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39A-034 (8) o n n � w c z a z _ � o Z TI 9 mY IAI Ul m L r g y d� � � VI N 1 a Z >uu o. th N ~� O K 'J°c vl 2'-8 9/16 G K O S N O s Z c °o O 3 zz K 0 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 Requ' d by 7oning Lot Size Frontage Front: Setbacks: Side: L. R: LZ R: Rear: Building Height Bldg Square Footage % Open Space: (Lot area minus bldg and Paved parking) # of Parking Spac # of Loadi Docks Fill: olume&location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: .? 4-/,?OI4 APPLICANT'S SIG NA 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 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE` TYPE' OR,PRINT ALL INFORMATION 1. Name of Applicant: ��0. l S • L't 01 ►`�''� , Address: ��? �� �1 � Telephone: 4�3 S$� BIOD 2. Owner of Property: Address: ?AR c Telephone: �c ( 3 3. Status of Applicant: '�Owner Contract Purchaser Lessee _Other(explain): \ t 4. Job Location: its& 0—oM2 sig-o—ZA► N°r�k OcK M/� Oi�GaC� Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existin U of Structure/Property: 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) WLe yaV 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans 8. Has a Special Perm iWariance/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: Hasa 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: Page 2 of 3 -� -� CGit3J Jorfur� ttxrt��an w ''/f{{dd � �iRMSS:YrljugFtts �W�` i�� DEPARTMEII-T OF BUILDING IN,5PEC.TI0A . �x 212 Main Street • Municipal Building y: Northampton, MA 01060 . Application for a Permit to Place or Maintain a Sign INSPECTOR Or other Advertising Device, or Marquee q / (Application to be filled out in ink or typewritten) Number Plans must be filed with the Building Inspector Erection..................( ) o before a permit will be granted. Alteration.................( ) Repair.....................( ) Repainting...............( ) Removal..................( ) FEE........PAGE �..... .PLOT....... Northampton, Mass. ........20.117 To the Building Commissioner: Application for a permit to place or maintain a sign or other advertising device orinarquee. C BUSINESS NAME ......1...................................... ... 1 a .....�-�, .o... . . .t ` ' • ..'. ..—.......................... o tI�Z STt�-mot a 1. Location, Street and No. .....��`a.�t....C..........................t...................... ..... 2. Owner's name ....�!�D�v�S.4 !� GZ �°.°" ............................................................ 3. Owner's address ....3 ' �( ✓ 4. Maker's name .... .e`��?�!4K...�!^.-....N.l!�:k't'........................................................... X 2..o ,L�cw`fit',^ ..S� 5. Maker's address ..P:.�.:.. .- .................�. ...................... 6. Erector's name ......5" .......................................................................................... 7. Erector's address ....................................................................................................... SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated ....... Non-illuminated ..'.... 2. Will sign obstruct a fire escape, window or door? .. D., Marquee ............... 3. Lower edge will be ... ft........ins above the public way. Projecting .............. 4. Upper edge will e . '���ft........ins above the public way. Roof ..................... 5. Height . ..ft.5.g1linns Width ..!.ft. .Xns Temporary..........: 6. Face area >..1WE .s q. ft. Wall ...........!..... � 7. Inner edge will be .YZ .ins from the building or pole. Ground ................ 8. Outer edge will be ..*.ins frgqm the building or pole. Other ................... 9. Face of building or pole Is .A/A.ins back from the street line. 10. Sign will project YV. Jns beyond the street line. �c �s �gg ins above the building or pole. (�tv\-m6tAA 11. Sign will extend .Y11.!`ft ..... . g pwtYlll�rv� 12. Of what material will sign be constructed? Frame .A`YL....•...••••••• •. Face....................... 13. Estimated cost $ ... The undersigned certifies that the above statements are true to the best of his knowledge and belief. Si nature of Owner or Agent) Page 1 of 3 File#BP-2014-0931 APPLICANT/CONTACT PERSON GHALIBAF MANSOUR ADDRESS/PHONE 36 King St. NORTHAMPTON (413)587-8100 O PROPERTY LOCATION 115A CONZ ST-FAIRFIELD INN MAP 39A PARCEL 034 001 ZONE GB(100)/URC(0)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out POO Fee Paid Typeof Construction: ERECT ILLUM FRONT WALL SIGN-FAIRFIELD INN 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 PWENTED: 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: § 3 SO — -7. 2(A-� (AAaW_r THA a /rt Ldw60� 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 a-1- 14.�, ,- I " 3 c 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.