38C-075 (4) File#BP-2019-0009
APPLICANT/CONTACT PERSON FEDERAL HEATH
ADDRESS/PHONE 1500 NORTH BOLTON RD JACKSONVILLE
PROPERTY LOCATION 54 EASTHAMPTON RD-RACING MART
MAP 38C PARCEL 075 001 ZONE SC(85)/GI(15)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T eofConstmction: REFACE EXISTING GROUND SIG
New Construction 1 4Z
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOATION 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 Stoma Water Management
Demolition Delay
/� 7 ; 18
Signature of 90ding 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.
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I DEPARTMENT OF BUILDING INSPECTIONS s a
212 Main Street e Municipal Building
Northampton, MA 01060 e �"
nsrcc'role Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device pp
(Application to be filled out in ink or Mewritten) Number .10�_�.7..'..9.
Pla ns ector Erection.................. )
be ma permit will be granted Alteration.................(,fi
Repair............... ... )
JUL — 2 2019 Repainting...............( )
Removal.... �}
DEPT OF BUILDMG INSPECTION viiFEES......PAGE. ....PLOT....... '
NORTHAMPTON.MA01060 p �a 1o0
�l t/ Northampton, Mass. ...............................20..... 1
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME ...fill.C/. .G..../l!IAe.7.
....FEL.5................................................
1. Location, Street and No. .5y..SAS..'/NAL12f.�ZQN...l?9:.....................................
2. Owner's name ..TM1 /,V Y.._LYA. off... 74,4. .,< TR.. ?4e, tr .s.G.G...
3. Owner's address ..�.w.._ A.ST...L�i9LN..S,::.._
4. Maker's name ...f�'G.Q.E-r.9.L.... /-].rH........................�..........................................
5. Maker's address .l�f.G.U_./!�Gk�ZAL...,/�ci.L,YCY.J... <.._✓.a.<' .SCY-a✓LC:CG,r..../X:... 75)�E,
6. Erector's name _4 0.r ztva....,SG.G! ..........................................................
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? ./>.&.. Marquee ...✓......
3. Lower edge will be ......ft........ins above the public way. Projecting ..............
4. Upper edge will be ......ft........ins above the public way. Roof .....................
5. Height ......ft......ins Width ......ft......ins Temporary.............
6. Face area .......sq. ft. Wall .....................
7. Inner edge will be ......ins from the building or pole. Sidewalk....................
8. Outer edge will be .......ins from the building or pole. Other.........................
9. Face of building or pole is .......ins back from the street line.
10. Sign will project .......ins beyond the street line.
11. Sign will extend .......ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame ........................ 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
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address' Telephone:
2. Owner of Properly: LAK 1�ET.CO LHUM /.LG.
Address: /G F sr Alii Sr. (/l`a>R wo MA Telephone'.
3. Status of Applicant: ,Owner _Contract Purchaser Lessee
_Other(explain):/
4. Job Location: 2 t"-ACrNA/Y/v772iv'
Parcel ID: Zoning Map# Parcel# Dislricl(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property GAS
6. Description of Proposed UseNJork/Project/Occupation:(Use additional sheets if necessary)
f7B FACE ininI r
T Attached Plans: _Sketch Plan �Site Plan Engineered/Surveyed Plans
S. Has a Special Perm it/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 Pai and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW ✓ YES
EYES: Hasa 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: MA , /n S'
Are there any proposed changes to or additions of,signs intended for the property? YES_ NOS
IF YES: Describe the size,type and location:
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 i Department
Existing Proposed Required by
Zoning
Lot Size a y7,1ct�5
Frontage
Front:
Setbacks:
Side: L: R; L: R:
Rear:
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus i and
Paved pending)
#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: 4211Y APPLICANT'S SIGNATURE
SKS VMA// . L'OM
Applicant's Email Address (required)
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.
Page 3 of 3