24B-069 (3) 176.0"
graphic
hic
U4.0"
28.0" IMP
signs
20.0"
aluminum fabricated decorative sign gn cap 800.458.2376
...painted to match ESB green aluminum fabricated sign cabinet wl CAM routered 3.443.0034
aluminum sign faces...1/2"thick push-thru acrylic copy/
lo
go faced with translucent green and grey vinyl film gisigns.com
Internal white LED module Illumination
alum.fabricated trim painted Sales Rep: M.Brazeau
to match ESB green IS Name: ESB Bank
Is Location:Northampton,
co
aluminum fabricated base shroud.... eet: I of 8
faux stucco painted finish Date:: 8/27/i5
to match Gobi Desert 710C-3
Job
1 12"thick raised PVC address,,, Scale: as noted
pamted to match duronodic bronze Drawn by: LH
ESB Bank
A
297 King Street
297 KING STREET Northampton, MA
Rev 9/1/15
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aPPgOVEDABNOTED
CLIENT 81 aN�TURE
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'\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Graphic Impact Signs, Inc.
Address: 575 Dalton Aveenue
City/State/Zip: Pittsfield, MA. 01201 Phone #: 800-458-2376
Are you an employer?Check the appropriate box: Type of project(required):
1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3711 am a homeowner doing all work myself. [No workers'comp.insurance required.]f
10❑ Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p
Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
14.DOther Signs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
(Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Granite State Insurance Company
Policy#or Self-ins. Lic.#: WC 005849357 Expiration Date: 08/19/2016
Job Site Address: -?q7 Al/1-5 City/State/Zip:Arr,
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: (1�c-�� G��w�L Date: 1!- "/"J
Phone#: 800-458-2376
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Page 2 of 3
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 Required by
Zoning
Lot Size
Frontage t/
Front: j 1 S�
Setbacks:
Side:
L: R: L: R:
Rear: ✓
Building Height v/
Bldg Square
Footage
%Open Space:
(Lot area minus bldg and
Paved parking)
#of Parking Spaces
#of Loading Docks
Fill: (volume&location) A f /
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge. )
DATE: APPLICANT'S SIGNATURE��/c c�,
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
Page 1 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: G 6A n ki ll_ l•►,d 4;1t_�tl;S, (N
Address: ✓ td Telephone: C�a. 0Q -+l S-1
2. Owner of Property: E ics�r d t;us
Address: F( L-cLL�L S'{-' c,+-" rto,-,"*.,c-,t" Telephone: 3
3. Status of Applicant:_Owner _Contract Purchaser _Lessee
I/ Other(explain):--J d b vt Ic(c 2 n t/a//erc. 445 ,.i—
4. Job Location: �2 C/ 7 k� St.
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: vac;s k-
6. Des(c�riptio/n of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary)
T GPI[ P 'eaGl�sJ/i1�y lh crnvn�,.( s c L)" CK-4 r5 h)
AIVYr�irvv,.. �r.�riCz -c1 pa Frn.h a I l4 r ("i l,.j" Let)11
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
+ 1y tym rZer��E2�r+s
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW__L YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW f 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
10. Do any signs exist on the property? YES v-' NO
IF/YES: Describe the size,type and location: L!ti @ -Sr�r c
t,"e c -R c { (c.�.t_ t t r e- acv 6-1
Are there any proposed changes to,or additions of,signs intended for the property? YES V NO_
IF YES: Describe the size,type and location: it). , 6 v .��c- a7z�-,u�r �, rj"-" t--0\
of Xort4ampton ric(
_ DL'PAR7MI;NT 01' BUILDING INSPFC7IONS
.r 212 Main Street • M()�tcipal Building NorLharnpton, MA 01060 z
Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee
(Application to be filled out in ink or typewritten) Number .....................
Plans must be filed with the Buildinq Inspector Erection..................( )
before a permit will be granted. Alteration.................(�Q
Repair.....................( )
Repainting...............( )
Removal..................( )
FEE........PAGE........PLOT.......
Northampton, Mass. �f l...c�....20?$—
............... .. ..
To the Building Commissioner: WJ
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME ..... f/}i�S.... .............................
1. Location, Street and No. ..x.1..7....�.t NJ....S !4. .r..............................................
2. Owner's name ..... S- 4................................................................
t-
3. Owner's address .. <.. Vic! t .. ............p<.?.r: .................................
4. Maker's name ... N..�J1�!C ...�rn�7.G�.c.f.... .t /vs.?..�N�...........................................
5. Maker's address .....e,T#.I�<,( r...!tt!`�....04?:°.1.........
6. Erector's name ........ ... 1!4n! -................................................................................
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? ..ol.VO. Marquee ...............
3. Lower edge will be .Q..ft...t? ..ins above the public way. Projecting ..............
4. Upper edge will be J 3..ft...Q...ins above the public way. Roof .....................
5. Height . ..ft.y...ins Width ./.�-ft.d..ins Temporary.............
6. Face area .8'1...sq.ft. Wall .....................
7. Inner edge will be ......ins from the building 9F pele v 114- Ground ........►r..
8. Outer edge will be .......ins from the building orb Other ...................
9. Face of building or pole is ..P 7ins back from the street line.
10. Sign will project C)...ins beyond the street line.
11. Sign will extend ..O..ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame .....�.��.......... Face......4t��1`'`!
13. Estimated cost $....
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
`
....... �....4.� ... `/0
.
(Signature of Owner or ent)
I�—�-
��
File#BP-2016-0348 WHAT m'
c �<o �G
APPLICANT/CONTACT PERSON GRAPHIC IMPACT SIGNS INC ���{
ADDRESS/PHONE 575 DALTON AVENUE PITTSFIELD01201 (413)443-0034 AS V+r'k
PROPERTY LOCATION 297 KING ST-EASTHAMPTON SAVINGS BANK
MAP 24B PARCEL 069 001 ZONE HB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT :54 TIVO
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE ILLUM MONUMENT SIGN -EASTHAMPTON_SAVINGS BANK
New Construction
Non Structural interior renovations
Addition to Existing-
Accessory Structure
Buildiniz Plans Included• -
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFQRMATION PRESENTED:
l/ 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: §
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 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.
City of Northampton Map 24B Lot069 Zone HB(100)/
Massachusetts Date issued 9/30/2015 0:00:00
Inspector of Buildings Permit # BP-2016-0348
Permit Fee$100.00
SIGN PERMIT
Business EASTHAMPTON SAVINGS BANK
Address 297 KING ST - EASTHAMPTON SAVINGS BANK
Applicant InstallerGRAPHIC IMPACT SIGNS INC
Applicant Installer Address 575 DALTON AVENUE
Work Description REPLACE ILLUM MONUMENT SIGN -
EASTHAMPTON SAVINGS BANK
Estimated Cost $18160.00
Building Department
Approval by: