23B-015 (18) City of Northampton Map 23B Lot015 Zone SI(100)/
Massachusetts Date issued 5/2/2019 0:00:00
Inspector of Buildings Permit # BP-2019-1219
Permit Fee$60.00
SIGN PERMIT
Business
Address 6 HATFIELD ST
Applicant InstallerGODFREY SIGN LLC
Applicant Installer Address 336 BERKSHIRE TRAIL
Work Description NON ILLUMINATED WALL SIGN - ATKINSON
FAMILY PRACTICE
Estimated Cost $700.00
Building Department
Approval by:
File 0 BP-2019.1219
APPLICANT/CONTACT PERSON GODFREY SIGN LLC
ADDRESS/PHONE 336 WEST ST NORTH HATFIELD
PROPERTY LOCATION 6 HATFIELD ST
MAP 23B PARCEL 015 001 ZONE SI(100
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
EN SED REQUIRED DATE
ZONINGFORM FILLED OUT
Fee Pi
Building erm' Filled out
Fee Paid k Z
Typeof ILLUMINATED WA SONFAMILY P
New Construction
Non Structural interior renovations
Addition to Existing
Accessore,Structure
Building Plans Included
Owner/Statement or License
3 sets of Plans/Plot Plan
THE WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved_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 Simon Water Management
Demolition Delay
Signatme of Building Official Data
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.
„trr THU of Xort4ampton
•Slnssnrljllsetts �s
OEPARTA(ENT OF BUILD/NO INSPECTIONS ss
212 Main Street • Municipal Building
Northampton, MA 01060 c •p x°��
INSPEcroi2 Application for a Permit to Place or Maintain a Sign
Side:01'n.
alk Simon M�a[4uI Advertising Device
t �R L-�• �I�dJ or wrin.n) Number.......7.4�S3.
Plans must be filed with the Buit Erection..................( )
beforea permit will be arented. O A terstion.................( )
APA 3 2019 Repair_...................( )
Repainting...............( )
DEFT
NORTHAMPTONINM f11p5pONa FEE. ... �Uv �r0
..PAGE........PLOT.......
Northampton,Mass. ...............................20.....
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME.. k.Y.S'�.S(J. .e.�`.�...�.Y°L��4 .....................
1. Location, Street and .................................................
2. Owner's name ..KG,.,tJN ;:I'I,-,. ,.,..(�`.. 4 15111— ...............................
3. Owner's address .A?....R&.ems"”'`^"a?.!�.' �'•^'vv`�"'� �'�
(� . .............. ..............................(.........................
4. Maker's name... -t.A..a�-C4��^. ^.�Z..els.1. ?w�::-C..................................................
5. Maker's
o .... `..........
6. Erector's name.....GIA7�:`.r�'.'(... ..................................
7. Erector's address cir��.4."
SIGN IOND OF SIGN
(pnynata)
1. Sign will be(check one) illuminated ....... Non-illuminated X
2. Will sign obstruct afire escape, window or door? .faL.0 Marquee ...............
3. Lower edge will be J.P.ft.(e...ins above the public way. Projecting ..............
4. Upper edge will be 1..?j.ft..eF...ins above the public way. Roof .....................
5. Height .,3.ft......ins Width .62A......ins Temporary.............
6. Face area do-sq.ft. Wall ..%...............
7. Inner edge will be .Q..ins from or pefa Sidewalk....................
8. Outer edge will be ..(....ins from•", w din pr Oda. Other........
9. Face of building a pole is-,-" a om the street line. C�ikf314. 1`
10. Sign will project .......ins beyond the street line.')-- /f-
11. Sign will extend .......ft .......ins above the building or pole.^--A,
12. Of what material will sign be constructed? Frame ALN.N.'\.......... Face..A.dk'n......
13. Estimated cost $.....CKill.........
The undersigned certifies that the above statements are trVe to the best of his knovMge and belief.
(Signatur 0 Agefit)
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
I 1PLEASE TYPE OR PRINT ALL
'INFORMATION
1. Nameof Applicant: C.Z�c ���C.n[L7 �La✓Z�¢ /`CT�I1 SGyL
Address: 33 G.(� ',,S I•z'He 1Y,C.�. �'Kelepnwle: 4Sei 96
2. OwnerofPmply.
erICL1�t'Vk¢X'r�2 ,A�. -141�ScY`
Address'17 Qt Scce.�c(//LV4 A� b./IUNS+. lf`\A Telephone:hl'4-4-Wl^ 6L'(OU
3. Status of Applicant:_Owner 1_1ConbacltI Purchase,' _Lessee
other(explein): 5±u'
4. Job Location: Mik
Parcel ID: Zoning Map# Parcel# Ostr t(a)
(TO BE FILLED IN BY THE BUILDING DEPARWENT)1
S. Existing Use of Structure/Property: �-Orv`/LEv Vhec4c&-( VC&L -E c'�-6, .
6. Description of Proposed Use/Woorrk/PmjecVOocupetion:((�Use additional sheets if necessary) 1
1-py.rtw�\£Gw'�`t9ti S�K -V�ISY -}Y2Jv�{ 07 DJiL1��v�K/' .
fJp�� ,A�ec�eZa,l nrac-HZ-� 3 cibo.� ear-�ya�I,.c� .
7. Attached Plans: Sketch Plan _Site Plan _Engineered/Surveyed Plans
B. Has a Special PerniWanance/Finding ever been issued for/on the site?
NO DON'T KNOW VES_ IF VES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'TKNOW VES
IFVES: Enter: Book Page and/or Document#
9. Does the site contain a bmck,body of water or"lands? NO_ DON'T KNOW c VES_
IF VES: Hasa permit been,or need to be,obtained from the Conservation Commission?
Needs to be obtained Obtained ,Dale issued
10. Do any signs mist on the property? YES NO_
IF VES: Describe the size,type and location: iZ�SV
(3.7 •�G�t�. �� St C ��.e11.c-sr5 t�Ca�'Eu�+`Le�GI fZ ol.sr
weirs N'cw�AltedL � e�nev:m,.p5 DcCc.'pr^^^7tS -
Are thereany proposed changes to,or additions of,signs Intended fortheproperly! YES NO_
/J '� 'y
IF VES: Describe the size,type and location RO-A
t\�!h . New4 �^�(ef..-�a.lticcsVyr, mv. (00: \d LIr
� O
Papa 2 of 3
11. ALL INFORMATION MUST BE COMPLETED:PERMfT CAN BE DENIED DUE TO LACK OF INFORMATION.
12. This column to be fillet in by
the Building Department.
Existing Proposed Required by
Zonis
Lot Size
Frontage
Froin:
Setbacks:
Side: L: R: L: R:
Rear:
Building Height
Bldg Square
Footage
%Open Space:
(Lot area minus bltlp and
Pwed pakMN)
#of Parking Spaces
#of Loading Docks
Fill: (volume a location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: n APPLICANT'S SIGNATURE
q c �y-Tum-y 5,�'h 11,c , cuw�
Applicant's Email Address(required)
NOTE: Issuance of a zoning permh 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2 01 7
www.massgov/dia
\\workers'Compensation Insurance Affidavit:Builders/Cootracmrs/Eimtricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(easiaeworgaaizen✓wlpdividu.p:�!o�ty gc4a3 U-C-
Address: 33& CJe✓ 6hlt'� Tri /I e-f7
City1State/Zip: jn L- o Phone#: e'1 �3 2 '✓ t M
Are ran u aP1aYm?ClwtmeaRraPriv hm:
Type of project(required):
I.❑I anaVloyawith etVloye,,(fiall meter put-lime).• 7. ❑New construction
1.®lam awle propicbrwpuoara,gmtllurc,w rnq,luym working formcin E. ❑Remodeling
my cVstay.Mo watua'rnnp.waacha ualmai.l
301=alwnmwnerdoingall mast mysclf[No workers camp imus eane,t wf]t 9. ❑Demolition
d.❑1 ani a hamwwoer and will he harm,contractors to cailuet all work m my Forma. 1 will 10❑Building addition
arc that W emnractma other loov wmtm•ei, urnweou finance or me sole I I.❑Electrical repairs or additions
Proprietors with no employe,,. 12.❑Plumbing repairs or additions
5 E l am aguval eamuta std l have hired the sub<moetmx hoof m the saaheE sbcee 13.�Roof fepairE
ditae aa6c000ectwsMaeemPloy«.ane nave watka:'wmP.imhaaamt
d.❑We art a wtpoation and ria omcem have cxcnox their right of excietuou Per MGL C. 14.JVOIher5161C
151,51(d),nerd we Tuve m wploYea.INowohers avmp_imurmwe rwuimtl i
;A^y VPluaw that clucks baa
ox#I natm fill out the section helow showing their woActoanpn
eamm policy int tion.
t Homrowar who rubmit this aifNavit indicating thry sa doing ill woh aaA torn Ida atmide emaaetaz than submit a new amdavit iMioting wen.
:Cmoanoathat chsk Nu boa mustanachsdadditionalsheetshowing theoofthe shtbsure wnMer or not tM1ose entities M1avc
employe,,. mMveemploYces 1M1eY mux( rovide Ner wohten come olicynabtee.
lam an employer thatisproviding workers'compensation insuranceformy employees Below is thepolicy andjob site
informaaan.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: Cay/State/Zip:
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 In the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby cerdfy under eltpails Vilialpichahles ofpeduryWar theinformaaon providedabmr is ave=it correct.
Simm.(;2 .
�1 rM46I e Dain
Phone#:
Ofiriclal use only. Do not write in this orta,W be completed by city or town oJficiat
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityrFown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M