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24A-221 (3)
File#BP-2017-0223 •t-0 LQ APPLICANT/CONTACT PERSON WESTGATE LLC ADDRESS/PHONE 21 LOCUST ST NORTHAMPTON PROPERTY LOCATION 21 LOCUST ST-EASTHAMPTON SAVINGS MAP 24A PARCEL 221 001 ZONE NB(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid '�j OD // (/D� Building Permit Filled out r (y Fee Paid Typeof Construction: ILLUMINATED GROUND 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 P1 EESENTED: 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: § 350—?s2CML. ✓ Finding 6R 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�-�- lL- -C8/Z 1 6 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. RECEIVED it of Ynrthttm inn 1' *- AUG18 2016 a S.s Sic r , �IttssttrlfusPtts t( • 't J 4% zz 14.' • .oFrsuun;Vc.•�• .• ; 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 72,/'i c. 1 rkrA c-t J i fw fs /n!'- Address: 5 7S £ a,(*N! Ate4- /'L nr(3(c() A44 Telephone: ?6O S 1 02376 2. Owner of Property: Address: Telephone: 3. Status of Applicant_Owner Contract Purchaser _Lessee '3,4ther(explain): /4 ye^t 4. Job Location: 2/ L6 c a SY- 51-E..eit-51- ZrcS�e Ai( Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IND BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: &ILA 6. Description of Proposed UseAWork/ProjecUOccupation:(Use additional sheets if necessary) x qo"r.t t lib Clo✓dt c. /Aslc enkl) i`I(0I tr.)��-� Qo.u.,<t t;)., -JO /444"'>1.-4'1.1 ca&%,e/.. �,;�u, Ao e4 cLlun'te'A •, FAQ , y � ._.:tom 7-h,Lu:.i /i ..u j d`c (J Mc e I. Lia:-.0111 ix /Lo✓pat„x, s.{ �tUL IfOPitowl GJl7( c+(ticca►tneF Sc.krf--4 • /a.usc 5”" 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans Use S,cir h�} sem/ pore. 1za e.u.•J ,�C FJ.c av�� s,3AV- 8. Has a Special PermitNariance/Finding ever been issued for/on the site? NO DONT 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: 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 f 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: 'MA_ i7c—a k i.t Up d h n} crAc �— Loj-o 1Aar a>--)aid 1-k SY�e s� -r, fl Re(Lo csi 5�. Page 2 of 3 '1 ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 12 Th:_colu^v lc be filled in by :ne BL Jir D-•arment. Existing Proposed Required by Zonin• Lot Size Frontage Front: Setbacks: Side: L: ;7 R: L: R: Rear: Building Height ✓ Bldg Square Footage /11/7/— %Open Space: (Lot area minus bldg and J/#Paved oarkiig) A)7,— # of Parking Spaces #of Loading Docks //9- Fill:(volume&location) ^v/e 13. Certification: I hereby certify that the information contained herein is true . d accurate to the best of my knowledge. DATE: r!, ,/ ` APPLICANT'S SIGNATURE I _. k 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 ha . . 90.0" aluminum fabricated decocatne sten cap...painted to mato nn room graphic 1 Impact signs 800.458.2376 p aluminum fabricated syn cabinet w/Cala roistered faX 413.443.0034 fax wr 3 0 mist 10 bank — aluminum syn faces 1/T tuck pusMthru acrylic copy/ y. to IoBo faced with translucent green and they vinyl film... QISIQnS.COm Ic.e.fared l d with LED module(green and bank'3 ' 1 ••`,,, alum.fabricated trim...palnt•d - !• - Sales Rep: a Rrazeau to match ES8 green IIIIIIIII Job Name: E58 Bank ��-- - 1/2"thick raised PVC address... painted to match duronodie bronze Job I tuattnn:Nwllwnplwa ---- - Sheet 1 01 7 LOCUST aluminum hbr caled base shroud... Dat": 8/26/15 ST laua stucco painted to match Gobi Desert 710C-1 Job O. ■ Scale: as noted l rpi Drawn by: LH 30.0" ESB Bank 21 Locust St. • j Northampton, MA 1 Rev 5/3/15 ,.- I I I I •s..wo Ave•aa:o Ae Mune 4 WWI aK:NARNIE Y .t -.�{�- 'c`a•t. 4. a7. �'..i, OAR ,-,,,...1...v.„.t^.., '\l.--r t,-%.-4-7...M.7..,'- P •?tom..— ` ` :left*. .1^. ~ . - -��. ^e .�,^ . •i: ..1,'. • h . •! 1' ` ' � ` _, . • Yy. '�-y.. • • > . e- ' .50 -spi,•.•-.1°... �X d .si • - P- , �_e .}.'�.q&+ . �. ... •.n.usce..w..-. (1)...DF Internally Illuminated Pylon Sign...1/2"=1'-0" „7;,,7 ,„ *re-use existing concrete footing/tube support steel 4 f' t 3 Y; I :t 1,� At 1111111.. graphic impact signs bankES - oar 800.458.2376 (ax 413.443.0034 16 gisigns.com , bankE 9 —_ _ 2 Existing Condition 1 •. LOCUST : Al Sale,Fine M Brarr•u ,Mb Hame: ESB Bank • 11111 •1 I` ' ST . , �, .Inb Location'Northampton _., Shoot 2 of 7 " •, t 1 ES 111 Delc, 11/76/IS Itprir!' I i3 ti • I i EASTHAMPTON y '°b •. 11 SAVINGS BANK Scalr, az noted Dtnwn by. LH - LOCUST ST.OFFICE ' i ESB Bank i _ r _� 21 Locust St. :�e+ 4 Northampton, MA �iJ I"ry ON Rev 5/3/15 '� ,- APPROVED AO Nnrq+ I tun 111111111k. —40,14.•OP<10•AOhl ACCORD DATE(NWDO/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 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(les)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 Lisa Bernard NAME: Coakley Pierpan Dolan & Collins Insurance Agency PHONEtt )_ (413)664-9366 r . 413)6 -4723 26 Union Street "AM lbernard@cpdcinsurance.com INSURERS)AFFORDING COVERAGE I MAPCO North Adams MA 01247 _ INSURERA Main Street America Ins. Co. ' 29939 INSUREDINSURER B I4GM Insurance Company 14788 GRAPHIC IMPACT SIGNS, INC. INSURER C Granite State Ins Co 575 DALTON AVE INSURER D: INSURER E: PITTSFIELD MA 01201-2908 INSURIERF: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXP I LTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER j 0151/DD/TYYY1 (M CMIDDNYTY) UNITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 DAIAANTED A I CLAIMET OCCUR PREMISES(EsEo rence) S 500,000 BPF9690P 8/19/2015 8/19/2016 MED EXP(Any one parson) S 10,000 • PERSONAL 8 ADV INJURY S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE i 5 4,000,000 POLICY X ECa LOC PRODUCTS-COMP/OPAGG S 4,000,000 OTHER MI S 10,000 AUTOMOBILE LABILITY COMBINED SINGLE LIMIT S 1,000,000 (Ea acciasr4) B X,ANY AUTO BODILY INJURY(Per person) S ALL SAUTOS AUTOS �SCHEDULED H9F5690P 8/19/2015 8/19/2016 BODILY INJURY(Per acc.dent) S NON-OWNED PROPERTY DAMAGE S HIRED AUTOS •AUTOS (Per accident)_ I 1 ELITE S X UMBRELLA LIAB I X !OCCUR EACH OCCURRENCE S 5,000,000 B EXCESS UAB 1CLAIMS-MADE AGGREGATE S 5,000,000 ' 1 DED 1 RETENTIONS CUF9690P 8/19/2015 8/19/2016 S WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L EACH ACCIDENT S 1,000,000 OFFICER/MEMBEREXCLUDED? N I N/A C (Mandatory In NH) WC00584 9357 8/19/2015 8/19/2016 E.L.DISEASE-EJB EMPLOYE S 1,000,000 If yes describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT S 1,000,000 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H 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 AUTHORQEDREPRESENTATTVE Northampton, Imo, 01060 Lisa Bernard/LISBER o� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD IHS1125 r�nianii The Commonwealth of Massachusetts Department of Industrial Accidents }•=Tv= f Office of Investigations E _ ;_y Congress Street, Suite 100 �61=_ • 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): 1.0 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. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. 0 Building addition [No workers' comp. insurance comp. insurance.* required.] 5. 0 We are a corporation and its 10.0 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 12.0 Roof repairs insurance required.]re t c. 152, §1(4),and we have no q ] employees. [No workers' 13.0 Other Signs comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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: 2/ L-0 C-U. 7' Sr City/State/Zip: A/D eta ip*v 4 %4 p pd o 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 51,500.00 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. I do hereby certify under the pains and penalties of perjury,that the information provided above is true and correct. Signature: 61,e-cfs.<. Date: Phone#: 7Q1) 5 7 7 , 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#: -MIP.-•, r