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23B-015 (21) City of Northampton Map 23B Lot015 Zone SI(100)/ 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 Building Department Approval by: 6 w, /> Lz File k BP-2020-0007 APPLICANT/CONTACT PERSON GODFREY SIGN LLC ADDRESS/PHONE 336 BERKSHIRE TRAIL CUMMINGTON PROPERTY LOCATION 6 HATFIELD ST MAP23BPARCEL015 001 ZONE SI(100 THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvpeofConstructiow NON ILLUMINTED WALL SIGN-BAYSTATE LAB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 13 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 r -4�1 Signature of Building Official Date r f 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. QW13 of xort4amptort":,IDEPARTMENT OF BUILDING INSPECTIONS (i) 212 Main Street a Municipal Building Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Sidewalk Sign, Marquee or other Advertising Device (Application to be filled out In Ink or ty dtten) Number ..................... Plans must be filed with the Buildin Ins e r Erection..................( ) before a pend will be granted. RECEIVED Akemtion..............._( , Repair..................._I ) Repainting...............( ) .JUL - 1 2019 � Removal.................. F .....PAGE........PLOT....... DEP?OF BUILDING 1��5p WT yt NOgiHAMPTON. yren, Mass. ..............................22(1..... To the Building r;ommissiorrer: Application for a permit to plaque or maintain a sign or other advertising device,or marquee. BUSINESS NAME 5pv... fac.'1-,i�C1 .... 1. Location, Street and No. ..a...... ..:`^.')_T..�T.1°A `5 No' .. . "..Y.�1 � 2. Owner's name. jr: lGG k l dv 11e ..... ......... ..... . ..... ...................................... 17 Rc r�xr-Q'� � : ,t vv�ltcv3'� lH 3. Owner's address......... .......5........................... .. ................1..... ................. 4. Makers name .....�tro�Vii!: ..s. �!'. .........................................L......._............... 5. Makers address.. e.'rksh� :r...........!.?.^"^^. Y.t:"'..4Y`�/� 6. Erectors name ...C�trrJeilre�7..5. . ............................................................. 7. Erectors address. 4... ::; ;Y�[ f'.....0 .t1„r,,, ,,,�.�Mr�, SIGN KIND OF SIGN leaalararq 1. Sign will be(check one) illuminated ....... Non4luminated .X... 2. Will sign obstruct a fire escape,window or door .KQ... Marquee ............... 3. Lower edge will be .J.P.ft...U..ins above the public way. Projecting .............. 4. Upper edge will be .!.?:.ft..!o..ins above the public way. Roof ..................... 5. Height .2.ft..lqins Width .ar. R.1Pins Temporary............. 6. Face area .t.&..sq.ft. Wall ..................?C 7. Inner edge will be .Q..Ins from the building or pole. Sidewalk.................... 8. Outer edge will be .......ins from the building or pole. Other......................... 9. Face of building orjppoole is .6-P.ins back from the street line. 10. Sign will project ...Q..ins beyond the street line. 11. Sign will extend ..Q.ft .......ins above the building or pole. , 12. Of what material will sign be constructed? Frame .PAV..V1)�..1um Face Al ^t`r-%U tvt 13. Estimated cost $...7..5'Z. P..:. The undersigned certifies that the above statements are to the best of his_knovAgdpe and belief. er (Signature fir en Page 1 of 3 1<,' THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant C7 ed s' �fo•s.%'F �r>� rn�y/— Address: 334 .�''�-sh:l.�e 2. Owner of Properly: Address: 47 ler 5csl.re.4, dr- kv t 1-104 TelephW.: u!3 Syr/ -�Yoo 3. Status of Applicant:_Owner _Camra Pumheser _Lessee XOMer(enrplain): .std b'..r 1:1�¢✓�u�lnS�`JR.,.\�-'� 4. Job Location: 6, l�-c�-EctGl � IV O.t�V�An^+�t'L L Parcel ID: Zoning Map# Parcel# DIsU1cIW (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Struchrre/Propany; INt,e cat �wc i •\'`7 6. Description of Proposed Use/ arkil"eOlOccupadon:(Use add'Nonal sheets if necessary) -ty s v s�t�rex� �(.pxc...��f' b✓3M�55 �ov-�u`7N� o� bl �Q 4 it'�S P.w�.V2%�G2 . 7. Attached Plans: --'Sketch Plan _Site Plan EngineeredSurveyed Plans & Has a Special PennlbVariance/Finding ever been issued Won the site? NO DONT KNOW1C YES_ IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IFYES: 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: Hasa permit been,or need to be,obtained from the Conservation Commission? Needs to be obtained Obtained ,Date issued 10. Do any signs east on the properly? YES )C NC_ �^ c IF YES: Describe dus size,type and location: 3 XC-� �t-a-�md¢ S�'L. cy ©✓-^^'�`� Wil^*. �iVhc.stAS Ov��z-w;\.� (�JAc�i'Lti . l.�!>f�+�+��'fav�• AA-s0 . �%C-A-Sf`*.4�k ov. 9,73-f utlacus-k5't. she Pxz>Q,e.✓t�' Aro Blare any proposed larges to,or addibore of.signs intended for do property.+ YES-Y-- No— , e o_ IF YES: Describe me size,type and location: Jam, S al(la, o� �Y bvs"messes a�$2esg t to N¢ F�a�dSl. cx a4 Page 2 of 3 11. ALL INFORMATION MUST BE COMPLETED:PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 12. This udumn to be Med in by the Building Departnat Existing Proposed Required by Zoning Lot Slee Frontage Front Setbacks: Side: L: R: L: R: Rear. Building Height Bldg Square Footage %Open Space: (Lot area minus bldg and Paved parking) #of Parking Spaces #of Loading Docks Fill: ha ante a location) 13. Certification:I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: 6 - 30• % '� APPLICANT'S SIGNATURE c -am4u,cr.-Cfr-& -Q�-su�-'7-5:Sf-r� 1 1 c , cct— Applicant's Email Address (required) U- 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 1 Congress Street,Suite 100 Boston,MA 01114-1017 www.mass.gov/dia Workers'CompensnDo,Insurance Affidavit General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicaat Informatloa Please Print Legibly Business/Organization Name: 61)r-"y Sicry �LC Address: Po &V /27 �✓3(v be!lShVic Tr / City/State/Zip ) X: 616Phone#: '4I3 —.241-51r& Arc you an employer?Check the appropriate boa: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail or Part-time)" 6. ❑Resmutant/Bar/Eating Establishment 2ao 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 10.0 Manufacturing no employees.[No workers'comp.insurance required]' 4.❑ We ere a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees.[No workers'comp.insurance req.] 12.®Other J5`/9/7Q`1 t, -Any applicant that checks box#1,run also fill ow the secomm telow showing then wohm'cpmpenwtion polity inf rmandow e9fda em meate otTicm have exempted themselves.bet the m,paratmn has ether employee,a workers'compensation policy is retained and such an or minion Amild check boa Ml. I am an employer that isproviding workers'compensation imuraneefor my employees. Belowisthepolicy infiwomdon. Insurance Company Name: Insurer's Address: City/SmWZip: — Policy#or Self-ins.Lia# Expiration Date: Atmch a copy of the worken'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a fine up to S 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerci ,un der thee}ettains�an�4pensdides ofper%ury that the information provided above is hue and correct Signature: /.�1 /�{ /lba Date 0130 Phone 413 — a 7 — "910 Officfa/use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk L Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www mass o.aia _ CIO v v � D Ln C) O �* Z r ill � D m -h r v � m y Z < !rDc0 o O � ( o m v n 0 m ' %Y"'�...� ��ir� ���.. Y e n ..v. �i,r � t :r r ,�✓K er,'� ...�. 3 v.: f ~ ui �%.'' ♦; '»' y'4� �'° : ��`w .z�� � � � � tx o- _" x ;"'r .,+�aya.,��wt z'e� x ` N�" ,' .. . 70.001 In Q [FIP LJ 01 O e o ayataft [Reference Laboratorr�oss o _ 64.21n — • it � ti K � 5 .t �. � � i a � z • � ` J f s a z lift w _ AFP NOHO yy k �cyy� V W 'xl t�rye _ N ♦ w t .. 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