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24B-075 (4) City of Northampton Map 24B Lot075 Zone HB(100)/ Massachusetts Date issued 11/1/2018 0:00:00 Inspector of Buildings Permit # BP-2019-0527 Permit Fee$30.00 SIGN PERMIT Business Address 344 KING ST Applicant InstallerCALLAHAN SIGN COMPANY Applicant Installer Address P O Box 744 Work Description ILLUMINATED CLEARANCE SIGN - BURGER KING - SIGN C Estimated Cost $1000.00 Building Department Approval by: File#BP-2019-0527 APPLICANT/CONTACT PERSON CALLAHAN SIGN COMPANY ADDRESS/PHONE P O Box 744 PITTSFIELD (413)443-5931 PROPERTY LOCATION 344 KING ST MAP 24B PARCEL 075 001 ZONE HB(100)/ THIS SECTION FOR QFFI!Q[AL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Meof Construction: ILLUMINATED CLEARANC SIGN-BURGER KING-SIGN C 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 YOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 _ l l __ 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. Cfitjj of Nort4ampton �� Sys,..;'«•:.siC `,.A. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Sidewalk Sign, Marquee or other Advertising Device G (Application to be filled out In ink or typewritten) Number ..................... Plans must be filed with the Buildingjmuc E C E I V E D Erection..................(XX) before a permit will be chanted. Alteration.................( ) Repair.....................( ) Repainting...............( ) r OCT 3 0 2018 Removal... 0,15 FEE..... 3 ...PAGE........P.PPLOT....... DEPT.OF BUILDING INSPECTIONS NORTHAMPTON.MA Olffdrthamg n, Mass. ...,,October 22 2018 To the Building Commissioner: Bp 19 - 5-A-7 Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME ,,,.Burger King ................................................................................... 1. Location, Street and No. ....344 King Street 2. Owner's name ......F.P,.S,...Inr................................................................................... 3. Owner's address .....158..Callege..Higlaway..(.EO 3..357.)...S.ouzh•.Hamp.t<on,.-MA..O.1073 4. Maker's name ...,Allen Industries 5. Maker's address .4100 Sheridan. CPurt, Greensboro,,,,NC„�,�•4,]:0...... ........................ 6. Erector's name .Callahan..Sign,..LLC....................................................................... 7. Erector's address ...8.,Fede.rico. . . ..Drive. ...(POB. ..744). . ....Pittsfield. . . . ,... ... MA 01201. .... . . . . ....... . . ..... . . . ..... . . . ........ ... . SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated ...X.. Non-illuminated ....... 2. Will sign obstruct a fire escape, window or door? ..No... Marquee ............... 3. Lower edge will be ...8-ft........ins above the public way. Projecting .............. 4. Upper edge will be ...9..ft........ins above the public way. Roof ..................... 5. Height 9....ft......ins Width ......ft......ins Temporary............. 6. Face area ..0..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...clearance„bar 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 ..alum /ACM ...... Face....................... 13. Estimated cost $....1000..-install only The undersigned certifies that the above statements are true to the best of his knowledge and belief. (Sign tura of yVylpy or Agent} James P. Callahan Page 1 of 3 Presentation Use Only BK Clearance Bar Not for Production with Faux Wood Finish s'-0• Page 10 of 12 QUANTrrY: 1 stn r-z V-41/2• VINYL COLOR REFERENCE: AGM COLOR REFERENCE: AKZO NOBEL COLOR REFERENCE: Jf' 3M VINYL#3630.125 YELLOW 4mm RON RED ACM _PAINTED RED#20643,SATIN FINISH r m e �' 3M VINYL#3630.33 RED 4mm ALPOLIC MTLC SMX SILVER ACM (EXPOSED STEEL PIPE SUPPORT) e•.6.4_mm A p[v_IC 3M VINYL 0363041703 BLUE 3mm ACM WITH 3M DI-NOC FAUX Top View MTLC SMX SILVER ACM O 3M WHITE 752570 WOOD FINISH VINYL Base 1'-21/8' Scale:1/2'=V-0" Construction Stn•�1 1'-r 1, 6'-41/2' I Exposed Steel painted Akzo Nobel Red#20643 LIMBO 9'-0" u m Routed and Bent 4mm ALPOLIC THE EASIEST CAME OF EVER. 1 MTLC SMX SILVER ACM Cover - Al ? Ly 3M White#772510 Ytnyl Graphic with Lv 3M Red#3630-33 Background applied i 1 sl surface to 4mm Silver ACM i 1_1/2' 1-1/2' . t 3: Routed and Bent 3 Routed and Bent T N 4mm Ron Red ACM Reveal 3"N"ACM with Di-! Faux Wood Finish Vinyl m _ with hon—tal grain. a FL m TWOC ._. 1.-Dr. V-6'From edge of curb Routed and Bent to center of base plate Base Plate 4mm Red ACM Base Cover with Tabs LT%t'S1EF1 NlalE NflDED TO �, IHE yr dA z]e'lgL srEiXxDtoa BDI.R. ISOIIIBtrIC VIEW POURED CONCRETE Tooaxo TD MEET Side View Not to Scale N1 STATE Nm lora 9NDWG COOE Front View aEauREMeMFOR STEEL utD'ox Scale:1/2'=1'-0' 9olTExanxrealAT10N Scale:1/2•=1'-0' Client Review StMLJ� Declaration ate'Description Project Information anme°ts°.rc�.a.mr+l-'01%- 'd,.+abed�.ed Copyrighto2oleaanDdustri s,lnc. 09/25/16 Issue Date C'Nr'Burger King BK F2200 w^r+�.+Pmrbaal�� al>�nemrewe�wml ae+,w,nP,�v „am,,,aarragN,,,rowN,,ectw a.+q: t 344 King St,Northampton,MA 01060 YOUR BRAND AT ITS BEST•• ° EIAW—d ppppae mNatrd ❑ ' 1-800-967-2553 Nac+ .Prasn�vw4-e.m.4.a..ra°en tr+>onrab.wtx.r. FIN BK F2200 Northarttpton.MA y°i�atl1°ai°e ir1s°Y�Oe°�°OB U" DeT"SPN Pm Jamie Bums www.allonindustries.com Tde Date dARa h..el�,hcl�Mpgeb JNenewt4 rc House City of Northampton Map 24B Lot075 Zone HB(100)/ Massachusetts Date issued 11/1/2018 0:00:00 Inspector of Buildings Permit # BP-2019-0525 Permit Fee$60.00 SIGN PERMIT Business Address 344 KING ST Applicant InstallerCALLAHAN SIGN COMPANY Applicant Installer Address P O Box 744 Work Description ILLUMINATED WALL SIGN - BURGER KING - SIGN A Estimated Cost $1000.00 Building Department Approval by: File#BP-2019-0525 APPLICANT/CONTACT PERSON CALLAHAN SIGN COMPANY ADDRESS/PHONE P O Box 744 PITTSFIELD (413)443-5931 PROPERTY LOCATION 344 KING ST MAP 24B PARCEL 075 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ILLUMINATED WALL SIGN-BURGER KING-SIGN A 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 YOLLOWING 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 Z=-- A,--J 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. �IAttssttrlTusPtts �:: � DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �6�sF .�`^sca Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Sidewalk Sign, Marquee or other Advertising Device (� 1 0 (Application to be filled out in Ink or typewritten) Number .............J. ... Plans must be filed Erection..................(y{) before a permit willa ra D Alteration.................( ) Repair.....................( ) Repainting...............( ) OCT 3 0 2018 �0 �1K G '1� FEE:_ . . PAGEd.'....YLOT....... DEPT OFSUILDINGINSPECTION S Northampton, Mass. .,,,.October 22 2018 To the Building C . NORTyAMPTON,P,AA 01060 Application for a permit to place or maintain a sign or other advertising device, or marquee. Burger King BUSINESSNAME ...................................................................................................... 1. Location, Street and No. ....344 King Street .............................................................. 2. Owner's name ......F,P,.S.,,,Inc..................... .............................................................. 3. Owner's address .....158..Callege..Hi.ghway...(.P.O.B..357.)...S.ou.th..Hamp.t~on,--.MA..01073 4. Maker's name .... Industries ............................................................................................................. 5. Maker's address .4100 Sheridan Court... reensb,oro,,.,NC„2,741Q 6. Erector's name .Callahan..Sign,LLC....................................................................... 8 Federico Drive (POB 744) Pittsfield, MA 01201 7. Erector's address ....................................................................................................... SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated ..x... Non-illuminated ....... 2. Will sign obstruct a fire escape, window or door? ..ND.... Marquee ............... 3. Lower edge will be ..20.ft........ins above the public way. Projecting .............. 4. Upper edge will be ..�4.ft........ins above the public way. Roof ..................... 5. Height .6...ft......ins Width ...6..ft......ins Temporary............. 6. Face area ...36sq. ft. Wall ....x............... 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 .....alum............. Face..Lexan............ 13. Estimated cost $.... ,.QQQ..�,nstall only The undersigned certifies that the above statements are true to the best of his knowledge and belief. .�.-:.............. (Si nature of QWAjoy or Agent) James P. Callahan Page 1 of 3 SQ.FT.=2826 20/20 Sign Design Cap Over Face,Wall Sign-6' 6'-0" s' Single Face,LED Illumination .K FORMED ABS BACKGROUND Page 5 of 72 FORMED ASS SIGN WITH FORMED POLYCARBONATE CAP OVER FACE PANELS GE LED INTERIOR ELECTRIC STUB ILLUMINATION POWERED \ BY LOW VOLTAGE POWER SUPPLY. ALL SIGNS EQUIPPED W1 UL APPROVED DISCONNECT SWITCH (20 AMP.1120 VOLT) 1/2"NON-METALLIC CONDUIT PASS THRU WALL TYP.(TOP 8 BOTTOM) ELECTRICAL DISCONNECT JUNCTION BOX BEHIND WALL NON CORROSIVE 3/a'LAGS OR THRU 0 8 CIO ELECTRICAL SERVICE \ .� BOLTS AS REO'0.CONTINGENT ON SWITCH AND CONNECTION \�\ WALLTYPE \� / 040"THICK FABRICATED TO CONCEAL LIGHT FROM ® i BACKER DETAIL \ x—ALUMINUM LIGHT BAFFLE % SCALE:nts \ INTER OR FLUORESCENT / FORMED POLYCARBONATE I LAMP ILLUMINATION 'CAP'OVER'FACE PANE �T1R•-" VHB TAPE MOUNT WITH 2ND SURFACE APPLIE WEEP HOLE DETAIL TRANSLUCENT GRAPHICS \ _/ -DIA W AL ER DRAIN 'WEEP HOLE" WALL ANCHORS AS NEEDED PAINT'SILVER'AND PER WALL CONSTRUCTION. RETURN SECOND-SURFACE ABS LOGO -LEAVE BORDER AREA WHITE' CABINET POLYCARBONATE FACE FRONT VIEW SIDE VIEW RUBBER GASKET #47230 ALUMINUM SCALE:3/4"=V-0" SCALE:1 112"=V-0" SIDE VIEW DETAIL RIV-NUT 112"PAN-HEAD SCALE:3/4"=1'-0" MACHINE SCREWS SPECIFICATIONS: •PAINT POLY FACE RETURN W1 WASHER,PAINTED 'SILVER'2NO SURFACE. WHITE SATIN FINISH CABINET:FABRICATED OF ROLLED ALUMINUM FRAME. •LEAVE BORDER AREA BACKS:FORMED.220"KORADABS. 'WHITE'-REFER TO DETAIL CAP OVER DETAIL CAP OVER FACE:FORMED.177"CLEAR SOLAR GRADE POLYCARBONATE Scale:NTS WITH UV INHIBITOR AND 1"DEEP RETURN. VACUUM FORMED TO CREATE CONVEX DOME SHAPE. DECORATION GRAPHICS:TO BE 3M OR ORACAL TRANSLUCENT VINYL ON 2ND SURFACE3M WHITE DIFFUSER. COLOR SPECIFICATIONS ILLUMINATION: G GE LED MODULES,POWER SUPPLIES AND COMPONENTS ® 3M TRANSLUCENT VINYL#3630-125 YELLOW ELECTRIC:120 VOLT 20 AMP PRIMARY ELECTRIC CIRCUITS BROUGHTTO BASE OF 3M TRANSLUCENT VINYL#3630-33 RED SIGN AND FINAL CONNECTION BY BUYER.(1)20 AMP CIRCUIT REQUIRED 3M TRANSLUCENT VINYL#3630-8703 BLUE O BK SILVER SATIN FINISH ,A)1Mw AmlimWes c®U`ELSIGN IC 3M WHITE DIFFUSER#363530 (i THIS SON IS INTENDED TO BE INSTALLED INACCORDANCEWITN THE REQUIREMENTS OF ARTICLE SppCp OF THE NATIONAL ELECTRICAL CODE EGROUNDEDL GRdMDINO MID O NLOE THAE CONE5.MS INCLUDES PROPER CONENECTI% C Client Review Status Declaration • • I/kffhldusowes taalydlasas.bllaab-DNn'DkpDlce'd-s:Dcsmb.Nd Capyriaao2otaABanlRduaRW,Bc 09125178 Issue Dale Oiei434Burcer KingnsIBKF2200 6vnMdsYpgYbayploSafnld!-eapuOthlll9stM lali9ofl. YOUR BRAND AT 175 BEST COW, OAppvmd DAppnxedasNand ORaeeaResu6nd TNIt.Iagnl.aerlNaa..q,aseq�rinara,,bcTnse..y. / 344KIrgSL.Northamoton.MA01060 a4riEbrynmtlN-blw l-eNyn ao•NOm.W.OITde/9 Ib..ntryDlMAsn baelN.I.N°�bMbbttDNlb-P�a4E•WT 1-800-987-2SS3 Nare ay.mevl mru.e.plmm�.mw«naaslab 6gm.wYo.w.TIN R• BK F2200 NOrthamobn.MA rds W% m=aAb^�sa��.s�Dci° tr rd s asn"wIIIIIxvb, LA S4�House D""9^ SEN PM Jamie Bums www.allenindustries.com City of Northampton Map 24B Lot075 Zone HB(100)/ Massachusetts Date issued 11/1/2018 0:00:00 Inspector of Buildings Permit # BP-2019-0528 Permit Fee$30.00 SIGN PERMIT Business Address 344 KING ST Applicant InstallerCALLAHAN SIGN COMPANY Applicant Installer Address P O Box 744 Work Description ILLUMINATED ORDER STATION SIGN - BURGER KING - SIGN D Estimated Cost $1000.00 Building Department Approval by: File#BP-2019-0528 APPLICANT/CONTACT PERSON CALLAHAN SIGN COMPANY ADDRESS/PHONE P 0 Box 744 PITTSFIELD (413)443-5931 PROPERTY LOCATION 344 KING ST MAP 24B PARCEL 075 001 ZONE HBO 00) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiny Permit Filled out Fee Paid Typeof Construction: ILLUMINATED ORDER STATION SIGN-BURGER KING-SIGN D New Construction Non Structural interior renovations Addition to Existing~ Accessory Structure Building_Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan TH"O LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IPMRMATION 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 )illSignature 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. Titq of Xort4am.ptart � � +.ARttssttrljusPtts �, �`_ •`�cc •+ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Sidewalk Sign, Marquee or other Advertising Device / (Application to be filled out In ink or typewritten) Number .....`.�K7Y.... Plans must be filed with the Buildin Ins a Erection..................(XX) before a permit will be granted. ECE'1 V/CD Alteration.................( ) C Repair.....................( ) Repainting...............( ) OCT 30 Removal...�..............( ) 2018 FEE........PAG?.0 PLOT.4.7.J DFPTON0RP 8UI)pINC InSPFCTI N rtha ton, Mass. October 22 2018 To the Building Commissioner: nPTON.°AA 01060 gP.- 9—5ay Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME ....Burger. . ..King ....... . . ..................................................................................... 1. Location, Street and No. ....344.King Street ................................................................................... 2. Owner's name ......F.P,.S....Inc.............................................. ..................................... 3. Owner's address .....158..CaLlege..Higlaway..(T.O.B..357.)...S.ou.th..Hamp.ton, .-MA•.0,1073 4. Maker's name .......Allen.............Industries......................................................................................... 5. Maker's address AN0..SheridenCourtGreensboroNC„ 7.4.10 „ . ,,,, 6. Erector's name .Callahan..Siga,..LLC....................................................................... 7. Erector's address ...8..Federico Drive (POB 744) Pittsfield, MA 01201 ................................................................... SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated ..X... Non-illuminated ....... 2. Will sign obstruct a fire escape, window or door? ..No.... Marquee ............... 3. Lower edge will be ......ft...99..ins above the public way. Projecting .............. 4. Upper edge will be ......ft....L1.6ins above the public way. Roof ..................... 5. Height ...9..ft..6..ins Width ......ft..3.4.ins Temporary............. 6. Face area.925..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...oCU................ 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 ...AlgWAPA,,,,,,_ Face....................... 13. Estimated cost $....1_,000-install only The undersigned certifies that the above statements are true to the best of his knowledge and belief. ................... � :l c, ........ (Signat re of Q py or Agent) James P. Callahan Page 1 of 3 BK Drive Thru OCU with Faux Wood Finish&No Screen Cutout VINYL COLOR REFERENCE: ACM CO OR REFERENCE AKZO NOBEL COLOR REFERENCE _3M#7725-12 Black Vnyl Text —4MM RON RED ACM PAINTED BRUSHED ALUM.SILVER,SATIN FINISH 3M#7725-10 While Vinyl Text 4MM SILVER ACM QUANTITY'X 3MMACM WITH DI-NOC FAUX WOOD FINISH VINYL 72' 81/8' 1-1/7 4-1/2' �4433I/8' t - -------- ------- -------------- ------- -------------------------- 40 31W l V N • Top View Scale:1n'=1'-O- I._1. 1'-1 tl4 y4 `1�• Y" ANCHOR BOLTS.sI�PFR ENG 3 � 1,_1. I 1 Isometric View scale:1/2'=/.-0' ALLEN INDUSTRIES TO SUPPLY 4 ANCHOR Side View / BOLTS AND TEMPLATE FOR INSTALL Scale:1/Y=1'-0' Front View POLPREDCONCRETE FOOTINGTOMEET 04 Swle.1/2-=1'-0' ALL STATE AND LOCAL BUILDING CODE REOUREk1ENTS FOR STEB.ANCHOR 2" POWEROUT BOLT SIGN INSTALLATION. 7S" STL. PLATE NOTE:ALL MET LABELS TO BE PLACED OUT OF EYE SIGHT /1�GY/I7tliVShlef a -ELECTRIC f � SIGN �►� - Project A//ems/edustiies N,nr ,mc matdrrn•OAcpeva'aarticnemoied CopydyeomlBAlen t�les.Inc. 9U1B Issue Date Burger Kine ii H� 1pnroaeHpb ben/pbbboneiwapaaxfmn6s-wni �- -��e�y M.N.W , roup artAwn AT lif BFiT'• []Appoved OAWINeduNoled ❑RwireaReaa,e • bwe bw�-abe *+�rol. ro., wk _ _ — 1-800-967-2553 o Nm m..eawea+w�row.am .bb.mo.�b,Tw W Fie api'lotinue4q�abotl.mobil-.ieidb h.mW�-.TN S.I._ De&*_ PM_ WWW.allenindustrles.com THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Callahan Sign, LLC Address: 8 Federico Dr Pittsfield, MA 01201 Telephone:413-443-5931 2. Owner of Property: F.P.S. Inc fpsbk@fpsbk.net Address: 158 College Highway (POB 357) Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee X Other(explain): sign installer 4. Job Location: 344 King Street Parcel ID: Zoning Map# 18D Parcel#047-001 District(s) C (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: Burger King 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) RK ,1nder, renovation and Callahan Will he hanging imr1T atad signage 7. Attached Plans: X 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 X 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 X 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 IF YES: Describe the size,type and location: existing Burger King signage and menuboards, etc. Are there any proposed changes to,or additions of,signs intended for the property? YES X NO IF YES: Describe the size,type and location: Front Burger King logo, "Fkame GrillinV front sign, clearance bar, and OCU (order station) 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 Front: Setbacks: Side: L: R: L: R' Rear: Building Height Bldg Square 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: 10/22/2018 APPLICANT'S SIGNATURE r'7 jcallahan@callahansign.com Ja es P. Callahan—Callahan Sign, LLC 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 Elevations 5g4r Graphic Layout 20.11Ar CHANW-L LETTERS Page 2 of 72 101 6r-0'CANGPY 8� 11'-9'CANGPY C1 9'4 1?CANOPY C2 9'-91?CANOPY C3 6'OK� —LOGO FA [I .q :A FRONT ELEVATION SCALE 1/8"=1'-0" 60-z 10'-r CANOPY o 11'-2'CANOPY E 11'd'CANOPY F 6'-10'CANOPY G 11'-r cANOPY H a "I SIDE ELEVATION SCALE 1/8"=1'-0" Client Review Status a R b �Project Information ,b�, �I/en/ad�stries NG �immiz amen�'CuwP '�*a� copyrgino2ot9AMn1nd wlrlw Nc 09!25/18 Issue Dale Burlier King BK F2200 ' saner a`a°`°d"`°m'd°'m'°"m'ig-aa�uwew+aQ.+ls n.raeyN.�mr.anc n.e+.:n: 1 344 King St,Northampton,MIA 01060 YOUR easNo AT ITS REST" n OMp��d OPPproe wNoted 13Relse&Resumrii .e.+.anra�nmrbo�awrdMneo..m�.�n.vibb.e pnroabpib/HenblWr.Yc.denab4lw�bvyuraa+e.ya. BK FZ100 Northampton.MA 1-800-967-2553 Name aoaDva+4 iMabn6a¢beanlibYeb b/bnnisbona.en Fila Tide Dere 'e-n°1e>,s=M�d,v k'"'0"'qb' LA saw House D-9n Sim Jamie Bums www.allenindustries.com Elevations 80 2' Graphic Layout Page 3 of 92 K-(r CANOPY I 8'-0'CANOPY J DRIVE THRU ELEVATION SCALE 1/8"=1'-0" r-rCANOPYK t~'I {- Q REAR ELEVATION SCALE 1/8"=1'-0" Client Review Status Declaration Date I Deiscripti.ri Project Information Ile, Indw.Wes rlg�& AIarIMSAIee.1 Npaes NNa�'OA9PUTd;dvnjbe.0Dred Copyright 02018 Alm Industries,Ina. 09/25/18 Issue Date Burger King BK F2200 M1anh diNilgnbNry pDDudmrekaeapadcbnidr miti�n. YOUR BRAND AT ITS REfT^ m¢s�ra�amnaa ow..s wamga..vc¢+n im lr,s aa..e¢ i 344 King St.Northampton.MA 01060 OApproved OAppmvedasNUed ❑ReviseBResimrrd +►Qbw"b@s�er.w��+rb�r �oradrde.^s ]� byou b�Nn MdeS 4c ad¢n9bh yvrnbanaeaiIDOrlw 1-800-967-2553 - Name oP.vm".mmea."vv m�ae eb �ra,w�¢a.ire -]}v FAe BK F2200 Northampton.MA sa.emb.a-.q a �n¢na�emnba TO. pas S'l�House ^SPIN "M Jamie Bums WWW.allenindustrles.0011'1 20/20 Sign Design Ebw wRe<a and a-0• kadea W*through slum aea name m)bw BK S-16-C Closed Building Canopy located I wall.fire did hole aid etobout comingout atleft And d Blocking behind a all with 4'LED Light Fixture li NRn.Light Bxaxe to be metaled al factory before shipment. Page 6 of 12 Thor Bolt pattern to Agn w'n cansu ns 3" 3" 0 z ij Nota:J0ed dherr mth re 7/ .-- -- ?i�-- _ 1/2"thru Aida.stainless ss steel bolts- _ - - -- - ---- -- .. - - ---' r - -• 1" 2" 2 314" - - - "' - LAMP MOUNTING BRACKET DETAIL 3/4" 1.314" v Koelerh USA LLC Decorative vapor Proof Light a i 2081111 TS LE.D.Light IMON-0VP-182.14-JY i `�S ----- 52314• 1 1/4"x 7-long x.125-Mk x 1 1/2"wile brake formed alum.angle welded to face 6" 4" 2" C&1 t+al/2'Caulk al WigP _ of 2-x 8-alum.tube rr� _ .125'x 3'x 1'aluminum s 1i4-platehargerbrackot—Wedlo n fRltpNCanopy�f�tK� tube Centr mount ,• ]" 0 6• 7- 1"x 3-t.:be a slot n roof panel ivy sepporls— J314" welded ro at tab - - IKE 1/2 i __. ..:1 3/4" 1. 314" wan plate 126'%B'%2'redangular Tie-Backs 6'-0'On Center Typical .125'x luminum lube anopy kahe Fasten laFRONT VIEW SIDE VIEW lamp to angles TOP VIEW DETAIL-TYPICAL CANOPY WITH CLOSED TOP AND LED LAMP FIXTURE with e>e10 x 1 � Tek Drew's WALL BRACKET DETAIL SCALE 1"=1'•0' � C1 Scale:1/4"=1'-0" Closed Canopy Guidelines: •4'LED Light Fixture to be installed at factory. ` •Closed Canopy mounting holes are to be pre-drilled at factory. •Canopies up to 11'-0'long are to have One(1)4'LED Light Fixture. S.S.Tumbuckle at each 318'da Merl comism resistant tru bats, •12'and longer canopies are to have Two(2)4'Light Fixtures. O end of threaded rod assembly SIR belts,,co structural V sl type. blocking -�'-------'"---- -- •Joined canopies are bolted together,same as the comer can joints. -use S.S.fasteners to A �Nr�•co end Pr on Well type. P o9 OPY 1 core-red to alum.date brackets Blocking bMkd rBl Prarided by GC. •Wall Mounting holes are to straddle the 1"x 3"aluminum tube support arms. •Threaded Rod and Sleeve are to be cut to size as needed in field. 318"9 S.S.threaded rod m• •Pre-drill canopy for electrical stub-out at left of light fixture with 6'whip. w/1.0 alum.tube slftve 14 c •1'x 3"Aluminum Tube Support Arte can not go over light fixture. Threaded rod and sleeve ' Canopy Length as Specified to be trimmed in field-�• Channel W 6. • * lsbert Ra�Y 1• .080'Aluminum r f panel ! D 22 31W 22 318" with brake formed,sloped .12Yx 3'x 1' sides and rear told. CANOPY•DEPTH VARIES aim tube Carter I�CenbrRla dlanq Rppod brad�eD -- Roof panel pitched at 6'_g _ T 7' r ropy su"ort 1"Per 4' 31 -0"depth.; T 2' 41 H M 1 • o L_ Koni USA.LLC Decorative Vapor Prod Light �� • Z � 0 B' 2%i6WT8LE.D.UgiKON-0VP-182-14JY o 6- 0 11 3• 12• .125 X 8'X 2' -1x-%g ounting lidos are o sliaddle the 1/4"plate hanger bracket HOTIN Canopy: Redangufar grrrinum ix 3'aium�num Nbe anepy support welded to 1•x 3'tufts R rN Backs recessed 1r loan 1'md a anopy TuOe Campy Frame slot in roof panel SIDE VIEW CANOPY DETAIL FRONT VIEW DETAIL-BUILDING CANOPY WITH LED LIGHT FIXTURE SCALE 1"=1'-0" SCALE 1"=1'-0" PAINT REFERENCE: y� THIS SIGN IS INTENDFJ7 TO BE INSTALLED IN ACCORDANCE WITH THE GROITIRNDEDL �,�//�IJR/�/AeS d N�gg ELECTRIC REQUIREMENTS OF ARTICLE 600 OF THE NATIONAL ELECTRICAL CODE CENNECTIONS �Akzo Nobel Brushed Aluminum Silver �(F%EA%6FRE11x50a �1® SIGN GROUNDINGANDBONDIINGOFOTHESIGNES.THISiNCLUDESPROPER Client Review Status DeclarationDescription NG sen ndullile.rcnw®enean'OApoed'da.:gb.awrd capyrlpxoxDleAhnlnduwiee Inc. 09/W18 Issue Date DoiBurger King BK F2200 egnar6aepdttbelyplod%bnrekNuPaddon iaeaEe YOUR BRAND BRAND AT ITS REST tragi-�uPrw.au.,.ge.areq�vwm-.rctraara.:gs 1 344 Kira St,Northamlkon,MA 01060 a OAppwed OAppaAdasNaled ❑ReveeeBResulb it xarrmblauemu.-bysr�sd�yem.em�.erwwkawV pb..ebfau eYNre liAeel-fax:ad.mlbM9-nb eyueaOtlr yea 1-800-967-2553 Nana u9a�mw0.uP.e+-M1mt�aetlAldb 6tloixlWowe.Pe Fie BK F2200 Northampton.MA nee Dab °a'�tivximi'.�1�"`°traw y��k wb�9b' �°s House i SPN %"Jamie Bums www.allenindustries.com 20120 Sign Design Canopy Construction Detail 318"dib.steel corrosion resistant bolts 25"THICK ALUMINUM PLATE Page 7 of 12 , WITH WELDED TABS or lag bolts,into structural 2x structural al blocking —� as Required,contingent on Wall type. Blocking behind wall Provided by GC. ° 3/8"DIA.SS CLEVIS WITH Op 3/8"DIA.FEMALE THREADED ° RECEIVER — 318"DIA.SS --- 1"OD ALUMINUM-- THREADED ROD ~ PIPE SLEEVE —- Tapered roof top at w w irl canopy comer with a a brake formed pitch O O to align pitched roof w U) with the 24"depth i ADJUSTAS NEEDED canopy. Tie-Back Canopy Support tV LL-- TOP VIEW CLOSED CORNER CANOPY DETAIL 114"plate hanger bracket welded to 1"x 3"tube&slot in roof panel O O 125"x 3"x 1"aluminum .125"X 8"X 2" N tube center mount Rectangular Aluminum canopy supports. Tube Canopy Frame v O 6" O Mounting Holes are to straddle the 1"x 3"aluminum tube canopy support. TOP VIEW CANOPY DETAIL FRONT VIEW CANOPY DETAIL BURG�R eae.u�asia�rem.gma�w*0A m"� gbe� copyriox®m1eamDwusare.,xx. 09n5/18,Isi—mbae ck"tBurgerKingSKF2200 //en/nd�stries hqn VE tlMlpnOr b'yprod 'I Rlc IXrloMJ ,daue19V151.VL YOUR BRAND AT ITS REST— masa,a�a.uam�e rta..�sgax.nmares b�TM+ea+ne 344 Kinq St Northampton MA 01060 DApprrned OIWPoved as Noled ❑ReoiseBRewtxrol ae�nfa+"mti:evww+ve vdy�m.�.m up aardewa —� 1-800-967-2553 Nacre m�"'Nr' ��„ r«rtaremgca Faa BK S9 Northampton MA TO. Dasa a.ddo�wn-.m1�,mrmvAndarwars,.m. sores House moi"SPN Pm Jamie Bums www.allenindustries.com 20/20 Sign Design Basic Canopy Blocking&Tie-Back Details 2 X 8 Wood Blocking / \ 2 X 8 Wood Blocking Page 8 of 12 24"to 36" --+ Covered or Open Canopy (Includes"Home of the Whopper") HOTW ti ��/ Installed over a fixed window and o / o attached to the"Home of the Whopper' N / N on the wall beside the Main Entry Doors. Canopy 6" - ------- - --- — ------- TJ 2 X 8 Wood Blocking 2'-0" T-0" i i 2 X 8 Wood Blocking Typical Tie-Back Dimensions - ----fi are shown for estimated material 48"to 72" A, I lengths required. j Covered Canopy Tie-Backs to be cut to length (Includes Canopies up to 6'-0"Projection) in field as needed. i � U Installed over a Doorway,Window or Drive Thru Window U 72"and Larger Variable Size Canopy Installed as the deep section of �; the"Home of the Whopper'Canopy over the Entry Doors �S 6" 6 LAILL6' Canopy Canopy 6'-0" 1-01 5 Scale 314"=1'-0" 6'-0" W,� G Client Review Status Declaration Date/Description Project information //en/adwrnes N I-ftd Irabwnnab,,d—.p..W.RM.m.ma Th. nomtea.nlnau.o+n.ma 09/25118 Issue Date BursiergSt.NoF2200 iamroam+vansypaacsonre.Rsap�m,.sm�e.�n �;-�„i„�,�y.,•,q�gN,,,�ar+..Km;e.+yb 3g4 King St..Nortliamoton.MIA 01060 YOUR BRAND AT ITS aesr- OAppwed Olwpwedas NoRd �NaseBRewbmi eEnBCbpunmiMc•b Y�uemYYn aoaeam..+bWiaE�c par.Obpu E�Nnbaelbs.ln:laemlb0.9or�btabatii[„s Fie BK F2200 Nortliamoton,MA 1-800-967-2553 Ny"• "� mvrim� aaµ( mbsNatab-Ae Mgbebp ba T& Dar a«�{`aae meeea nU-re nevaeMaei.bomb k —� House DesT 2N Pm Jamie Bums WWW.allenindustries.00111 Closed Canopy Typical Drawings 20/20 Sign Design SCALE 3116"=V-0' NOTE:DEPTH OF THE C CANOPY SECTIONS TO BE FIELD VERIFIED Canopy Construction Details NOTE:ALL CANOPY TIE-BACKS ARE CENTERED NTH CANOPIES C2 AND C3 LOCATED LEFT OF THE ARCHON Page 9 of 12 IN THE LENGTH OF THE CANOPY. 20-41/8'CHANNEL LETTERS 10'-2"CANOPY A 6'-0"CANOPY B 11-9'CANOPYC1 9'-9 1/2"CANOPY C2 9'-91/2"CANOPY C3 T.-T CANOPY K KULKA LED WALL SCONCE TOP VIEW DOWN LIGHT FIXTURE, rHIGH X I R'LONG Xg*DEEP 2L 5-0" 5'-0' 3'-1 I -- - -- -- -- - t J I ------------- - ----------- --------- - FRONT VIEW Joining Canopies are thm bolted together REAR ELEVATION FRONT ELEVATION .d,112"die.stainless steel bolts 10'-2'CANOPY D 11'-2"CANOPY E 11-8"CANOPY F 6'-10"CANOPY G 11'-T CANOPY H V-(r CANOPY 1 8'-0*CANOPY J TOP VIEW ;a --------------- ------ --- --------------- ---------- - 6*-W . ------- -- ---------- ------I-------- --------- - -------- FRONTa - VIEW SIDE ELEVATION DRIVE THRU ELEVATION client Review Status Declaration Date i Description Project Information OVIRGR Cl OM18 I%wDate ClID4 Burger Kkm 8K F22DO ofile, Indwries I= YOUR BRAND AT ITS BEST'- hmftdm,itp=baWM&� M4 Ming SIL.NoqLw�n ,MA 01060 OAppw,d DApp—d.Notal OR�&Rmilxrd KING4t, 1-800-967-2553 Na Re BKF2200Nordanaton.MA TO. Dat, d.House www.iklionindustries.com ORDER CONFIRMATION UNIT Clearance Bar & Drive Thru Canopy FACE OF J Steel Base Plate Placement CURB (TYP) Page 11 of 12 n 61 v`ri 35' m w ter; a I U' CLEARAN SIGN® MENU BOARD DRIVE THRU LANE ALLOW FOR 20' OPT. PREVIEW BOARD RR�OO�TITTATIOOHN OF (TYP.(OF SOOPWR EW 9OARD ALSO PREFERRED LAYOUT CURB NOTE:THE PREFERRED LAYOUT SHOULD BE USED WHENEVER SPACE ALLOWS ANGLES BETWEEN THE PREFERRED LAYOUT AND MINIMUM LAYOUT ARE ACCEPTABLE AS LONG AS: (1)THE DISTANCES FROM THE CENTER LINES OF THE STEEL SUPPORT OF THE MENU BOARD &PREVIEW BOARD TO THE FACE OF CURB ARE REDUCED BY 4"FOR EVERY 5 DEGREES OF ROTATION. (2)THE DISTANCE FROM THE CENTERLINE OF THE OCU(ORDER CONFIRMATION UNIT)&CENTER LINE iv THIS SIDE FACES CAR OF THE MENU BOARD IS REDUCED BY 3'FOR EVERY 5 DEGREES OF ROTATION. THE CENTER LINE OF THE MENU BOARD TO CENTER LINE OF PREVIEW BOARD REMAINS AT 201. s + ORDER CONFIRMATION UNIT j * \ BASE PLATE DETAIL FACE OF cuRe (TYP) f ' 3/4"THICK STEEL o do BASE PLATE WITH o Cl) 1"DIA. HOLES AND n 3/4"DIA.ANCHOR BOLTS. is V)� 2 • �' ^ CL SIGN �3/4- MENU ALLOWP 20'— OPT. PREVIEW BOARD g OAF (S EW so" 12'—6" 13" P ALSO. Minimum Layout NOTE THAT DIMENSIONS 14^Dia. SCALE: ," 10' ARE CRITICAL. DRIVE-THRU ORDER STATION 2020 IMAGE BASE PLATE DETAIL SCALE:3116"=1'-0" G a (3w • //en/nd�st�ies O�VN sur:,,acRa•o1r.'Okauecoa:yc.mrRd cogyNosafaa.nlnavameamc 098918 Issue Date Burger Kine BK tanMtlYMP�baMOD��N�r.eaP� �Neearariaon ns.,, w�.� aa•baby�rwn`err nc n.e.+v 34410ng SL,Norftmoton,MA 01060 Q�Ored ppyPoedr N*d OR&m&ReaMd .Miidbginwkeobrpru..Wryh oar.d..aib piyW bby YOUR BRAND AT Iia alai'• O p...,,bylknblrl.bC Wswbbv�bjr"- NN,,, "d.7�darfunivvmdnpmalwbdandi0bdn ggindii.wr.TM Fd. BK('2200 NortlfartrDton.MA • Tae ON. 6si immri.d�clmri tro�w yb m�r'9bAN -House tee^SPN mJamie Bums www.allenindustries.com ACC)R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 10/23/2018 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 CONTNAME: DOMINIC SINOPOLI SINOPOLI INSURANCE AGENCY PHONE 413-528-1710 we No,:413-528-2519 30 STOCKBRIDGE RD qp RIEss:DOMINIC.SINOPOLI FARM-FAMILY.COM GREAT BARRINGTON, MA 01230 INSURERS AFFORDING COVERAGE NAIC0 INSURER A:FARM FAMILY CASUALTY INSURANCE 13803 INSURED INSURER B: CALLAHAN SIGN LLC 8 FEDERICO DRIVE,#B INSURER C PO BOX 744 INSURER D: PITTSFIELD, MA 01201 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE IN POLICY EFF POLICY EXP LTR SWVD UBR POLICY NUMBER MMDD/YYW MM D /Y DYYY LIMITS A X COMMERCIALGENERALLIABILITY 2001X1338 12/19/2017 12/19/2018 EACH OCCURRENCE $ 2,000 000 CLAIMSMADE FIOCCUR PREMISES Ea occurrence) $ 100,000 X CPP MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000000 X j POLICY aEa LOC PRODUCTS-COMP/OP AGG 5 4,000,000 OTHER: A AUTOMOBILE LIABILITY 2001 C6191 12/19/201712/19/2018 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS X X NON-OWNED PROPER HIRED AUTOS TY DAMAGE AUTOS Per accident $ A UMBRELLA L X OCCUR 2001 E1293 12/19/2017 12/19/2018 EACH OCCURRENCE $ 3,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE S 3,000,000 DED RETENTIONS 10,000 $ A WORKERS COMPENSATION 2001W7978 12/19/201712/19/2018 X STATUTE 01RH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SIGN INSTALLATION, ERECTION, REPAIR &GRAPHIC DESIGN AND PRINTING. 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 212 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTHAMPTON, MA 01060 AUTHO ED REP ESENTATIVE 1988-24 A ORD CORPORATION. All rights reserved. ACORD 26(2014/011 The ACORD name and Joao are registered marks of ACOR '\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 " www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH TME PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Callahan Sign, LLC Address:8 Federico Drive#13 City/State/Zip:Pittsfield, MA 01201 Phone#:413-443-5931 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 5 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. ❑Demolition 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]r 10E]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 1 l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.❑✓ OtherSign 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:Farm Family Policy#or Self-ins.Lic.#:2001 W7978 Expiration Date:12/19/2018 Job Site Address: 344 King Street City/State/Zip:Northampton, MA 01060 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 andpenalties ofperjury that the information provided above is true and correct. Signature: James P. CallahanDate: 10/22/2018 Phone#:413-443-5931 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#: