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39A-032 (6) City of Northampton Map 39A Lot032 Zone GB(100)/ Massachusetts Date issued 3/5/2020 0:00:00 Inspector of Buildings Permit # BP-2020-0988 Permit Fee$100.00 SIGN PERMIT Business Address 506 PLEASANT ST Applicant InstallerFEDERAL HEATH Applicant Installer Address 1500 NORTH BOLTON RD Work Description ILLUMINATED HI-RISE SIGN - SHELL STATION Estimated Cost $10000.00 Building Department Approval by: File#BP-2020-0988 APPLICANT/CONTACT PERSON FEDERAL HEATH ADDRESS/PHONE 1500 NORTH BOLTON RD JACKSONVILLE PROPERTY LOCATION 506 PLEASANT ST MAP 39A PARCEL 032 001 ZONE GB000V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED IRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ILLUMINATED HI-RISE SIGN-SHELL SIATION 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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 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. - TU14 of XVrtaM tVn - �Rttssttr>Tusetts �, ..... „r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building J`rs.. Northampton, MA 01060 INSPECTOR Application for a Permit to Place or Maintain a Sign Sidewalk Sign, t4acquee or other Advertising Device C,44r33,7Y (Applica,140ob�ftlred u�t in ink or typewritten) Number Plans must be filed with the Building Inspector Erection..................( ) before a permit will be granted. �� �\_,� Alteration.................( ) Repair.....................( ) �ORepainting...............( ) :I �0 Removal..................( ) �� 0�>jFlCp FEE........PAGE........PLOT..�. . N.req o>Gs j�Nc 419 �Iorthampton, Mass. ........... ....20.0!riC� To the Building Commissioner: Application for a permit to place or maintain/a sign or other advertising device, or marquee. BUSINESS NAME .. �(.. .......................................................................... 1. Location, Street and No. .. Q ...P!� Tl 7—,,S** ,,?` .. 2. Owner's name 'LI.....�7rC.O.T. r ...C=Ul". !t/,�'./... -k ka............... 3. Owner's address .s�1.��..S'DnC,j 5�Tit -114.... .. . 4. Maker's name ..,Fk-D16P19 �..... / ............................................. 5. Maker's address ...T .�r14Qly. 6. Erector's name -461F...467.... ..� ...../ .7 .................. 7. Erector's address10.Tle-.!E .5 SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated . ... . Non-illuminated Will sign obstruct a fire escape, window or door. . . ... Marquee ............... 3. Lower edge will be ......ft........ins above the public way. Projecting .............. 4. Upper edge will be ......ft........ins above the public way. Roof ..................... 5. Height ......ft......ins Width ......ft......ins Temporary... 6. Face area .......sq. ft. Wall ..................... 7. Inner edge will be ......ins from the building or pole. Sidewalk.......... ......... 8. Outer edge will be .......ins from the building or pole. Other. 9. Face of building or pole is .......ins back from the street line. 10. Sign will project .......ins beyond the street line. 11. Sign will extend .......ft .......ins above the building or ole. cc// 12. Of what material will sign be constructed? Frame .�/t............. Face...1�Y4J'0, 13. Estimated cost $.,A07-506! ?)! The undersigned certifies that the above statements are t to the est of k edge and belief. ..... ......... . .... ..... .. .. .. ........ (Sign re of Owner or Agent) Page 1 of 3 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING PERMIT APPLICATION PLEASE TYPPE�OR PRINT ALL INFORMATION 1. Name of Applicant: 4�r X048 ss: XD�D .you s/'rt C�S� � �G -0202 _ /9o2 Addre ) 7-syi9 Telephone: 2. Owner of Property: . Address: Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee —Other(explain)` 4. Job Location: J�)/,0 ;V4,67,4'SA'Al7 - `S Z&,6,&7- Parcel %& 6Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) / 5. Existing Use of Structure/Property: 52/!nS S✓/9 71-6.,V 6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary) le,�,o!qc, ocls7zlyc 1y/- els 6' SA741, / '4-91I 7T�Ixl .EX/�'T/•t/�' �5'�U��� SOD TA <� 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans 8. Has a Special Perm iWaria nce/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: Are there any proposed changes to,or additions of,signs intended for the property? YES NO'X— 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 column to 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 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: oZ9 lo2e) APPLICANT'S SIGNATUR yv ,� zu 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 Works and other applicable permit granting authorities. Page 3 of 3 1--fl-- gl56- 5g Gl(l, //Is%� L 4 f t f mail' VoPower• Per6monce Fuels t Replace existing sign cabinet with same size a -y •fi.�trp� 0 �Do DATE(MM/DDIYYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 1/23/2020 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 NAME: PEOPLES UNITED INSURANCE AGENCY INC PHONE 860-52l-7600 FAX AIC,No.Egg AIC NO: _ 1 FINANCIAL PLZ LOWR 2 E-MAIL ADDRESS: HARTFORD CT 06103-2601 INSURER(S)AFFORDING COVERAGE _- ._. NAIC N INSURERA: SELECTIVE INS CO OF SOUTH CAROLINA 19259 INSURED INSURER B: SELECTIVE IMS CO OF SOUTH CAROLINA 19259 J S PECHULIS LAND DEVELOPMENT SERVICES INC DBA INSURERC: SELECTIVE INS CO OF THE SOUTHEAST 39926 181 NOTRE DAME ST INSURER D: INSURER E: WESTFIELD MA 01085-1772 I-INSURER F COVERAGES CERTIFICATE NUMBER: 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. -- - MSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MMIDCY EFF MPMID Y EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY X S 2139905 1/15/2020 1/15/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE � OCCUR PREMIDAMAGESES T RENTED S 500.000 MED EXP(Any one person) S 13,000 A PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 Z LOC PRODUCTS-COMP/OPAGG S 3,000,000 POLICY[K]JECOT OTHER: $ C AUTOMOBILE LUtBILITY Z A 9099894 1/15/2020 1/15/2021 EaMBa�INt IN LE LIM $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYE AUTOS E HIRED AUTOS NON-OWNED ROP adenDAMAGE $ ONLY E AUTOS ONLY $ A X UMBRELLA LIAB Z OCCURS 2139905 1/15/2020 1/15/2021 --- EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2.000,000 DED I Z I RETENTION ZERO $ PR B WORKERS COMPENSATION NC 902!!5! 1/15/2020 1/1S/2021 Z STATUT ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Ya E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) This Certificate of Liability Insurance was created by Selective on behalf of the agent. Sample is included as additional insured with respect to General Liability, Automobile as required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Sample SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sample THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Sample MA 01085 AUTHORIZED,RAEP-RESE�NTATIV E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: ACRD ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED PEOPLES UNITED INSURANCE AGENCY INC J S PECHULIS LAND DEVELOPMENT SERVICES INC DBA POLICY NUMBER 181 NOTRE DAME ST S 2139905 CARRIER NAIC CODE WESTFIELD MA 01085-1772 SELECTIVE INS CO OF SOUTH CAROLINA 19259 EFFECTIVE DATE: 1/15/2020 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: AcoRn 2s FORM TITLE: of LTABTL• = INSURANCE JOB # JOB LOCATION ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Owner Authorization i his correspondence serves as confirmation that JSP Land Development (JSP) and their agents are hereby authorized to serve as agent of Global Companies, LLC and their subsidiaries (Global Alliance, Alliance Energy, Global Montello, etc_)_ JSP's authority—and their agents authority is limited to project permitting on the behalf of global Companies, LLC_ Representation of the orwner's interests by JSP and their agents is authorized for submittal of written matehals, personal correspondence. and representation at public meetings/hearings. Authorization Global Companies, LLC Owner of Record Jamie Cook Director Name_Title M`Y. Autl- i zed Signature 04/18/17 Date • February 22,2020 City of Northampton Puchalski Municipal Building 212 Main Street Northampton,MA 01060 Attn: Mr. Louis Hasbrouck Shell Building Commissioner 506 Pleasant Street Northampton,MA 01060 Delivery: Regular mail Dear Mr. Hasbrouck, Enclosed please find(1)one Application for Permit to Replace or Maintain a Sign and(1) one copy of the existing/proposed Hi-Rise sign at the Shell gas station located at 506 Pleasant Street, Northampton,MA.The sign replacement is being proposed because the existing Hi-Rise sign has been damaged over the years. They will remove and replace the sign panels with new of the exact size. The height, location and footings will remain as is. Due to the height and location of the sign they will field measure it once they obtain the permit and then drawings will be done by Federal Heath and a copy will be sent to you for your file. The contractor for the project is JSP Land Development, 181 Notre Dame Street, Westfield,MA 01085,a copy of their Worker's Compensation Insurance is enclosed.An owner authorization letter allowing me to obtain permits is also enclosed.An electrical permit will be obtained by a licensed electrician, if required,prior to the sign modifications. Lastly,please find check#3328 amount of$100.00 for the Sign Permit fees. If you find everything is in order please return the permit to me in the enclosed self-addressed stamped envelope. If you have any questions or require additional information please call me at(774)239-2781. Thank you in advance for your time in helping to expedite this matter. Sinc y, Carolyn A. arker Cc: JSP Land Development SPECIALIZING IN THE PETROLEUM INDUSTRY Project Management,Permit Expediting,Drafting 6'Fire Suppression Plans 3 Lorion AvenueXorcester, MA 01606 • Tel: 508-853-1167 0 Fax: 508-853-1176 • Cell: 774-239-2781 • capconsulting@verizon.net