23B-015 (20) City of Northampton Map 23B Lot015 Zone SI(100)t
Massachusetts Date issued 7/5/2019 0:00:00
Inspector of Buildings Permit # BP-2020-0006
Permit Fee$100.00
SIGN PERMIT
Business
Address 6 HATFIELD ST
Applicant InstallerGODFREY SIGN LLC
Applicant Installer Address 336 BERKSHIRE TRAIL
Work Description NON ILLUMINTED RIDER SIGN - BAYSTATE LAB
Estimated Cost $400.00
Buildinp_ Department
Approval by:
A,,� 0-,�L
File#BP-2020-0006
APPLICANT/CONTACT PERSON GODFREY SIGN LLC
ADDRESS/PHONE 336 BERKSHIRE TRAIL CUMMINGTON
PROPERTY LOCATION 6 HATFIELD ST
MAP 23B PARCEL 015 001 ZONE S1000V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENC REQUIRED DATE
ZONING FORM FILLED OUT T.
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: NON I L MINTED RIDER SIGN- TE LAB
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
INION 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 Storm Water Management
Demolition Delay
Signature Building Official Date
Now: 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(hose applicants who meet the strict standards of MGL 40A.Contact Office of
Planning& Development for more information.
THU of xort4ampton
' I. lessarhusetls .�
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.11`•1 DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building
r. o�
c
0\-. Northampton, MA 01060 io
INSPECr01t Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device
(Applleaaon b a rabC out In Ink or typewritten) Number .....................
Plans must be filed h the Bufldin I Erection..................( )
before a Beano will be omnted. C E I V E D AHeration................ )
Repair.....................( )
Repainting...............( )
JULE2019 Removal..................I I
FEEAPAG EAPLAP..
DEPT.OF BUILDING INSPECrTnIpuNsy,,,
NORTHAMPTON.MAOIoed�`""� pion, Mass. ..............................20.....
To the Building Commissioner
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME ..BP'l.�. rte...'?f—.R(Q-1-t � :Cs.........
1. Location, Street and No. ...<�....N^.4�T�9.��[?�.s�?.4
2. owners5h...A-.4.•.�n4!?X. ...................................
3. Owner's address.1.7..R f :�CF4iF��. .._d? 3r.! 4........................
4. Makers name...t'_'. 7r!rtv:rr:t�...�D:l? +:L..................................................................
5. Makers
6. Erectors name ............................... .. .. �
n
7. Erectors address 3."�e... ..... .....s�T.Sr--S...l.:e::........�-!xww,. ... .........� !.....
SIGN KIND OF SIGN
1. Sign will be(check one)illuminated ....... Non-illuminated .x.
2. Will sign obstruct a fire escape,window or door? ..0 Marquee ...............
3. Lower edge will be .5 ft...' Ans above the public way. Projecting ..............
4. Upper edge will be ..G..R....-.ins above the public way. Roof.....................
5. Heght ..(...ft..—ins Width Temporary.............
6. Face area:01z.sq.ft. Ir%z TF Wall .....................
7. Inner edge will be .O..ins from the building or pole. Sidewalk....................
8. Outer edge will be /.f�:.ins from the building or pole. Other.....................?a
9. Face of building orpole Is Spins back from the street line. Qe ASS. i-�l
10. Sign will project iris beyond the street line. r,.. 8X 2oa.d
11. Sign will extend .......ft .......ins above the building or pole. i5ts.s-i'r..ctw'e. -
12. Of what material will sign be constructed? Frame .A41.w..r.!4>•g��.. Face..E?r/sJr..u?.�{w1
13. Estimated cost
The undersigned certifies that the above statements are true to the best of his knowledgQ and belief.
(Signature of er o )
Page 1 of 3
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THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR MIST ALL INFORMATION
t. Name of Applicant: 4w- 1'n'�1 5�''9-V� 1 $2o6,cv �zc J
Address: ale Bim.-✓ash ;,`tr� �ygalaq,a„e: 417- 2c/7-5984
2. Ovmeraproperly:
Address: / 7 R�S efa.. b✓_ /X, Zrt✓3 e, r74 TeMplrorw W{- SH9 -SVd-el,
3. Status of Applicant:_Owner _Contract PurMmer, _Lessee
)�-OBlegtoiplain): S Y2A;'" Go lolcv-� \ h S•\u(I.P�✓'
4. Job Location: Noy�A"'%4 WI.a
Parcel lD: Zoning Map# Panel# Districts)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. E>osbng Use of Strucctuure(Property: -V; «l t X21
6. Description of Proposed Use/WoddPmject/Cmupation: (Use additional
lssheet�s If necessary)
5r`1`r'�00 rG CN �-prvs'f 5't_ 'rACaI�Q� Sim [?� PJD c (�
DW 10.tw�'{C�Ca�C�t � �e_ Se�..va'� y�^2d 12ev1 O,�-TFCr2
7. Attached Plans: Nv Sketch Plan Site Plan _Entimeemd/Surveyed Plans
8. Has a Special Permit/Variance/Finding over been issued fa/on the site?
NO DONT KNOW_K YES_ IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO_ DONT KNOW_,, YES_
IF YES: Enter. Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO_ DONT 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 most on the property? YES__
^^ NO_(i
IF YES: Describe the size,type and location:
ry ��'-Lnnart S4, SC'�.e o� « I ;+Y' �-ap`✓Ps"-.—T' t�a"+�d„
Are there any proposed changes to,or additions of,signs intended for property?the properYES_,,Y' NO_
IF YES: Describe the size,type and location T.-., po-�
W.Ct.%V-- I-
pq-ot,e Lr 5--53-A-A, ak'"�7-j-,-V' �'. -5rj' '
Pnge s oT 3 -l-v AA,..e p f�-'e-tt-Sce daseS�
hra .....
rl' IA _
1'•3:d rNE1,Wr lr •• r •r�qi
SL7i?Id'G' o�'FSv^JIl 4'ht:! ii:42t�:16.4
11. ALL INFORMATION MUST BE COMPLETED:PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
12. This alum b be filed in by
_
the Bulkirc Dw awnent
Existing PropwM Required by
Zoning
Lot SM
Frontage
Feet
Setbacks:
side: L• R: L: R:
Rear.
Building Height
Bldg Square
Footage
%Open Space:
(Lot area minus bkp and
Paved parking)
A 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: In `'3 U - 9 APPLICANT'S SIGNATURE (Z
0-V4W � Q-00�'lv�� S.��v� 1 I C C ON--k
Applicant's Email Address(required) f—I
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
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:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ADDlicant Information Please Print Legibly
Business/Organimion Name: G O D FP-C y S( Cr/,) LLC - -
Address: n0 13oK 12"I i 3310 f3[r ILSh 1 rc 7r/
,p
City/State/Zip: T1 0102(o Phone#: -4) 247- J ! No
Are you an employer?Cheek the appropriate boa: Business Type(required):
1.❑ 1 am a employer with employees(full and/ 5. ❑Retail
I�
m part-time).* 6. ❑RestairmadBar/Eating Establishment
2.0 1 azo a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,aura,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] & ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§I(4),and we have 10.❑Manufacturing
no employees.[No workers'comp.insurance required]* 11 ❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers, -
with no employees. [No workers'comp.insurance req.] 12.M Other .54/)12,-e-
*Any applicant Was checks box#1 now aso fill out We section below dioxins their workers'compconation policy Wfmautme.
**If the c n,onuc officers have exempted Wemadves,but We corporation has other employees,a workers compensation policy is required and such an
organization should check box#I.
I am an employer that is providing workers'compensation insurance jor my employees Below is the policy information.
Insurance Company Name:
Insurer's Address:
City/Smte/Zip:
Policy#or Self-ins.Lie.# Expiration Date:
Altaeh a coov otthe wos_kers'comoeosadonpoBcy declera[Io�aQeiahawinz thepolicy number sod aapiratbn dates
—
Failure tnseeure coverage asmquiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to 31,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up m$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
1 do hereby cera under the paincwand pen/alates afperlury that the information provided above is true and correct.
S' (-j - Date,
G�30� •`�G
Phone#: -7
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Licemc#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Citylrown Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
ContaeCPersan: - — — - - - - - - Phone#:
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