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24D-085 (2) City of Northampton Map 24D Lot085 Zone HB(100)/ Massachusetts Date issued 12/26/2019 0:00:00 Inspector of Buildings Permit # BP-2020-0753 Permit Fee$100.00 SIGN PERMIT Business. Address 143 KING ST Applicant InstallerPROSIGN Applicant Installer Address 110 FORGE RIVER PARKWAY Work Description ILLUMINATED MARQUEE SIGN - SAFELITE AUTO GLASS Estimated Cost $1300.00 Buildinp, Department Approval by: i City of Northampton Map 24D Lot085 Zone HB(100)/ Massachusetts i Date issued 12/26/2019 0:00:00 Inspector of Build�ngs Permit # BP-2020-0754 Permit Fee$60.00 SIGN PERMIT Business Address 143 KING ST Applicant InstallerPROSIGN Applicant Installer Address 110 FORGE RIVER PARKWAY Work Descri tion ILLUMINATED WALL SIGN - SAFELITE AUTO GLASS Estimated Cost $1000.00 Building Deartment Approval by: Ali File#BP-2020-0754 APPLICANT/CONTACT PERSON PROSIGN ADDRESS/PHONE 110 FORGE RIVER PARKWAY RAYNHAM PROPERTY LOCATION 143 KING ST MAP 24D PARCEL 085 001 ONE HB 100 / THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCL UIRED DATE ZONING FORM FILLED OU Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ILLUMINATE WALLS N-SAFELITE AUTO GLASS New Construction Non Structural interior renovations Addition to Existing AccessoU Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Pla THE FOLLOWING ACTIO HAS BEEN TAKEN ON THIS APPLICATION BASED ON IJORMATION PRESENT9D: FF''Approved Additional permits required(see below) PLANNING BOARD ERMIT 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& R corded 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 Co servation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay l 2 26 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 information. File#BP-2020-0753 APPLICANT/CONTACT PERSON PROSIGN ADDRESS/PHONE 110 FORGE RIVER PARKWAY RAYNHAM PROPERTY LOCATION 143 KING ST MAP 24D PARCEL 085 001 ZONE HB 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 T eof Construction: ILLUMI ATE MAR UEE SJGN-SAFELITE AUTO GLASS New Construction Non Structural interior r novations Addition to Existin Accessoa 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 INF RMATION PRESENTED: Approved Additiona 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&R corded at Registry of Deeds Proof Enclosed Other Permits Require Curb Cut from PW Water Availability Sewer Availability Septic Approva� 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 1 12 26 it 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 information. Titq of Xort4ampton 'r DEPARTMENT OF BUILDING INSPECTIONS s ;z 212 Main Street • Municipal Building Northampton, MA 01060 ' INSPE' TOR Application for a Permit to Place or Maintain a Sign Sidewalk Sigh, M, ee or other Advertising Device r (App)icationj��oc typewritten) Number ..................... ^� vv _ b Plans must be filed with the Building Inspectbr r � Erection..................( ) before a permit will be granted. ! ar Alteration.................( %,,r f �? Repair.....................( ) 2019 Repainting...............( ) ^R.A4eo, o N' Removal...a..... tiQrU,lnINrNAMr,ro 'NspecMA0r! NS FEE........PAGE.......,.r.PLOT LOT...). ... 60 Northamp Mass. *.1 h..20.1�. To the Building Commissioner: Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESSNAME .39K.1 .................................................................................... 1. Location, Street and No. ..�.y.�..I11 ` .. " .���."........................................................ 2. Owner's name .POA6 . . LLC ... ............................................................................. 3. Owner's address ..y... rG !°...�1—TJ�1�..0 r�V.2,..f.SCL1t11..l C�C�.i. ).�.1.�1Ca �u 4. Maker's name . 0. Gx'OC,I?. 5. Maker's address "2S.O..... ............. 6. Erector's name7 C Q ...Q�X.VAS.4................................................................... 7. Erector's address A16 ...0�.X67 SIGN J KIND OF SIGN / (Designate) 1. Sign will be (check one) illuminated .✓... Non-illuminated ....... 2. Will sign obstruct a fire escape, window or door? .tJrJ... Marquee .....✓... .W" 3. Lower edge will be .%O..ft........ins above the public way. Projecting .............. 4. Upper e0 a will be '`.i..ft........ins above the public way. Roof ..................... 5. Height34IMNO?'.ins Width A...ft.ll'IA1ns Temporary..... 6. Face areaYi;'kl..sq. ft. Wall .........!. 7. Inner edge will be ..l...ins from the building or pole. Sidewalk.................... 8. Outer edge will be .`i....ins from the building or pole. Other......................... 9. Face of building or pole is .......ins back from the street line. 10. Sign will project .2P...ins beyond the street line. 11. Sign will extend .0...ft .......ins above the building or pole. 12. Of what material will sign be constructed? Frame C.00...lL0_;<.�..Y. ..... Face.QC(.(—.k(( ....... 13. Estimated cost $.&,,, .......... The undersigned certifies that the above statements tatr ?,to best of his knowledge and belief. . ..... ................... (Signature of Owner or Agent) Page 1 of 3 .. THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: ftX-'C' Hol uC h Address:(Q.0 II 1j+ &, S('j)4-jt ECj0M,rM Telephone: SQA g44U(r'(4qg CC7a ��S 2. Owner of Property:�Y noci 7(1 L-L-C Address:y Telephone: IJA 3. Status of Applicant: Owner ✓Contract Purchaser Lessee _Other(explain): 4. Job Location: kyl ) 1(\� Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: 1 _►^(1Clb;If f7[a IR 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) lc1" aje cnA TeyiciCe 1C['a GI to e1'I541ing cW11 & n ?-CCl sJe 0216 2 n Q& IeYe►y-, "fit 5 in DO f ro-It n4 D-Alon 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW / YES IF YES,date issued: IF YES: Was the permit recorded at the Registry 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? YES ✓ NO IF YES: Describe the size,type and location: (I) 'X .I I h" x I'-I I92" IA ou SI!�n . %i l si ci 1Q)kkh Ll� S`y IOSS'-IO'Ll^ Mb(N-CA MCA t ) II'-11513" k 3' -11 r3/t(, Are there any proposed changes to,or additions of,signs intended for the property? YES ✓ NO IF YES: Describe the size,type and location: 1CM000X SL,40 In A-) &A i/Z" y Page 2 of 3 M / 11. ALL INFORMATION MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. 12. This column to be filled in by the Building Department. Existing Proposed Required by Zoning Lot Size L Frontage Maj Ll(0, Front: Setbacks: Side: L: R: L: R: Rear: Building Height Bldg Square U y l y 0 Footage % Open Space: (Lot area minus bldg and Paved parking) #of Parking Spaces #of Loading Docks Fill: (volume&location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: �C')1I-11Iq APPLICANT'S SIGNATURE �cOV(0S!QngLaphI(S_ Conn Applicant's mail AddrTequired) 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 .r 4 I i 4 r i I j '000�-Ar I F felife. AutoGlass 143 KING STREET G NORTHAMPTON, MA 01060 0349 - REV Z I REVISI • DATE: REVISION#&DESCRIPTION DESIGNER ' 800.861.8006 11/06/19 SIGN 3.1 IS THE PREFERRED SIGN ]B AU VAN CESIGNGRU11P.00M 11/12/19 BLUE PAINT TO BE REPAINTED GREY ]B ADVANCE SIGN GROUP C UL US SUMMARY OF SIGNAGE j ® -WEST ELEVATION 1.O -POLYCARB SIGN W/VINYL 39.41 � -ILLUMINATED r TOP PYLON SIGN t [20] -TWO POLYCARB PANELS W/VINYL 51•[x] -ILLUMINATED -BOTTOM PYLON SIGN A t i3.O -TWO POLYCARB PANELS W/VINYL ]•� - Itra• /" r• -ILLUMINATED F Tl SIGNS 2.0,3.0 r ' I t I i - I SIGN i IL SITE MAP NOT TO SCALE ©NORTH DRAWING Na DATE OF n THl5DRAWING SUPERCEDES ALL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION CONSVL—T. LAST CHANGE: AND INSTALLATION OFTHIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WILL BETAKEN AS r APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. PROJECT MANAGER: 800.861.8006 030349 11/12/19 °� ' ADVANCESIGNGRDUP.COM Safelite. AuWGass a DESIGNER REVISION NO. Q CLIENT APPROVED SIGNANRF: DATE: 143 KING STREET SUNT DESIGN DOCUMINTATION II DL5101v I,n L PkOPeI 'A,)-11 1-L l 110114 r Uri6 n.';. FILE IOC NORTHAMPTON,MA 01060 SITE 2 "--.N MAY LF.UEDORLIST RICUTt.DHITIa,uTAPPROVAL OF ADVANCE'Ar,r ADVANCE SIGN GROUP C ul. US c 9'-11 1/2"C.S. 9'-8 3/4'V.O. _..J JN Phillips • 77 r 0 Safelife -AUTOGLASS AutoGlass POLY ARSONATE PANELSCALE 3/4"=V-0" (1)ONE REQUIRED 39.4' SQUARI FcFI DETAILSSIGN O 3/16"WHITE POLYCARBONATE ® FIRST SURFACE BLACK VINYL&3M 3630-143 POPPY RED AutoGlass EXISTING/PROPOSED NOT TO SCALE DRAWING NO. DATEOF N TMS DRAWING SUPERCEDES/LLL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION CONSULTANT ' LAST CHANGE: L AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WILL BE TAKEN AS -I 800.861.8006 }'�( 8 APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. SEA' ` El 8 0 0.8 61.8 0 0 6 Safel%fe AutoG/ass 030349 11/12/19 ;II d De1N"� AOVANCESIGNGROUP.COM SIGN REVISION NO. Q CLIENT-OWOSIGNATORE DATE. DESIGN DOCUMENTATION: FILE LOC:, , 143 KING STREET 1, NORTHAMPTON,MA 01060 ,0 - - ADVANCE SIGN GROUP C I L US 8'-10 1/4°C.S. - 8'-71/4"V.O. IF i • / SII 71 , V Safelite ) + i<1 in POLYCARBONATE PANELS SCALE 1/Z'=1'-O" (2)TWO REQUIRED 51.97 SQUARE FEET • AutoGlass SIGN DETAILS 3/16'WHITE POLYCARBONATE FIRST SURFACE BLACK VINYL&3M 3630-143 POPPY RED •t EXISTING/PROPOSED NOT IU 3LALL DRAINING NO. DATE OF THIS DRAWING SUPERCEDE5 ALL OTHER DOCUMENTS PROVIDED CONCERNINGTHE FABRICATION CONSULTANT 800.861.8006 }�( (j'(�(h1'I1 }({1 (h1 LAST CHANGE: L AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WALL BE TAKEN AS �J O O.V V 1.Y OO V 0 AND OF THE DESIGN AND SPECIFICATIONS AS NOTED. P.OJEcr MAN"m 030349 11/12/19 w Safelite AutoGlass 6 DE96NER I ADVANCESIGNGROUP.COM SIGN REVISION NO. <QlEMN owo A6NAf m Dwn: 143 KING STREET 'Y DESIGN DocuMENTAnoN , -I:ny: r iI eo u H nsvnr+ L I iac:.:I ulI nye n FILE SOC: NORTHAMPTON,MA 01060 2.0 2 N MNI BE USED 1,R DISTRIEUTED'NITHOUT APPROVAL Or ADVAN CE SIe' ADVANCE SIGN GROUP C UL US 3-11 13/16"C.S. 3'-10 1/2"V.O. • 4A 1 v 61 Auto Glass Repair to >' In b I and Replacement POLYCARSONATE PANELS SCALE 1"=1'-0" F77,TWO REQUIRED 7.84 SQUARE FEET safelife SIGN • DETAILS 3/16"WHITE POLYCARBONATE • FIRST SURFACE 3M 3630-143 POPPY RED 7� 1 EXISTING/PROPOSED , • • DRAWING NO. DATE OFL/�THIS DRAWING SUPERCEDE5 ALL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION CONSULTANT LAST CHANGE: <AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WALL BE TAKEN AS APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. 'ROJKF YANA•FC ' 800.061.800G 030349 11/12/19 ° ADVANCESIGNGROUP.CDM Safe%te AutoGiass � SIGN REVISION NO. ` CLIFM-ROVED A6NATV•F: BATF: F 143 KING STREET DESIeNDOCUMENTATI N: .. FILE LOC, NORTHAMPTON,MA 01060 3,0 2 ADVANCE SIGN GROUP C VI US '404�-Adr afellife. AutoGlass 143 KING STREET NORTHAMPTON, MA 01060 030349 - REV 2 REVISIONS DATE: REVISION#&DESCRIPTION _ DESIGNER El 800.861.8006 11/06/19 SIGN 3.1 IS THE PREFERRED SIGN IB AOVANCESIGNGROUP.COM 11/12/19 BLUE PAINT TO BE REPAINTED GREY ]B CUL US f a SUMMARY OF WEST �.0 ELEVATION OLYCARBSIGN W/VINYL 39.41 -ILLUMINATED -TOP PYLON SIGN 2.0 -TWO POLYCARB PANELS W/VINYL 51.97 -ILLUMINATED -BOTTOM PYLON SIGN • '�" n�'i -� 3.O TWO POLYCA N PANELS W/VINYL 7.84 84 • ��' -ILLUMINATED As r b' SITE MAP NOT TO SCALE ©NORTH DRAWING NO. DATEOF N THIS DRAWING SUPERCEDES ALL OTHE0.DOCUMENTS PROVIDED CONCERNING THE FABRICATION CONSULTANT LAST CHANGE: Q AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WILL BE TAKEN AS APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. MOIER UANAGEIC ' 800.861.8006 030349 11/12/19 & Safelite, AutoGlass 4 es"m ADVANCESIGNGROUP.COM REVISION NO. Q CLIENT-0O 0 SIGNATURE: DATE: A DESIGN DOCUMENTATION: FILE LOC: 143 KING STREET SVM / ESIADVANCE SIGN GROUP C VI US NORTHAMPTON,MA 01060 SITE (� • 9'-11 1/2"C.S. 9'-8 3/4"V.O. JN Phillips vi u '51S felifes 877-AUTOGLASSm AutoGlass fM1 --------- POLYCARBONATE _ SCALE 3/4"-V-0- (1) '0"(1)ONE REQUIRED 39 41 SQUARE FEET DETAILSSIGN • 3/16"WHITE POLYCARBONATE • FIRST SURFACE BLACK VINYL&3M 3630-143 POPPY RED , • Glass _ I { EXISTING/PROPOSED • • DRAWING NO. DATE OF THIS DRAWING SUPERCEDES ALL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION I.—I.'ANT ANGE: LAST CHL AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAVANG VALL BE TAKEN AS F:: APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. MO1ER MANA••R: 800.861.8006 Safelite AutoG/ass 030349 11/12/19 A M d ' AUVANCESIGNGROUP.COM SIGNREVISION NO. t Q1ENr uPROVFD SIGNATVRF ypC 143 KING STREET 1I DESIGNDOCUMENTATION: (,ROUT NETIIILR MIL FILE LOC NORTHAMPTON,MA 01060 +.If, BE W�RUISTRIRIRDm l:vL'TAPNR eALOVADNANCESIC�1 _ ADVANCE SIGN GROUP C SUS 8'-to 1/4°CS 8'-7 1/4"V.0, Safelife." V1 in 1 I •• scare yr=r o- (2)TWO REQUIRED 51.97 SQUARE FEET • AutoGlass SIGN DETAILS 4, L / O 3/16"WHITE POLYCARBONATE • FIRST SURFACE BLACK VINYL&3M 3630.143 POPPY RED l I - EXISTING/PROPOSED NOT DRAWING NO. DATE OFIIS TMS DRAWING SUPERCEDES ALL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION coNsu.ar,i LAST CHANGE: `AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING MALL BE TAKEN AS 800.861.8006 O.w w�'w O O w 1 APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. �F.L. ECE MANAGER: �oJ Ivy LoJ lob Safe/ite AutoG�ass 030349 11/12/19 ° .� _ CL °"'�` ' ADVANCESIGNGROWCOM SIGNREVISION NO. Q CLIEW AWROVEDSIGNATURE: DArt: 143 KING STREET DESIGN DOCUMENTATION: LOCNORTHAMPTON,MA 01060 2,0 2ADVANCE SIGN GROUP C ul US v 3'-11 13/16"C.S. J T-10 1/2"V.0. � a . , Glass Repairo and Replacement I POLYCARBONATE PANELS SCALE I"=1-r (2)TWO REQUIRED 7.84 SQUARE FEET • • SIGN DETAILS r • 3/16'WHITE POLYCARBONATE • FIRST SURFACE 3M 3630-143 POPPY RED t EXISTING/PROPOSED NOT TO SCALE DRAWING NO. DATE OF In THIS DRAWING SUPERCEDES ALL OTHER DOCUMENTS PROVIDED CONCERNING THE FABRICATION CONSULTIWT: LAST CHANGE: AND INSTALLATION OF THIS DESIGN.A SIGNATURE ANYWHERE ON THE DRAWING WILL BE TAKEN AS APPROVAL OF THE DESIGN AND SPECIFICATIONS AS NOTED. PROTECT MANAGER: 800.861.8006 030349 11/12/19 ° ��, Safellte AutoGiass d SIGN REVISION NO. <WENTA OWDSIGNATORF wDE ADVANCESIGNGRDUP.CDM 143 KING STREET DESIGN DOCUMENTATION SV;ral erh';I •:::r,�-.I-��euol,Ni lurc, l+.. FILE LOQ NORTHAMPTON,MA 01060 3"0 2 - -�•NUAr LE IX(D OR DISTRIBUI ED MTHOU'I APPROVAL Or ADVANCE ADVANCE SIGN GROUP C U� US Wednesday,December 04,201911:37:55 AM Page 1 of PURCHASE ORDER ADVANCE$!GN GROUP - Ib"'WA.1,0- '�JiUld�+c Purchase Order Num 015043 Ship By PO Created By Janel/I Date of Purchase 121412019 Due/Expected Delivery Our Invc Num V PROSIGN004 S Sarelite- Northampton MA E PRO SIGN SERVICE LLC H 143 King St N 110 FORGE RIVER PKWY, UNIT D D RAYNHAM h14 02767 USA R Northampton AIA 01060 0 (77.1)218-4602 Ex T R Contact JESSE O Email siQns(aeprosignservice.com Item Id Item Description Otv Uom Price Total Price INSTALLATION Installation-performed during normal business 1 EACH $2,262.50 $2,262.50 hours Installation w/Two Techs&Bucket Truck Receive,inspect and install:Swap building cabinet poly Paint cabinet black-paint included Remove and dispose of existing pylon panels(4)Install new pylon panels(4)Onsite LED Retrofit: Retro building cabinet Retro pylon(2 cabinets)At the time of installation 0000-JANEL HEDGEPETH Janel Hedgepeth 0 each $0.00 $0.00 Project Manager Direct:614.429.2094 Cell:614.900.0390 Fax:614.429.2150 jhedgepeth@advancesigngroup.com 0000-NOTES Terms 45 days 0 EACH $0.00 $0.00 Shipping $0.00 Order Total $2,262.50 TERMS AND CONDITIONS PRODUCTS&MANUFACTURED GOODS •No additional charges will be paid without the prior written consent of Advance Sign Group,LLC. 'Our Purchase Order number must appear on your invoice,packing slip and package. "If this order cannot be fulfilled completely and exactly as indicated above,please notify us at once. In case of any changes,do not ship without a revised Purchase Order. We reserve the right to refuse items not shipped as specified. Orders not delivered by the stated Due/Expected Delivery date above,or not sent according to our routing instructions may be subject to a chargeback or penalty. "If purchase order pricing does not reflect current pricing,contact us at once. "A reconciliation fee of$25.00 will be charged for processing overbillings. 'Receiving hours:7:30am-2pm M-F INSTALLATION&SERVICE This PO must be signed and sent back to your Advance Sign Group(ASG)Project Manager within 24 hours to acknowledge receipt,scope of work, pricing,and terms. ASG requires copies of current W-9,Worker's Compensation Certificate and Certificate of Insurance with Advance Sign Group,LLC shown as "certificate holder"and"additional insured"prior to Installation/Service. All ASG installation vendors are required to at all times be in compliance with all federal,state,and local laws and safety regulations that apply to the work they perform,including,but not limited to OSHA regulations regarding certified crane operators. "All containers delivered to you must be inspected immediately for damage upon arrival.Damage not noted on the carrier Delivery Receipt or Bill of Lading and not substantiated with photographs is the responsibility of the vendor. Concealed damage(i.e.that which may be present inside of a container that did not appear damaged upon arrival at your facility)must be reported to ASG within 24 hours of delivery by the carrier. Photographs of all damage must be sent to your Project Manager within 24 hours of delivery. Any damage not reported as indicated herein is the responsibility of the �ullrot lvllwieauil ul 1waab4i11ub0r� tz0 Division of Professional Licensure Board of Building Regulations and Standards Construcli'6r� `Supervisor CS - 107219 Expires , 07/19/2021 DOMENIC JOSEPH VENTURELLI, SR. 528 LUNNS WAY PLYMOUTH ,JVIA 02360 Commissioner �-- QP DATE(MM/DDlVVVV) CERTIFICATE OF LIABILITY INSURANCE 12/17/19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Donna Walsh NAME: Morse Insurance Agency,Inc. PHONN Ext): (508)238-0056 AX(AIC,No): (508)230-8367 285 Washington Street E-MAIL ADDRESS: donnawalsh@morseins.com INSURER(S)AFFORDING COVERAGE NAIC i1 North Easton MA 02356 INSURERA: Selective Insurance Company of South Carolina 19259 INSURED INSURER B: Selective Insurance Company of the Southeast 39926 PRO SIGN SERVICE LLC INSURER C: 110 FORGE RIVER PKWY INSURER D: UNIT D INSURER E: RAYNHAM MA 02767-5514 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADULSUBRI POLICY EFF POLICY EXP LTR N D POLICYNUMBER MMIDDIYYYY MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE T CLAIMS-MADE [XI OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A S 2376617 09/23/2019 09/23/2020 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY ECT PRO- FLOC PRODUCTS-COMP/OPAGG $ 3,000,000 - OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED Ix SCHEDULED A 9100062 09/23/2019 09/23/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X SPER TATUTE ERH AND EMPLOYERS'LIABILITY YIN 1'000'000 B ANY PROPRIETOR/PARTNER/EXECUTIVE N/A WC 9059617 09/23/2019 09/23/2020 E.L.EACH ACCIDENT E (Mandatory inOFFICER/MENH) EXCLUDED? 1,000,000 (Mandatory in NN) E.L.DISEASE-EA EMPLOYEE E If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT E DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents i Office of Investigations I Congress Street, Suite 100 - Boston, MA 02114-2017 www mass.gov/dia 'Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Pro Sign Service Address: 110 Forge River Parkway City/State/Zip: Ra Wham, MA 02767 Phone #: 508-339-5289 Are you an employer? Check the appropriate box: Type of project(required): 1. ■❑ I am a employer with 5 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no Si ns employees. [No workers' 13.❑� Other 9 comp. insurance required.] .Any applicant that checks box#1 must also f II out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selective Insurance Company of SC _ Policy#or Self-ins. Lic. #: WC 9059617 Expiration Date: 09/23/20 Job Site Address: 143 King St City/State/zip: Northampton/MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration 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$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. do hereby�cyyertify under the pains and penalties of perjury that the information provided above is true and correct. Signature: fly N" Date: 12/17/2019 Phone#: 5082308901 Oyfic•ial use ontl•. Do not write in this area, to be completed by c•it1,or town ofJicial. City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: