT GROUND SIGN-CDC FOR MIDWIFERY CARE
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_A/ 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
35-0 ZONING BOARD PERMIT REQUIRED UNDER: § � /. ; 0
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 bfBua Officiff Date
N6te: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.