18D-001 (24) City of Northampton Map 18D LOt001 Zone
HB(I 00)/WP(I 6)/
Massachusetts Date issued 3/26/2019 0:00:00
Inspector of Buildings Permit # BP-2019-1032
Permit Fee$100.00
SIGN PERMIT
Business
Address 122 NORTH KING ST
Applicant InstallerSIGN TECHNIOUES INC
Applicant Installer Address 361 CHICOPEE ST
Work Description ILLUMINATED GROUND SIGN - PLANET FITNESS
Estimated Cost $2206.00
Building Department
Approval by:
6xW , Al�, ezvx,--L
File p BP-2019-1032
APPLICANT/CONTACT PERSON SIGN TECHNIQUES INC
ADDRESS/PHONE 361 CHICOPEE ST CHICOPEE (413)594-8886
PROPERTY LOCATION 122 NORTH KING ST
MAP 18DPARCEL00I 001 ZONE HB(l00VWP(16)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid a.
Buildina Permit Filled out
Fee Paid
Tvneof Constructiom ILLUMINATED GROUND SIGN-PLANET FITNESS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included-
Owner/Statement or License
3 sets of Plans/Plat Plan
THEYOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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/OA Special Permit With Sire 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
,�_�
Signal=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 infommtion.
(4ifg of i�Turfl�ttm}Tfon
" �"" �lassar!(usetts (i)DEPARTMENT OF BUILDING INSPECTIONS212 Main BtrccL • Municipal Building
Northampton. MA 01060
iN5PLUR)k Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Devjcp !Q (031
(Application to be filled out in ink ort ewritten) Number . ..................
Plans must be filed with the Building Inspector 1 E C E I V E D Erection..................( )
before a permit will be granted. Alteration.................
Repair.....................( )
MAA 2 0 2019 Repainting...............( )
Removal..................
F A PAGE.A..�OT.. 99/
Northampton,mpton, Mass. ......20%1
To the Building Commissioner.
Application for a permit to place a maintain a sign or other advertising device,or marquee.
BUSINESS NAME ...R.gxict...F62as..............................................................
'/
t. Location, Street and No. .�G!'G�i...MarP!..K!,. ..5t..../ s. � /.35Nkiay
2. Owner's name..r,J.'SF.m .?........./�.4kN''11,f....T.... . . .......L......
.�.�.,./....................................
3. Owner'saddress .J.�I.�.S... eWrI.�.V.'.Q.,t.s�Oc%!�f?.,t;IV.A?k.QflCQ..............
4. Maker's name ..,S[9n.. o �Gnl�!?.C:n..'.........................................................
5. Makers address ..`JS�rL. h.! .. . ?:1f..eV.e4�/....`.'.f:.......I:ILLI.OIO.°!e£..��.����....................
l
6. Erector's name .�9R. .���in�/,X-!.!Q!N°�..^.�!1.e.r...n...'..................................................
7. Erector's address...ti3..P. ..N:G/C.9O.GG...'. ....W!/49040 /Y/ C�10�.3
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one)illuminated ...q.. Non-illuminated .......
2. Will sign obstruct a fire escape, window or door? WO.. Marquee ...............
3. Lower edge will bezli. ........ins above the public way. Projecting ..............
4. Upper edge will be . ... ........ins above the public way. Roof .....................
5. Height ..T..ft..44ins Width ./.#..ft......ins Temporary.............
6. Face area Js.7 sq. It Wall .....................
7. Inner edge will be kiM pont the building or pole. Sidewalk............ .......
8. Outer edge will be 7`.f.. frqrt)the building or pole. Other....QCP.N'! .4k n
9. Face of building or,pole is /. Plr s back from the street line. acntz.r`t ng.15
10. Sign will project ..CJ..ins beyond the street line.
11. Sign will extend .Z.A ..0..ins above the building or p11
12. Of what material will sign be constructed? Frame ..✓.U .............. Face.�F.XGt.CiylY.rJ.24/
13. Estimated cost $..-ZJQ0la...........
The undersigned certifies that the above statements are tru th st of his knowledge and belief.
. .. ...................I.............................
(Signature of Owner or Agent)
Page 1 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 Buildina Debaftent.
Existing Proposed Required by
rw ceke2a, Zoning
Lot Size /a�QW2S
Frontage
Front
Setbacks:
Side: H0 L: °/S R: L: R:
Rear: nZ O
Building Height any
Bldg Square lK20 mos.vt
Footage / /
% Open Space:
(Lot area minus bldg and
Paved parking) '/Q
#of Parking Spaces Ale/e/
#of Loading Docks ✓f
Fill: (volume 8localion)
/, //1�
13. Certification: I hereby certifythatthe information contained herein is true and accurate to the best
of my knowledge.
DATE: fT� APPLICANT'S SIGNATURE -W r��
&Yilcw!/�GwCa7Q/on Crhr 4 er 13--tApplicant's Email Addr (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
168 in
28 in
• ) planet
i
WORLD
Pal Translucent Vinyl
/ /''� AL 11 Oracal 8800 Series
' I
CLASS ■ 24150 422 Mulberry
MARKET 1080
Avery■ 1 A9113-T3-T
■ Black Avery A9001-T PHARMACY
r_
-KENS' EYEWEAR WAVES WORLD
CLASDELAP MARK
ANM6T
REAL ESTATE :e
EnnuiHeaRhtereStofe GENERAL CLEANERSIAUUOROMAT PHARMACY
_ w
-- — - '- SEES ETWEAE NAVES
ASSESr
placement reference existing
General description
".�" ; Two replacement faces 33 sq It layout
A� ^- - 3116"white acrylic faces with translucent graphics
ry o cl Txn 1, —All nenti eameq.
iIIII �- 168 in -
28 in ) planet
WORLDit Pannone Translucent Vinyl
L Oracal 0800 Series
® CLASS ■ 24150 422 Mulberry
MARKET
■ 108C Avery 13-T
H913-T
■ Black AVA90ro
81--T
PHARMACY
IF
KENS' EYEWEAR WAVES
ss
!ILARKET
PHARMACY
ometownHeakhcare5tore 6ENERALCLEANERS LAUNDROMAT
MEXSEIEWEAR WAVES
placement reference existing
u ":»::=w.. General description
a=0.µ m"" - Two replacement faces 33 sq It layout
-3/16"white acrylic faces with translucent graphics
~a arw Wc�.v«rnavad i"�,ai nerm,....rv.n
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street,Suite 100
Boston,MA 0211 4-2 01 7
thoww.mass gov/dia
Workers' Compensation Insurance Affidavit: General Businesses
AnDlicant Information Please Print Legibly
Business/Organization Name: �S�� �.� i_ej ss e-
Address: sZW C&I!,3pez St
City/State/Zip: 0 Phone #: SI13 5-9S< 92 S�
Arc you an employer'Check the appropriate box: Business Type(required):
1.9 1 am a employer with LY---L employees(full and/ 5. []Retail
or part-time).- 6. ❑RestaumnUBar/Eating Establishment
2.❑ 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp. insurance required] S. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10MManufacturing
no employees. [No workers comp. insurance requiredl•
4.❑ We are a non-profit organitmon,staffed by volunteers, I I.❑ Health Care
with no employees. [No workers'comp. insurance req.] 12.0 Other
•My appliu i out checks box al must dso GI]out the suction below showing theirworkers'coup amnio poh,mfoomtion.
"Iflhmoryome off..haveexempted Nem+elves,but the corpor.awn has other employees,a worker'compensationpolicyurequirodandauchan
m,amoomn should check Ma ei.
I are an employer rliat is pro.iding warFner„s''cnmpensarian in,t urance far my emplQvicey. Below is the policy information.
Insurancecomp any Neme: LM (Xq ICU/L7/)C'e
Insurer's Address: II__ -- e/ e4 St
City/Srate/Zip: (30 hln W!! 2l it.
Policy#or Self ins.Lic.# (.UCS-3IS-33q 2199-038 Expiration Date: L
Attach a copy of the workers'compensation polity declaration page(showing the policy number od expinttoo 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 S1,500M and/or one-yew 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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cenlfy, der&e pa' and penalties of perjury Our hrfens atlon provided above is true and correct
Si Date: 31 i91/9
rte#' S19M,
Ofllelal use onty. Do not write In this area,to he compleled by city or sown official
City or Town:_ Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
b.Other
Contact Person: Phone k:
www massaov/Na