The URL can be used to link to this page

32A-123 (10) H , 'I u !� a J '� N j '� u 9 'i d '� 'I N rk O {' i! d I�III if11�ILM 11mall Awallas rwilil IIIIi1�11 �, I MAN llt�l�p�'1 r r II11�N 11i!1111 Iil fill u i pliflu lnl!l 12molll MUM r N M M The Commonwealth of Massachusetts Department of IndustfialAccidems I Congress Street, Suite 100 < Boston, MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeiblv 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): V[D I am a employer with 16 employees(full and/or part-time).' 7. []New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 3.[J I am a homeowner doing ll work myself r 9. El Demolition g y [No workers'comp. insurance required.] 4.0 1 am a homeowner and will be hiring contractors to conduct all work on m property, I will 10E]Building addition Y P PertY ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.0Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c 14.[21 Other Signs 152,§](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. tContractors 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 informmtio& Insurance Company Name: Granite State Insurance Company Policy#or Self-ins. Lic.#: WC 005849357 Expiration Date: 08/19/2016 Job Site Address: ( K k—(N, C`=1— City/State/Zip: A hfAdLv�* pn1; ,�A o/c6c) 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: /lD /?�� Date: 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#• 0 0�* LED ELECTRICAL CHART LTR.I WHITE LED I TRANSFORMER JAMPS 120 AMP FRANCE O LOGO 15 1 110 1 (LED-1260PS) TOTAL 1 15 1 1.10 1 POWER SUPPLY NOTE: (1)20 AMP CIRCUIT REQUIRED g ELECTRICAL INSTALLATION KIT SWITCH,TIME-CLOCK ETC... AN ELECTRICAL INSTALLATION KIT TO BE INCLUDED WITH ALL LETTERSETS SHIPPED. 120 VAC INPUT FROM BREAKER THESE SHALL INCLUDE; OR DISCONNECT SWITCH TO 1. (1)MOUNTING PATTERN POWER SUPPLIES BREAKER PANEL 2. (30')WATERPROOF CONDUIT 3. (2)JUNCTION BOXES 4. (20)CONDUIT CONNECTORS 5. (1)TRANSFORMER BOX WITH POWER SUPPLY FRONT ELEVATION @ LED LAYOUT (SEE ELECTRICAL CHART) NOTE: NOTE: MANUFACTURER TO FOLLOW LED MANUFACTURER TO FOLLOW LED LAYOUT EXACTLY.PLEASE USE LAYOUT EXACTLY WHERE TO PLACE 18 GAUGE WIRE FOR LED JUMPS ELECTRICAL HOLES TO ENSURE WHEN NEEDED.THIS IS TO ENSURE PROPER EVEN ILLUMINATION. PROPER EVEN ILLUMINATION. CLIENT'. DESCRIPTION: mm, SHT. BV. Prgecl Number: pure Barre 24"LOGO Al "°w ma° °°"'""'«""°""""'°" 4 JPR PBC0332 .. THe - '6'SOe.Tom H 379 propntx a TM Iesk.group.erootM pppxxlmlN 1«ur mbd ILLUMINATED REMOTE tho,t`�.t�pp k' :np"p° pmw z�zx.. wce:8.5.32.820 a7est mw m"m a TM h51b group. D wp m pt any of lM OF DATE. Drawing NUmOer. .. I n' tt�Group 865.3426200 q iMN-1 pp�o;Wh l�b.;,I.r W. 4 7/22/15 B356219 865 539,6311 FIND# DESCRIPTION TOTAL QUANTITY EE IFUR L000119E LaE) 24' SSSE THN.x 3'IS ALUNIN RN(SEE COLOR WLE) ALUM—9ACN(SEE—SOHE ) CAPISEE COLOR SC—E)11116-THK 13lE.—lF.S MIN GOO FRANCE(LED- SPS)POWER SUPPLY WI EASTENEFS LIW b TIGHT CONDUR CONNEC a re'DIP.LIQUID TIGHT 11E%BLE-111 XI AM'.1.—.1GGLEDISCONNECT SWITCH SHE 11 1g /L`nf,. (Vl/N x/•x/jr� xlouuNwuN FLAT PnN HEnn scREw IR are'DIA.N—TING FASTENER(SEE FASrE D I IS 11E TEA—CLIT 1 CaoR S (S w LEI x AENL IEE C CAE) AM (EHEW-1 ROP-1. .SS SESCHEWIEI IB MATET WORasc-_RL. 11 SAII—ES 1 FRONT ELEVATION @ 24"LOGO (SEE COLOR SCHEDULE ON SHT 2) ELECTRICAL: 1, MANUFACTURER TO PROVIDE 10'-0"ELECTRICAL PIGTAIL TO EACH INDIVIDUAL LETTER&LOGO. NOTE: ++ CONSTRUCTION NOTES: INSTALLATION NOTES: GENERAL NOTES: 20 AMP DISCONNECT SWITCH SHOULD BE 1. FACE TREATMENT: 1. MANUFACTURER TO PROVIDE FULL SIZE MOUNTING 1, DO NOT USE GRAPHICS SHOWN ON THIS DRAWING FOR LOCATED ON THE PRIMARY SIDE OF ALL SEE COLOR SCHEDULE. PATTERN. PRODUCTION REFER TO PRODUCTION ELECTRONIC FILES. POWER SUPPLIES.SWITCH MUST BE 2, RETURN TO BACK ATTACHMENT: 2. INSTALLER TO DRILL MOUNTING HOLES, 2, MANUFACTURER TO REFERENCE COLOR ARTWORK TO LOCATED IN SIGHT OF LETTERS OR HAVE STAPLED,WELDED OR RIVETED. INSTALL CONDUIT ON BACK OF LETTERS TO PASS ENSURE THAT ALL COLORS ARE CORRECT,IMMEDIATELY CAPABILITY OF BEING LOCKED IN OPEN 3. LED SPECIFICATIONS: THRU WALL. CONTACT THE INSITE GROUP IF COLOR ART WORK AND CIRCUIT POSITION TO MEET U.L. GOO 3LED WHITE LEDS. 3. JUNCTION BOXES TO BE INSTALLED ON THE INSIDE OF PRODUCT DRAWING HAVE ANY DISCREPANCIES OR HAVE REQUIREMENTS. 4. LETTER INTERIOR: WALL BEHIND LETTERS. NOT BEEN PROVIDED. PAINT INTERIOR STARBRITE WHITE OR EQUIV. 4. INSTALLER TO RUN CONDUIT AND CONNECTING 3. INSTALLER SHALL VERIFY ALL SITE CONDITIONS CAULK INSIDE PERIMETER OF LETTERS WIRE TO EACH JUNCTION BOX. AND DIMENSIONS. TO PREVENT LIGHT LEAKS. 5. INSTALLATION OF JUNCTION BOXES AND ELECTRICAL 4. EXISTING WALL CONSTRUCTION TYPE MUST BE NOTE: 5. PAINT: CONNECTIONS TO BE DONE BY QUALIFIED INDIVIDUAL DETERMINED AT THE ACTUAL PROPOSED LOCATION WHERE DISSIMILAR METALS ARE ALL EXTERIOR PAINTS TO HAVE THAT MEETS LOCAL AND NATIONAL CODES. OF THE LETTERS BY THE INSTALLER. SATIN-GLOSS FINISH(SEE COLOR SCHEDULE) 6, MANUFACTURER TO SUPPLY TRANSFORMER BOX 5. INSTALLER SHALL VERIFY THAT FASTENERS CHOSEN ARE IN CONTACT THEY MUST BE ALL PAINTS TO HAVE A 2.8 VOC. WITH LOUVERED VENTS AND SCREENS,TO HELP IN SUITABLE WITH WALL CONDITION TO WITHSTAND THE COATED OR A BARRIER MUST OR LESS AS REQUIRED BY CODE. THE DISSIPATION OF HEAT. STATED PULLOUT FORCE. BE PLACED BETWEEN THEM TO 7, INSTALLER TO SUPPLY MOUNTING ANGLE. 6. THE BUILDING ENGINEER SHALL INCLUDE THE LOADS PREVENT GALVANIC REACTION. 8. WHEN USING HILTI ANCHORING SYSTEM,IT IS TO BE APPLIED BY THE SIGN STRUCTURE IN THE DESIGN OF THE USED IN STRICT ACCORDANCE WITH WALL SYSTEM. MANUFACTURER'S GUIDELINES. 7. INSTALLATION SHALL CONFORM TO NATIONAL ELECTRICAL 9, INSTALLER TO SUPPLY FASTENERS TO MOUNT CODE AND OTHER APPLICABLE CODES. LETTERS TO BUILDING WALL. CLIENT: DESCRIPTION'. SHT. BY P,_N-1—: "dy m. DakdeO°"ink ao.rRy°r.me.a. 1 JPR PBC0332 •• pure b a r r e 24"LOGO P.n.y., „�,.D ,°,w .y,, „ d„ THE 7675OakTem Highway proj..l.Ilee d 83ew tlwi�. Plum PE art Writhe dh.r KnorviN Tennessee37937 ILLUMINATED REMOTE u°NTheId. f 1.kSft :nonaP°nlbx.a.<nw tn. of DATE Draw DgNUmbe "InSiteGroue Vase:665.3426311 .rut.R°oR..Ne d The ksx.cmw. peekwn d°Ry d<ne M I:d F-;"aM 4 7/22/15 8356219 FaM 665.539.6311 r S l Crti� � 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 /6N- Setbacks: N lo— Setbacks: Side: L: R: L: R: Rear: Building Height i y N(4 Bldg Square Footage %Open Space: (Lot area minus bldg and Paved parking) N #of Parking Spaces N #of Loading Docks Fill: (volumes location) A)Ir4- 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: �D APPLICANT'S SIGNATURE Z' / �-• i 4 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 Si u C_' 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: C:�--('ZE_P k'C I r"IX.0 j— 'J t SM S j�C_ Cam, Address: 57S 8�('ton1 � (�M Cdd et Telephone: 1' 90 45Z a_37-4 2. Owner of Property: & a"—" 1,'C-( G is Address:�7 kt.'�, Sf. �0rya^p N /� l7 Telephone: O 7 7 Y 3L L� r 3. Status of Applicant:_Owner _Contract Purchaser _Lessee ✓Other(explain): 61J22 11110-5+,-(1 e,,- 4. Job Location: Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: rC-Min - 6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary) INS f-A( 5:k_h o, � r 7. Attached Plans: I 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 record ed at the Registry of Deeds? NO DON'T KNOW V/ 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 NO ✓ JV COY `��+�r .n s/ � 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: IN Seal( /L'sC-j I%je x6m �.tl„� � c�ci►.�. h��, Cat�-it Me C �e�k a� )n t-�.r�.�1� V-- r-e�+Cam- -ac n.;cu•�- I _x` 'S c TitV of Xort4amptan +�RttssttrlYusrtfs y°; �`� DEPARTMENT OF BUILDING INSPECTIONS 4D 212 Main Street • Municipal Building f 1�0 CD Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign o Or other Advertising Device, or Marquee (Application to be tilled out in ink or typewritten) Number ..................... Q m u1 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 pa sign or other advertising device,or marquee. BUSINESS NAME .....P.J. V.................. ...�..f........................................... 1. Location, Street and No. ... �...... 2. Owner's name ...�T...e........�`.....`..... .I ... ..... 1..................................... k ln, 1 Vic"0_e f--...l�c�r Of �. .!'� )�k�1.....�` ....................... 3. Owner's address ...!G?.Z...........5....... p:. 4. Maker's name ......�jc,...J kj..!�i.:t G!'a.O.'r...................................................... 5. Maker's address ..7b7S....�-...e- c..... ....KN..UN.V,.��.e- TN..... �cL,3� 6. Erector's name ... 1-ftyakl-..... .i raS....LNc ......................................... 7. Erector's address .> :?-.......P ........... SIGN KIND OF SIGN (Designate) 1. Sign will be(check one) illuminated Non-illuminated ....... 2. Will sign obstruct a fire escape,window or door? ...r.?i. Marquee ............... 3. Lower edge will be ..FS .ft..lo...ins above the public way. Projecting .............. 4. Upper edge will be ...ins above the public way. Roof ..................... 5. Height .,&A..ft.Q..ins Width .-_9-.ft.. ..ins Temporary............. 6. Face area ..L.J..sq.ft. Wall ...........t%.... 7. Inner edge will be ......ins from the building or pole. Ground ................ 8. Outer edge will be .......ins from the building or pole.N/r+ Other ................... 9. Face of building or pole is .......ins back from the street line. 10. Sign will project ..P...ins beyond the street line. 11. Sign will extend ..©...ft .......ins above the building or pole. 12. Of what material will si n be constructed? Frame ...Ai(� im..k)xr.I.. Face..�.:-4 ..k......... 13. Estimated cost $........... .FS:Q.i.00 The undersigned certifies that the above statements are true to the best of his knowledge and belief. .... . . .. . .. ........... �t///",51gn ur oY w r or Agent) File#BP-2016-0482 APPLICANT/CONTACT PERSON GRAPHIC IMPACT SIGNS INC ADDRESS/PHONE 575 DALTON AVENUE PITTSFIELD01201 (413)443-0034 PROPERTY LOCATION 63 KING ST MAP 32A PARCEL 123 001 ZONE CB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid nd Buildinp,Permit Filled out Fee Paid Typeof Construction: ERECT ILLUM WALL SIGN-PURE BARRE New Construction Non Structural interior renovations Addition to Existiniz 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 INF911MATION PRESENTED: proved 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 ,t0 iS Is- SignatureYfBuilding 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 32A Lot123 Zone CB(100)/ Massachusetts Date issued 10/15/2015 0:00:00 Inspector of Buildings Permit # BP-2016-0482 Permit Fee$60.00 SIGN PERMIT Business PURE BARRE Address 63 KING ST Applicant InstallerGRAPHIC IMPACT SIGNS INC Applicant Installer Address 575 DALTON AVENUE Work Description ERECT ILLUM WALL SIGN - PURE BARRE Estimated Cost $988.00 Building Department Approval by: