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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 R ' d by
n i n g
7
Lot Size
Frontage
Front:
Setbacks:
Side: L. R: L: 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:^���' U APPLICANT'S SIGNATU
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
`PLE``A'-SE' TYPE (OR PRINT ALL INFORMAT�e
1. Name of Applicant: �A�0. i-�\S• g oVA%" � 1�^'c �
Address: 36 \►^ti klt."� Telephone: 4k3 S$"1 81OD
2. Owner of Property: N l A-\1SuAV-- QA i.i.9 4
Address: 3�P C+tom Telephone: 4 l 3 S�6 �1 g (dam
3. Status of Applicant: `�Owner Contract Purchaser Lessee
_Other(explain): \\
4. Job Location: LtG& ( OMZ �' �-'�► N°�tk 0 M/� ���
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existin eof Structure/Property:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sh'e'ets if necessary)
1d�
�
V6O�. kdluL -c- SKI�u •tt���
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
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 '"'e 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:
Page 2 of 3
,'� ARMSSMrt(usrt#s ki� Xte,
DEPARTMEII T OF BUILDING INSPECTI0A,,
212 Main Street • Municipal BuildingsJ�� �1� :.;
Northampton. MA 01060
Application for a Permit to Place or Maintain a Sign
INSPECTOR
Or other Advertising Device, or Marquee !L�
(Application to be filled out in ink or typewritten) Number V!./.... ....
Plans must be filed with the Building Inspector Erection..................( )
before a permit will be granted. Alteration.................( )
Repair.....................( )
Repainting...............( )
Removal..................( )
FEE...,.......PAGE-........PLOT.......
Northampton, Mass. 20.�
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, omarquee.
BUSINESS NAME ..... 1 a�k... ��\S ?.loY!!^� t ...�.................................
1. Location, Street and No. .....
�..... ...... t......................P....
2. Owner's name ....�!1Q¢u��.� !� 1 �°.° ............................................................
3. Owner's address .... e
•-••••••
vJ�w! - .....................................................
4. Maker's name .....�e-.+rS°!ti'`...54�^•••-•.-.••'•11
W r. - ww.�.. ...5. 2c�
5. Maker's address .....�-a.:.�91.�......21�..�..................... ...................
6. Erector's name .......l�'�^'!"'`'`` ...-................................................................................
7. Erector's address .......................................................................................................
SIGN �,k,� LEA KIND OF SIGN
*\V1 � (Designate)
1. Sign will be (check one) illuminated . `�.. Non-illuminated .......
2. Will sign obstruct a fir escape, window or door? ..l�1O.. Marquee ...............
3. Lower edge will be hraft........ins above the public way. Projecting ..............
4. Upper edge will be '.. .. ........ins above the public way. Roof .....................
5. Height .A .ft.: .ins Width .2.S.ft. 1.ins Temporary......... ...
6. Face area A\\ .sq. ft. Wall ........._!�. 4..2,
7. Inner edge will be .:e-.ins from the building or pole. Ground .... .....
8. Outer edge will be .5...ins rom the building or pole. Other ...................
9. Face of building or pole isq.-ins back from the street line.
10. Sign will project !N I'ins beyond the street line. S
11. Sign will extend .v� . ft .......ins above the building or pole. C� U�-
12. Of what material will sign be constructed? Frame i, Ayy„ffiMvA ....... Face.......................
13. Estimated cost
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
..................
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2014-0929
APPLICANT/CONTACT PERSON GHALIBAF MANSOUR
ADDRESS/PHONE 36 King St. NORTHAMPTON (413) 587-8100()
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 ?v
Fee Paid
Typeof Construction: ERECT ILLUM SIDE WALL SIGN-FAIRFIELD INN
New Construction
Non Structural interior renovations
Addition to Existing
AccessoKy 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:
—44proved 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 Finding Special Permit (x� 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 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.