23B-015 (19) i
City of Northampton Map 23B Lot015 Zone SI(IOO)/
Massachusetts Date issued 5/2/2019 0:00:00
Inspector of Buildings Permit # BP-2019-1218
Permit Fee$100.00
SIGN PERMIT
Business
Address 6 HATFIELD ST
Applicant InstallerGODFREY SIGN LLC
Applicant Installer Address 336 BERKSHIRE TRAIL
Work Description NON ILLUMINATED GROUND SIGN - ATKINSON
FAMILY PRACTICE
Estimated Cost $850.00
Building Department
Approval by:
File N BP-2019.1218
APPLICANT/CONTACT PERSON GODFREY SIGN LLC
ADDRESS/PHONE 336 WEST ST NORTH HATFIELD
PROPERTY LOCATION 6 HATFIELD ST
MAP23BPARCEL015 001 ZONE SI(100)/
THIS SECTION FOR OFFICIAL USE ONLY-
PERMIT APPLICATION CHECKLIST
ENC D REQUIRED DATE
Fee Paid 4
ZONING FORM FILLED
Building Permit Fill
pl—
Fee Pi
Tvveof Construction, NON ILLUMINATED ROUND SNN-6&INSON FAMILY PRACTICE
New Construction
Non Structural interior renovations
Addition to Existina
Accessory Structure
Building Plans Included
Owner/Statement or License
3 sets of Plans/Plot Plan
T,POLLOW ING 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/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
S 2 /
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 SOA.Contact Office of
Planning&Development for mora information.
(ltitg of Xort4umpton
BgassarE[usrtta �r� °r�
DEPARTMENT Main SOF BUILDING INSPECTIONS '' ^
212 Main Street • Municipal Building .JFSJY�aea
Northampton. MA 01060
e rccrole Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Devii 9
(Application to be fllNd out In ink or"wrltten) Number .... ... .....
Plans must be filed with the Buildin ns e EC E I V E D Erection..................( )
before a permit will be granted. Alteration.................( )
Repair.....................( )
Repainting...............( )
APO 3 0 2019 Removal............. ....( )
FE .V.PAGE. �OT...oi6
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON.MA 146 ,Mass. ...............................20.....
To the Building Commissioner.
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME..A±-..1- !i,-,SCU.trAJ ........!1!. .y�...LFA.&_C+a_7f.........................
1. Location, Street and No. ...�R....�'Xyl.�t.'.T..,.Q.l/a1. .....7..`1..................................................
2. Owner's name ...Y-..Gt`: L&f/.�.k�.Q..S- rl" 1. 4.Y.Y,7 �
3. Owner's address..j.Z... .......
1�.:`... . .yl!yY.VO.V�S.71,.t..Y.:.!.
4. Makers name....�A.R^.. . ...... . . . . U-h.m.............................................
5. Maker's address . .....c..1.?^P'..1.-.'. ..,Ch`:^�Td.-...C1.itMdkV.`�A.:.) .,.:!".1.9.......
6. Erectors name ..�il7.c!!Si(''.V�'.4'�Z..p.U. t �(? q.�L�...............UU....... ,.,.......,..,...............�.
7. Erector's address .3.: a..07.:5" .TPS- .UY.1l�.1.vCTS.-..�t.(Y.v.W..Arl.v�r..yur.� �J"X
SIGN KIND OF SIGN
(Daalanate)
1. Sign will be(check one)illuminated ....... Non-illuminated ..).4..
2. Will sign obstruct a fire escape, window or door? til U. Marquee ...............
3. Lower edge will be ..( .JL.La..ins above the public way. Projecting ..............
4. Upper edge will be C.D..ft...0 Jn above the public way. Roof .....................
5. Height ..!-t.ft...�.ins Width ..4nft......ins Temporary.............
6. Face area _52-sq.ft. Wall .....................
7. Inner edge will be ......ins from the building or pole. f� Sidewalk............. ..
8. Outer edge will be .......ins+�fro,,nm the building or pole.'l✓fr Other.5!. .. �:S-..,�0..3"Y
9. Face of building or pole is _W.lns back from the street line. t-
10.
10. Sign will project .......ins beyond the street line. 14//6 v
11. Sign will extend ...Y..ft ..-.ins above the building or pple. 1 �1 L
12. Of what material will yssi n be constructed? Frame ....�.rr. .�L.UaDe..t4l.sm..Ccr. �
13. Estimated cost $..... �X A -iti'1r�.5 A5'yi-Uc'}r�12 —
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature Own o Ag )
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION Y /� ��
7. Name of Applicant: KnD/1�/�^ CO+�LS1'It;7 7-pr eCR.�,ny-Culn¢.J (7Vk'- 50,'
Address ,33� / ';'-9a�r(' ...//.''.Wt�D+•.I r�iaphorte: H/3 - 2N7-5-986
2. Owner of Property: X2'�/tL✓+'�T.G.
Telepl,bne�/j
Adawas:/7�.v_StH.rc�i jY✓ (�y„ /ib✓3riilQO�'Sy9 -S�dd
3. Status of Applicant:_Owner _Contract Purchaser _Lessee
,'Other(explain): -iAuf ae-E- AOS wn�e,/✓
4. Job Location:
ParcellD: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMEHn
5. EAaling Use of Structure/Property: 65! '1'\ �O, I(-,-A-Z c.-�� Com`��f2
S. Description of Proposed Use/Work/Project/Occupe8on:(Use additional sheets if necessary)
1 .,e .c,c e'xr`f+rlVNji 5 han: L01411,- ne!A-- � aa✓s 51r p��'ZS.
7. Ateclhed Plans: Sketch Plan _Site Plan EngineeredtSurveyed Plans
8. Has a Special PermiWadence/Finding ever been issued for/on the site?
NO DON'T KNOW YES_ IF YES,data issued:
IF YES: Was the permit retarded at the Regisby of Deeds?
NO DON'T KNOW YES
IF YES: Enter: Book_ Page_ and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO DON'T KNOW YES_
IF YES: Has a permit been,or need to be,obtained from the Conservation Commission?
Needs to be obtained_ Obtained_,Date issued
10. Do any signs exist on the property? VES 4 NO
IFYrES: Describe the size,type and location:
((�n:
5 S .k �`� ��5ii•� �$�w(`K��(/an� �L�
�+�ez'4- 25 t7l.LL'_h�Y'•(T31"'� two Lu S-Fr I"��-7"���P� S .
Are thew any proposed charges to,or additions of,
signs intended for th(e�propW YES�c NOT
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 cdumn W 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 ane minus dog and
Psved paMingl
#of Parking Spaces
#of Loading Docks
Fill:holume a IwUon)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 'I- 2 - /9 APPLICANT'S SIGNATURE
artwc�✓k@ 9OSJ� 1\ C . Lo✓H
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 Warks 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 02774-2017
www.tnass.gorldja
Wil.rkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information I Please Print Leeibh
Name (Businez4Organbation/a�dividuap:C-O� U C-
Address:/J?3& O2✓ILSh i✓'G fYl
City/State/Zip: Phone#: '7 3 all 7 'j'q
Are you so employs?Clack the appfaprlaa Into Type of project(required):
L[3 1 ams employs wrb cml.yas(full attNor put-firm).• 7. ❑New construction
2.501 am a sole proprietor or partnership and have tw employes muting for me in 8. Remodeling
mY mpaciN.
IN.work,.'comp.ams.nce r,mmi.l
3.❑ism,homeowner doingall work mymY(No workers'comp.mramam.mgwmd.i t 4 Demolition
4.❑ m
1 am a hoeowmr and will Im hiring contract...coMus all w.t pm
on my p,ny. 1 will 1 O❑Building addition
..rho all coomcrors,iWo arm workeri c.apraom lmaanceorma sale ll.❑Electrical repairs or additions
pwmaoe with m employes.
12.❑Plumbing repairs or additions
5.[3 I am a genea]contractor and l hive hsooMe attched shat.
These eubcomruo.have employes and lasso worters'comn inurenct 13,E]Roof re airs
6.❑We are a cmpomtion and in officers have c mmitW their.,hr ofenemplimi per MGL c. 141.X10ther til9 m4 e
152,§I(4),a.d we have m ers,loyces.IN.workers arms.imawance rauired.]
•My.,pliant that chaka boa Imoat also fill ont we action below showingflmn- atentcompensation policy information.
t Nomanwnrn who submit this alndard indicating they am doing all worth and Neo him ouwide contractors must submit a new aRaavit humating such.
:Contractor that check this box mustached an additional Anal showing the name ofthe subconaactora and sort whaher or not,Nose amtsn have
employes. Ifthe rub-,mtmctom have employees,they must provide their woten'comp policy number.
Tam an employer that is providing workers'compensation insurance for my employers. Below is dhepoliay,and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compemation 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 ander t poi a ndpenahies ofperjary that the information provided above Is true andcomea2
Si lure Date HAg�aoe 9
Phone# 1;.3-
Ojpcial use only. Do not wrim in this area,to be completed by city or town official.
City or Town: Permidl.icense#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
CoWto t Person: Phone#: