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24B-069 (4)
City of Northampton Map 24B Lot069 Zone HB(100)/ Massachusetts Date issued 3/17/2016 0:00:00 Inspector of Buildings Permit # BP-2016-1087 Permit Fee$60.00 SIGN PERMIT Business EASTHAMPTON SAVINGS BANK Address 297 KING ST Applicant InstallerGRAPHIC IMPACT SIGNS INC Applicant Installer Address 575 DALTON AVENUE Work Description REPLACE ILLUM FRONT WALL SIGN - EASTHAMPTON SAVINGS BANK Estimated Cost $2500.00 Building Department Approval b File#BP-2016-1087 APPLICANT/CONTACT PERSON GRAPHIC IMPACT SIGNS INC ADDRESS/PHONE 575 DALTON AVENUE PITTSFIELD01201 (413)443-0034 PROPERTY LOCATION 297 KING ST MAP 24B PARCEL 069 001 ZONE HB(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT _ 04pr Fee Paid Ay,t9 Building Permit Filled out Fee Paid Typeof Construction: REPLACE ILLUM FRONT WALL SIGN-EASTHAMPTON SAVINGS BANK 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 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 1716 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. Titg of Xort4ampton � ' +..)tllttssttrllusriis � �� DIsPAXTMI NT OF RU11 UINC INSPL'CI'IONS v6s oc� 212 Main Street • Municipal Building sNiv syo Nor•LliarnpLori, MA 01060 Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee i (Application to be filled out in ink or typewritten) Number ..................... z Q PI a"� ust be filed with the BuildingInspector Erection.................. be ( ) W — d ermit will be granted. Alteration.................( ) 0 > cv Repair.....................( ) p Repainting...............( ) Removal.................. UJ ( ) V 'n W 0FEE........PAGE........PLOT....... fY aZ {i+ o Northampton, Mass. ...............................20..... To the uilding Commissioner: Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME ..... f�lG�!*p.fir,...��i�:�.! �.J:....t4w� ............................ 1. Location, Street and No. .. c?.7 kt�,= Str�wc r 2. Owner's name ... .................................................................................. 3. Owner's address F.1. ...... .(c?r�„cc:�.. -tt4................................ 4. Maker's name ... 7.Y?¢ tYnJ...E. !u.<..:.................................................. 5. Maker's address ...5751t� LA : .........: :: . ... ... .... ...Pf1 /.................... 6. Erector's name ...... .............................................................................................. 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? ....lel O Marquee ............... 3. Lower edge will be .Ia t..g....ins above the public way. Projecting .............. 4. Upper edge will be 1.5.. ...ins above the public way. Roof ..................... 5. Height �3...ft.�.Jns Width ...;..ft..S..ins Temporary............. 6. Face area ,k,:.sq.ft. Wall ...........✓.... �� 7. Inner edge will be .1R:.'ins from the building or pole. Ground ................ 8. Outer edge will be .. ...ins from the building eppoie. Other 9. Face of buildings �! back from the street line. . `!...ins 10. Sign will project beyond the street line. 11. Sign will extend ..P...ft .......ins above the building or pole. 12. Of what material will sign be constructed? Frame ...... Face.. 13. Estimated cost $....a?r�.............. The undersigned certifies that the above statements are true to the best of his knowledge and belief. .................................. (Signature of Owner or Agent) Page I of 3 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION I Name of Applicant: (;ret k("C— SL�a-,' 1"C- Address:!-'75 Telephone: Z'00 4-S ?" 2. Owner of Property: f1c-i-4d 4NJI-2v5, Address: ; —"t , F �tA- Telephone: -'>F6 3. Status of Applicant: Owner Contract Purchaser Lessee �Other(,,pl,in): 15-1'�;, e 4. Job Location:-�)Y-7 L(t! S-t-1, Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: &PA- 6. Description of Proposed Use/Work/ProjecVOocupation:(Use additional sheets if necessary) iZQ-IACL��- 7. Attached Plans: V/Sketch Plan Site Plan _Engineered/Surveyed Plans 5 -a A.13 r,.S t P12-C r C's 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW_G, 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: 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: Are there any proposed changes to,or-aeiditions of,signs intended for the property? YES NO IF YES: Describe the size,type and location: 2 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 / � V Setbacks: Front: o Side: L: .j R: L: R: Rear: N Building Height Bldg Square vvvv Footage %Open Space: (Lot area minus bldg and Paved parking) #of Parking Spaces #of Loading Docks Fill: (volume&location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: —/—4 APPLICANT'S SIGNATURE 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 graphic Impact signs & fax 800. 458.2376 13 44 3.0034 o 1211 gisigns.com K � E Com„ w ,w .` Sales Rep: M.Brueau t+ s,,� (1)...internaiiy iiluminated Contir5i 3�Viii1 i + in^^ � i�I. �.'�� Job Name: ESB Bank Y5 ui.Y..r+Mrr4�li�r+r�r.pitrn�rrr�.�I�i.r nwr.rr r +MilrYf .ir� '6-deep aluminum fibW.AtW cloud *M.OP cabblef...painted WhIte...blteftlalwhite LED madule,Su lination Job Location:Northampton,MA r w 1 of 4 'vaphia/letterhtg faced with translucent{teen and pw vinyi fpm '120 YAC at 60 W P.suppil.to be located vrlthln contour sift callinat Date: zizeii s 'aluminum fabricated mounting bracket/spKer...painted to match fascia behind Proposed. Job n: Scale: as noted Drawn by: LH ESB Bank 297 King Street Northampton,MA Rev 2/26/16 Existing Condition �om—w a�YAA11Wt1�M��AdR�s.alllk. CLIENT 9NatNTUFE DAIS i nw+: nslx .i, im n w v I s sicca«gnec I syp•� AC4 RE® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 9/10/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lisa Bernard Coakley Pierpan Dolan & Collins Insurance AgencyPHONE (413)664-9366 ac No:(413)664-4723 26 Union Street AppREs :lbernard@cpdcinsurance.com INSURERS AFFORDING COVERAGE NAIC# North Adams MA 01247 INSURERA-Main Street America Ins. Co. 29939 INSURED INSURER B NGM Insurance Company 14788 GRAPHIC IMPACT SIGNS, INC. INSURER C:Granite State Ins Co 575 DALTON AVE INSURER D: INSURER E PITTSFIELD MA 01201-2908 INSURER F: COVERAGES CERTIFICATE NUMBER:2015-2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE fiM_ POLICY NUMBER MM/ M / LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ BPF9690P 8/19/2015 8/19/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY 1XI JERCOT- LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: EPLI $ 10,000 AUTOMOBILE LIABILITY Ea aBcideDtSINGLE LIMIT $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ AOSCHEDULED M9F9690P 8/19/2015 8/19/2016 BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Paraccident $ ELITE $ X UMBRELLA X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5 000 000 DED RETENTION$ CUF9690P 8/19/2015 8/19/2016 $ WORKERS COMPENSATIONPER 0TH- AND EMPLOYERS'LIABILITY Y/N X STATUTE I IER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? 7NN/A C (Mandatory in NH) WC005849357 8/19/2015 8/19/2016 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Office of Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. Municipal Building 212 Main Street AUTHORIZED REPRESENTATIVE Northampton, MA 01060 Lisa Bernard/LIBBER ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INSff28 om4nn The Commonwealth of Massachusetts fu Department of IndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Graphic Impact Signs, Inc. Address: 575 Dalton Avenue 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 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. E] Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑■ Other Signs 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. #: WC005849357 Expiration Date: 8/19/16 Job Site Address: kl<'1 City/State/Zip: 4,/ _c(,AL 6 r e 6 61 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: