18D-001 (25) File#BP-2019-1033
APPLICANT/CONTACT PERSON SIGN TECHNIQUES INC
ADDRESSIPHONE 361 CHICOPEE ST CHICOPEE (413)594-8886
PROPERTY LOCATION 122 NORTH KING ST
MAP IBD PARCEL 001 001 ZONE HB(I00)/WP(16U
THIS SECTION FOR OFFICIAL.USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
BuildinePermit illedout
Fee Paid
Tvnex,f Construction, ILLUMINATED W -PLANET FITNESS
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 PermiWith Site Plat dn turyj S-f T
ZONING BOARD PERMIT REQUIRED UNDER: f C- r ' 4Q
Finding Special Permit Variantte FSA
Received&Recorded at Registry of Dads 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
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 infommtion.
Titij of Nartltampton�assar4usetts
(i)DEPARTMENT OF BUILDING INSPECTIONS212 Main Street • Municipal BuildingNorthampton. MA 01060
INFPGc I ON Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device
nn p ^ /� y
(Appewaon to be Oiled out in ink or typ•wda•n) NUmt>sf.OP.'SQ.....4.33
Plans must be filed with the Buildino I E C E I V E D Erection..................(0 )
before a oermit will be aranted. Alteration.................( )
Repair.....................( )
HR0 2019 Repainting................ )
Remomoval......9...........(
FEE`P.PAGEI.R YPL& .....
OFPT OF 6NLDINf.INSPECTIONS
NOnTHMIPiOPl bv.nl pap a11: • !7
amp n. Mass. .../( fC//.....(J...20%/
To the Building Commissioner:
Application for a permit to place or maintain asisign or other advertising device,or marquee.
BUSINESS NAME....Y.'�LG�Z�Gt.I..../..l.r I_ 51L.��......................................................... /'
1. Location, Streetand No. ...(vZ.vZ...N..u.: hJ....[?.L� .5�.......�f..z.-�...!V'.K!.lka..W..( IS /
l
2. Owner's name 4A iaAwv--C....PMn�C../.1�?.. r5.�....��............... �..J.....................�.,... ........ CO
3. Owner's address NRI.L.C.5..0. ....5.4.4:?.I.S*...IRMl.�5.t... .(!.!.Vrl ?.[:Nd...'.�!t ...GTl1SJ.2,......
4. Makers name .U., .11... r. cIKnG..........`..1...........n................................
5. Makers address... (.P. ....4cy.I1t_rApeQ..�7.��:1.n. 1.l:D�J!PA..11AR...oio.1.5t.............
6. Erector's name ...�.in...Y.`fl(�1J.�1..r1F.!S�r................................................F..........
7. Erectors address.....
a�... 1ro�.ee..St,J ?.k�ta_....!V.1/C.�,!piz......
SIGN KIND OF SIGN
lo•:is•al•1
1. Sign will be (check one) illuminated Non-illumin ted .......
2. Will sign obstruct a fire escape,pe,window or door? Q. Marquee ...............
3. Lower edge will be ...l�ft.... ...ins above the public way. Projecting .............. I
4. Upper ad�ga will be .'&P.ft..l.4...ins above the public way. Roof .....................
5. Height ..`.f..ft.Yins Width3.`fft.../..Ins Temporary.............
6. Face area IL.`.t.sq. ft. Wall .........a*.......
7. Inner edge will be .{YA,,;ns from the building or pole. Sidewalk....................
8. Outer edge will be .......ins from the building or pole. Other.........................
9. Face of building or pole istaOW.ins back from the street line.
10. Sign will project .9...ins beyond the street line.
11. Sign will extend ...O.ft ..Q.ins above the buildingpr�pole.
12. Of what material will sign be constructed? Frame L4 .1!!?W..-J........ Face..
13. Estimated cost $...1I41s.L.t5...... J
The undersigned certifies that the above statements are true to best of his knowledge and belief.
.... .. ..r. ...........
....................
(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 Sukhumi DeDartmal
Existing Proposed Required by
nno 11—U'1A6r1
Zonin
Lot Size �97 QC/es
Frontage of x `t
Front: 3ba
Setbacks:
Side: YD L: YS R: L: R:
Rear.
Building Height as
Bldg Square 20 coo
Footage i
cst'r'�t
%Open Space:
(Lot area minus bldg and
Paved parldrg)
#of Parking Spaces N
#of Loading Docks �1/�'
FIII: (volume a buuan) NA'
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: /S / I APPLICANT'S SIGNATURE
54r9r'7(�-
lLI W II UA 1451!]r'ITQC:!11�1Ou�,1�[r
Applicant's Email Ad ss(require )
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 authodBes.
Page 3 of 3
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Par one Translucent Vinyl Paint pre-Finished Letter Coil
Oscal 8800 Series We Nobel
24150 422 Mulberry Grip Guard 490-D6
^"••^•• ^•,. .a••.� ■ 108C Avery UC900 Akzo Nobel .040 Yellow/5.3'
A91 13-T Goo Guard 429-A5
m...a q�.»......� _ .......... ■ Avery UC900 Akzo Nobel
BWCMC A9081-T Grip Guard 509-114 .040 Black 5.3'
EEL
LI
Pr
•...+a __
planet
all v
placement reference
One on of front mW hob qt dwM bttere, rA eq ft lWyvut
eea94 w anm.
••'. «',°�.sa.�.s ••••-••••, -3h6'aay4c fxeo. 1'trM Cap,9'Aeep.C)4O rttum,.040 wh2e backs
�I Pentons Translucent vinyl Paint pre-Finished Lefler Coil
,,,,,.„.m..,�,...,,,,e., .�*wr.+uww ■ 24150 O2wI88005enes ANzo Nobel
422 Mulberry Grip Guard 490-06
—,e,��, �, ,,,,`., ■ 108C Avery UG W Akzo Nobel .010 Yellow/5]'
A9113-T GripA5
Guard 429-
- —""""`"'r ` ���� ■ BlackC Avery UC900 Akzo Nobel ,040 Black 15.3'
A9081-T Grip Guard 509.114
planet fitness
placement reference
'vs:,. « •--° -Ghe eet of front all halo IN;ward letters. 164 eq ft laywt
ai
�„ .......... -3W ac;r*faces.}'trim aT.9'Awl,D4O mbur ls..O4O wfita badm
� n�geepn i�miqua.I� NrpM,raee.vetl.
The Commonwealth ofMassaehuserts
Department of Industrial Accidents
Ogee of Investigations
I Congress Street,Suite 100
Boston,MA 0211 4-2 01 7
www.massgov/dia
Workers' Compensation Insurance Affidavit: General Businesses
Applicant Information Please Print Leaibiv
Busincss/Organization Name: cgne_
p�p1 �
Address: c3(Q(f ('A&. U,IF
UL.
City/State/Zip: Phone #: 11(/3 �59cf-888/0
Are you an employer'Check the appropriate box: Business Type(required):
1.9 1 am a employer with /j/ employees(full and/ 5. ❑Retail
or pari-time).• 6. ❑Restaurant/BulEating 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] 8. ❑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 10.®Manufacturing
no employees. [No workers'comp. insurance required]'
4.❑ We area non-profit organization,staffed by volunteers, I I.[]Health Care
with no employees.(No workers'comp. insurance req.] 12.❑Other
'My applinnt Wt checks box M 1 mint dw fill..,the satin.below showing Nei,workers' ..,tembob policy information.
•9fthe coryonte omceo have elempted thiuveNes,but the arponaon hes nthv empinyvcs.n wahm'eompewtion polity n requited wtA such m
areentnewu should check Ma al.
lam an employer that lc providing workers'compensation insurance for my employees. Below A the polity,int rmatimr.
Insurance Company Name: Ls�t.�^G�-/ GQ/nrLraziitee Cgp .,a91-at7b-k7
Insurer's Address:
City/State/Zip: 20S7On 09d&
Policy#orSelf-ins.Lic.# GlJCe5—$/LS-33928'1-D38 Expiration Date: (/�20/ZD/g'
Attach a copy of the workers'compensation policy declaration page(showing the policy number and e.pintion 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 Mat a copy of this statement may be forwaided to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ttn/l , nder the fns and penaales of perjury that the information provided above 6 true and correct.
Sumat,re. Date: ,/a4l? _
Offlclal use only. Do not write in this area,to be completed by city or town offlelat
City or Town: Permit[License#
Issuing Authority(circle one):
I.Board of Health 2. Building Department 3.Citv/fown Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
intact Person: Phone#:
w„umna.govNio