24D-070 STOP & SHOP SIGNS File#BP-2020-1268
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055' SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(]00)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid LZ
Typeof Construction: ILLUMINATED PYLON SIGN-J
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
INFORMATION 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
Sig ture 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.
- C2it of Xart4ampton(( +AltttssttrlTuspits �� '<<�
iL W
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 ��"h' -y")
INSPECTOR Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising DeYiJ�/p �)
(Application to be filled out in ink or typewritten) Number .IJ.[. xv...�V
Plans must be filed with the Building Inspector Erection..................( Y
before a permit will be granted Alteration.................(✓)
Repair.....................( )
Repainting...............( )
RArnoval..................( )
FEE.....' PAGE........PLOT.......
To the Building Commissioner: Northampton, Mass.
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME.......5 .. .... ... .Q... C.C:�
l .............................
1. Location,Street and No. ...a.,�.. .....
2. Owner's name.....:..... ,,,,,, O
f ya .'.:........................................................
3. Owner's address ...�...
4. Maker's name .... ..
.. ...... . . ..................................................................
5. Maker's address
GU 6/
...................... � ....
6. Erector's name ................
7. Erector's address ..........................................................
.............................................
SIGN KIND OF SIGN
1. Sign will be (check one) illuminated . (Designate) C.......
2. Will sign obstruct a fire escape, window or door? . `,
� Marquee ...............
3. Lower edge will be ......ft........ins above the public way. Projecting .............. <f ( C)
4. Upper edge will be ......ft........ins above the public way. Roof ..................... ' c
5. Height ......ft.:#.t.ins Width .. .ft......ins Temporary.............
6. Face area 2.!...sq. ft. Wall .....................
7. Inner edge will be ..`:'..ins from the buildingole.
or P Sidewalk....... ............
8. Outer edge will be . :'....ins from the building or pole. Other... .y�( a•,}0
9. Face of building oryole 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 pole.
12. Of what material will sign be constructed? Frame ........................ Face..l..l..�
13. Estimated cost $..l.O,.P..C�........
The undersigned certifies that the above statements arrtrue to the best of his knowledge and belief.
............................. ....�/.�....(
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1267
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070.001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 1101
Building Permit Filled out
Fee Paid
Typeof Construction: NON ILLUMINATED CANO Y SIGN - I
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
INFORMATION 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
Sig ture'of LBuilding 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.
�, +�Rttssttrllusrtts c�`�s`s S,c'<<
f
Yl
DEPARTMENT OF BUILDING INSPECTIONS yeti a
212 Main Street • Municipal Building f �c
--_-- Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign 1-41
Sidewalk Sign, Marquee or other Advertising De
(Application to be fllled out In ink or typewritten) Number. 0,�,�ZG �' Z p
19
Plans must be filed with the Building Insoector Erection..................( ) 09�9 �0 c0�
beforea Permit will b ranted. Alteration.................( ) Q
qT iq�
Repair.....................(
Repainting...............(
emoval..................( ) oy C'T
FEE.. .....PAGE........PLOT.......
To the Building Commissioner: Northampton,Mass.
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME ... .}�,,,`f ,.. �1.,P,....... 0 'f Gt_S
1 ` .........�.......................
GG
1. Location,Street and No. . .Q........ (..HCl b......ST.
....................................
2. Owner's name
3. Owner's address......�..3.. ..... �rn..CL7.G�..4L
4. Maker's name....
................................................:....................................... I
5. Maker's address.....�.s�c�-........ .Q.. .... N..Ca'7Zl.N...S.�........S.tX z, 6 rl�e Lp
(� !
6. Erector's name ... .. ..... . moll.......1...�..�'.O.J......0`7 ,
7. Erector's address - -... p.��. (,IU G,i rte: S
SIGN , / KIND OF SIGN
1- Sign will be(check one)illuminated ....... Non-illuminated ..I/.. (Designate)
2. Will sign obstruct a fire escape, window or door? .P.�. 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..................... 0 y
5. Height.1....ft..�..ins Width .1.7..ft.Ln.ins Temporary............. _
6. Face area `�. ..sq.ft. Wall .....................
7. Inner edge will be .0..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 .e...ins beyond the street line.
11. Sign will extend .�...ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame ........................ Face/4-.z-
.... (�
13. Estimated cost $...l. a ........
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1266
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED UIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building,Permit Filled out
Fee Paid
Typeof Construction: ILLUMINATED CANOOPY SIGN-H
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
INFORMATION 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
aOV
ao
Si ature 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.
/, IIttS85tP 1tSPftB ��`' c�i`G
DEPARTMENT OF BUILDING INSPECTIONS s �
\ 212 Main Street • Municipal Building 0'6s �cD
— Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Device <T
(Application to be fllled out in ink or typewritten) Number..............:
Plans must be filed with the Building Inspector
before a Permit will be granted Erection..................( ) �'�✓�
Alteration.................(t/j °1 ✓SA
Repair.....................( ) q F
Repainting...............( )
.
0,
Removal.......... ....Ts°o( )Z0
.0PAGE..}49O ..
......P ... .. r°ti
s
To the Building Commissioner: Northampton, Mass.
Application for a permit to place or maintain a sign or other advertising device,or marquee.
GG.. ... .� ........Shu . Cc—sBUSINESS NAME... � ....
..............
1. Location,Street and No. . a .Q........ ,(„N. S
2. Owner's name..... . ,j?., 7 1!t v �O
3. Owner's address......�..�?.. ..... ..0 0.L..�...S. -........ �. +✓
4. Maker's name..... ... ... .xk.. r N
_-
�.
5. Maker's address ..... a-........ ..Q. .... 6 f L�
6. Erectors name... .. ., OI
4.�......�:`�.:.................. .
7. Erector's address
SIGN KIND OF SIGN
1. Sign will be(check one)illuminated . Non-illuminated ....... (Designate)
2. Will sign obstruct a fire escape,window or door? Marquee ...............
3. Lower edge will be .I -ft........ins above the public way. Projecting .............. t S
4. Upper edge will be ......ft........ins above the public way. Roof..................... ]
5. Height .1...ft..gJns Width .!.7ft..�-Jns or p SidewalkTemporary � �
6. Face area ..J.asq.ft. p ry"'"""""' 1
7. Inner edge will be ..52 ins from the buildingole. Wall ..Sidewalk
................
............... J
8. Outer edge will be . ....ins from the building or pole. Other...L,r !�?.�?.(b �--
9. Face of building or pole is ........ins back from the street line.
10. Sign will project ..a...ins beyond the street line. So
11. Sign will extend .ft.......ins above the building or ole. _
12. Of what material will sign be constructed? Frame .. ............... Face... '�i1 i���1 L S ( C> CAs
13. Estimated cost $...Z`r1.R.4�.......
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
. ........... .(J`
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1265
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction:_ILLUMINATED WALL SIGN-G
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
IORMATION 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
Lo �G
Si ture 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.
- \ (City arf Xart4amptan
+Massarhusetts
Jl
1; ` DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
-~— Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign
Sidewalk Sign, Marquee or other Advertising Devicpe -�/,
(Application to be filled out in ink or typewritten) 19
Number.�!..�a10��, W q���G/
Plans must be filed with the Building Inspector Lir O�
before a Permit will be granted Erection..................( ), T
Alteration.................( )
Repair.....................( ) o 0
Repainting...............( ) 116-0�Ols
Removal.......�........(
F T.J...PAGE........PLOT.......
Northampton,Mass. .�?.1�,� �_"'-.20�-4
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME... .' "...S/t!_ Q S�[j1.Q,+ cs SLS
(............... ........... 1 ..............
1. Location,Street and No. . ..... [„N„G, S (.
2. Owner's name
3. Owner's address......�. 3.. ..... ..G ..4L ...S 7L........4' .11.E..N...C- r 7T
4. Maker's name..... ... ... ..! P J ; N C -
...................�....I..............................
5. Maker's address ..... .s a'........ .4. .... N..Ca'7Z1.N... .1........5.6efz/t-)6 rl pt-(1-4
.
6. Erector's name ... . . ... t l....,... l
.. .................................................. r
7. Erector's address--I -... Q.�Q `l.lU G,i r�: S� �' IT t N 6 F(q L f' l�-t �-
..... .i. ..............................
SIGN / KIND OF SIGN
1. Sign will be(check one)illuminated !�.... Non-illuminated ....... (Designate)
2. Will sign obstruct a fire escape, window or door? .N .. Marquee ...............
3. Lower edge will be ......ft........ins above the public way. Projecting .............. /� 1/4
4. Upper edge will be ......ft........ins above the public way. Roof..................... I r
5. Height:T.A......ins Width /v-: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 buildingor ole.
P Other..P..�(.ro.t1:.., Gf
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 pole. l
12. Of what material will sign be constructed? Frame ........................ Face....... �.....
13. Estimated cost $. ot� t�
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1264
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENC ED QUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
TypeofConstruction:_ILLUMINATED WALL SIGN-F
New Construction
Non Structural interior renovations
Addition to Existiniz
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
INFORMATION 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
Sig ature of Building Official UU 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.
- (City of Xort4ampton
' +�Attssttrllusrtts ��? '<<
DEPARTMENT OF BUILDING INSPECTIONS s r
212 Main Street • Municipal Building ,r �`ca
Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sin ✓ �/� `�.
Sidewalk Sign, Marquee or other Advertising Dec _ �� 1 ►
(Application to be filled out in ink or typewritten) NumberV- 19
.'._0...���-rig. c
Plans must be filed with the Building Inspector ✓ �0� /
before a permit will be granted Erection..................( ) Tyq�n.�✓tiG
Alteration.................(�� Oti✓A
Repair
.................
Re ( ) A�gposp✓
Painting...............( ) o o 4rs
(\ Removal..................( )
FEE.V'.r�...PAGE........PLOT.......
Northampton, Mass. S.U..V .5 . ,
To the Building Commissioner:
Application for a permit to place or maintain a sign
�or,,other advertising device,or marquee.
BUSINESS NAME... GG ...d.Y`U... ........ ..... ...��.�.0 S...............
1. Location,Street and No. . .c�.,....., S
2. Owner's name...
3. Owner's address......�.
4. Maker's name..... ... ... ..}'�..?
................... .!v..... .:...........................p........... .
5. Maker's address..... ....s"�c�-........ J.O. .... N.Ca? U.N... .�........�.(.. 1N 6
6. Erector's name... .. .. �1.l,.....,Sf aJ �.�
.................................../.....................
7. Erector's address t c ' ...(.h.)p-&Ttt';(.tU G. r.: S� ile ( ly G F LD �-L-
t............................
SIGN / KIND OF SIGN
1. Sign will be(check one)illuminated ." (Designate)
...... Non-illuminated .......
2. Will sign obstruct a fire escape,window or door? ..!� o Marquee ...............
3. Lower edge will be -...ft........ins above the public way. Projecting
4. Upper edge will be .'-I...ft........ins above the public way. Roof..................... STS O 11 S
5. Height .1....ft......ins Width _ .ft...Lins Temporary.... d ' ►`'
6. Face area ..l.(`?sq.ft. Wall .....:.✓............ �.o ,� (-
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 .v...ins back from the street line.
10. Sign will project .�...ins beyond the street line.
11. Sign will extend .. ..ft.......ins above the building o pole.
12. Of what material will sign be constructed? FrameL'".lA,)l/M Face..Ct2*./,..0
13. Estimated cost $...�}o.sC?......
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1263
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE.P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid '
Building Permit Filled out
Fee Paid
Typeof Construction:_NON - ILLUMINATED WALL SIGN- E
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
INFORMATION 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
V w6ilt —
Si ature of Building Official UU 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.
+.]lllttssttrlfusrtts �� 'c��
TA
DEPARTMENT OF BUILDING INSPECTIONS
\ 212 Main Street • Municipal Building
`-— Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign o� 4 1
Sidewalk Sign, Marquee or other Advertising De is a 9
Thy
(Application to be filled out in ink or typewritten) Number. .oZ t1� Cf <000
. .. ............
Plans must_be filed with the Building Inspector y�4�;,,)i
before aPermit will bearantedwill be granted Erection..................( )_ �ti ��So
Alteration.................( ✓) o T�
Repair.....................( ) Mq C;,
Repair
Repainting...............( )
R moval........... ..( )
;�
FE ........PAGE PLOT......
To the Building Commissioner: Northampton, Mass.
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME....
. ....fi... �. ........ f .f ...� °C,S
' .. ,.
1. Location,Street and No. . .A........ ,�,.lV S �.
........................................
2. Owner's name... *.,,,.
...........v
. .p......................................................... i'v ! `
3. Owner's address ......f'..3..�..... ..GL7..�..�...��.f..........
�.11.E..N...C-Y1
1"1
4. Maker's name.... ;l �4,
................... ................ .:.......................................
5. Maker's address.....�?. c3'............ ...Q N.�?zl.N.S .1........S.f �N 6 f C
6. Erector's name...' C.. .. t.. 0 l„
e• ...... ............................................
7. Erectors address--U?: -.;4.7.... ice....% �-
i
SIGN KIND OF SIGN
1. Sign will be(check one)illuminated ....... Non-illumin ted ..�!/ (Designate)
...
2. Will sign obstruct a fire escape, window or door? 1 .. Marquee ............... ,� p
3. Lower edge will be .6...ft........ins above the public way. Projecting .............. C) ! l l
4. Upper edge will be .5...ft..2:.ins above the public way. Roof.....................
5. Height ......ft..-. Jns Width .7..ft......ins
Temporary............. IC.-e-� ✓n
6. Face area .�...sq.ft. Wall .....................
7. Inner edge will be .O.ins from the building or pole. Sidewalk....................
8. Outer edge will be .......ins from the building or pole. Other................
9. Face of building obpole is ..v...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 pole. c
12. Of what material will sign be constructed? Frame ........................ Face-ef c--).-Z..L-Cc--
13. Estimated cost $...5..C7.,D.....
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
.."`......... .......
(Signature of Owner or Agent)
Page 1 of 3
1
File# BP-2020-1262
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Tyneof Construction: ILLUMINATED WALL SIGN-D
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
INFORMATION 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
a �o
SidFature of Building-officUr VO 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.
Titu of Xorrt4arapton
S` �C
(, +A4ttssttrllusPtts W�a '<<G
DEPARTMENT OF BUILDING INSPECTIONS i
212 Main Street • Municipal Building
Northampton, MA 01060 r ✓ y
INSPECTOR Application for a Permit to Place or Maintain a Sign UN
Sidewalk Sign, Marquee or other Advertising Device °F r .9
(Application to be fllled out in ink or typewritten) Number&27:.a 21 01?0
Plans must be filed with the Building Inspector
before a permit will be granted Erection..................( ) N Sp
Alteration.................( ) o
�qCps
Repair.....................( ) 7�6o0'yS
Repainting...............( )
R oval..................( )
FEE ... ....PAGE........PLOT.......
Mass.
To the Building Commissioner: Northampton,
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME... ,.' ... - j .f c� SLS
GG `
1. Location,Street and No. . .Q........ .(„�tJ S 1.
2. Owner's name... •(?.. ,,.,. il v
3. Owner's address...... ..... Gr..�... ........ �.11.�..N... -y 1�-�/
4. Maker's name..... ... ... .. N C o -
...................�'.............................
5. Maker's address... -........` .�. ....
6. Erector's name... .. .. .. °�!.......- !..�.a�......�,
7. Erector's address-a,?: -?-7... p,>2, -t• G.i� rte: S g re ( lu(o F( LD M -
t............................ . p
SIGN / KIND OF SIGN
1. Sign will be(check one)illuminated . Non-illuminated ....... (Designate)
2. Will sign obstruct a fire escape, window or door? .. �?. Marquee ...............
3. Lower edge will be S.A... ..ins above the public way. Projecting
4. Upper edge will/be .9..ft... ..ins above the public way. Roof....................
5. Height ......fl: ZJns Width .J.1A.P..ins Temporary”
6. Face area .......sq.ft. """ "' '
Wall .......�.� .... `
7. Inner edge will be .12...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 .0....ins back from the street line.
10. Sign will project . ?...ins beyond the street line.
11. Sign will extend S?...ft.......ins above the building or pole.
12. Of what material will sign be constructed? Frame
�U,c�C.cl'�UJ`' ace.. .Ll
13. Estimated cost $..5��.��. .....,,.
. . ...v
The undersigned certifies that the above statements are tr to the best o his know)gdge and belief.
..... .. ....�`�t
........ ........... . ........
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1261
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
S REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Typeof Construction: ILLUMINATED WALL S[ N-C
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
INFORMATION PRESENTED:
Approved Additional permits required(see be
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
&& � . -Tias
Sig ature of Building Official IU 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.
SSS- r d�
1 t DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign JAN
Sidewalk Sign, Marquee or other Advertising Device 9 2020
(Application to be filled out In ink or typewritten) Number
Plans must be filed with the Building Inspecto
before a perm Hn a granted r Erection..................( ) tig49nj�M��SpFCT
Alteration.................(✓) q Oros�Ng
Repair.....................( )
Repainting...............( )
rr emoval..................( )
FE.1J....PAGE........PLOT.......
To the Building Commissioner: Northampton,Mass.
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME... ,.` (j ,p ��(j� f C� SLS
i ..............
1. Location,Street and No. . .. ..
.�..lU..�......5.. .........................................
2. Owner's name.... .... . ..�?..,,
3. Owner's address ......1..3........H_ZLrt..GL7., .L...t.........(!P..11 L
4. Maker's name..... ... ... ..�'� C
!� N v .
5. Maker's address....... a-........ .o. .... .Ca'7 Z1.h.'.. .f........S�.ifefL.N 6 re C Lp
6. Erector's name ... .. .. O�I �( �
7. Erector's address__L-_—..;4 (�
SIGN KIND OF SIGN
1. Sign will be(check one)illuminated Z.. Non-illuminated ....... (Designate)
2. Will sign obstruct a fire escape, window or door? Marquee ...............
3. Lower edge will be/$.'.ft........ins above the public way. Projecting !
....... ...... I'� ,� /
4. Upper edge will be .,��'.ft........ins above the public way. Roof...................... `IJ
5. Height . ..ft......ins Width .i2.ft..`!.'..ins Tem ora
6. Face area .ASsq.ft. p ry""""""'
Wall .....................
7. Inner edge will be ..IP.ins from the building or pole.
8. Outer edge will be .5-..Ins from the buildingor ole. Sidewalk....................
Other.........................
9. Face of building orpole is 0....ins back from the street line.
10. Sign will project .......ins beyond the street line.
11. Sign will extend ..Z>...ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame kh-vq.f.�.!� Face... L/C
13. Estimated cost
The undersigned certifies that the above statements are trruu�e to the best of his k owledge and belief.
......1.. c......... �4,^,
...
..........
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1260
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
TypeofConstruction: NON-ILLUMINATED SIGN - B
New Construction
Non Structural interior renovations
Addition to Existiniz
Accesso1y 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
INFORMATION 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
LA, I M,�t —
a 20
Signture of Building Official IU 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.
TRY of Nort4amptan
i G
�. �Rt188At�1tS3Plt8 ��}S`S sc�CG ; __.�'
R DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
-- Northampton, MA 01060
INSPECTOR Application for a Permit to Place or Maintain a Sign `SUN 19
Sidewalk Sign, Marquee or other Advertising Device 2020
(Application to be filled out in ink or typewritten) Number
0AtN Mp,A/r�N
Plans must be filed with the Building Inspector Erection..................( ✓) TSN Mq p�T�OMS
before a permit will be granted
Alteration.................( )
060
Repair.....................( )
Repainting...............( )
Removal......
0
A&...PAGE.�4 PLOTA...
To the Building Commissioner: Northampton,Mass. �••••••20•••••
Application for a permit to place or maintain a sign or other advertising device,or marquee.
BUSINESS NAME... . .... ...S4!.-v... ........5 .f �C�S
......................
1. Location,Street and No. . .A........L`.�..N.... ......S..(.................................
2. Owner's name..... .f�2.+?..�•,.,•� v
3. Owner's address ......�. 3.. .....� t1..0 C7.L..�... .t........ 1.u.E..N...C l 1�
4. Maker's name..... Yl �! __
................... .....N......�. ..........................................
5. Maker's address ..... .sol,. .....! .Q.. .... N..Ca`7Z1.N... .1........�.f'.I L/�6 Irl LT J I
6. Erector's name... .. .. .. °1.,.......s�..�OJ......C.
.............................................
7. Erector's address c�-� (�1,1{�•�2 -( IU C�_i� �; S`� �' ( IU(p LD �-(�-.
SIGN KIND OF SIGN
1. Sign will be(check one)illuminated . ✓ (Designate)
...... Non-ilium'l�ated .......
2. Will sign obstruct a fire escape,window or door? .!'�. Marquee ...............
3. Lower edge will be .rf...ft........ins above the public way. Projecting .............. —Ce r U I ti 6 Q L) 2
4. Upper edge will e . ft..gLins above the public way. Roof.....................
5. Height ..:...ft..'.Tins Width .�.ft..�..ins a /�-c M v 77 S
6. Face area 'V..sq.ft. Temporary............. C
7. Inner edge will be .U..ins from the building or pole. Wall ..Sidewallkk................
....................
8. Outer edge will be ..a...ins from the building or pole. Other.........................
9. Face of building or pole is ..!?!Jns back from the street line.
10. Sign will project .°...ins beyond the street line.
11. Sign will extend .e...ft .......ins above the building or pole.
12. Of what material will sign be constructed? Frame ........................ Face.,l ¢�
3. Estimated cost $../�.��,•,,,,,.
. ..... ............
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
File#BP-2020-1259
APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111
PROPERTY LOCATION 238 KING ST-STOP AND SHOP
MAP 24D PARCEL 070 001 ZONE HB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ILLUMINATED WALL SIGN -A
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildinyz Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Additional permits required(se below)
PLANNING BOARD PERMIT REQUIRE UNDER:§
Intermediate Project: Site Plan ANDOR Special Permit With Site Plan
Major Project: Site Plan AN /OR Special Permit With Site Plan
i
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry o$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
D
Sig ature of Building Official to 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.
_.---- C�i�� of �IIr�l�ttm�tun `✓ -- �
+�Rttssttrllusrfts �� '� << v L
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 h 3��^ co
iNShr;c rolz Application for a Permit to Place or Maintain a Sign o
Sidewalk Sign, Marquee or other Advertising Devic JT o
(Application to be filled out in ink or typewritten) Number .. ................ y,
Plans must be filed with the Building Inspector Erection..................( ) ��
before a permit will be-granted. Alteration.................Py -�
Repair.....................( )
Repainting...............( )
emoval.. 4V**(
.... )17V
ke
FEE........PAGE........PLOT.......
Northampton,Mass. .. .Q.w.E.... ."-_.20�-O
To the Building Commissioner:
Application for a permit to place or maintain a sign
o{rother advertising device,or marquee.
BUSINESS NAME ... .GG ...Id��.!".U... ........5.l.V. ...�.. 5...............
1. Location,Street and No. . ......5..t ......................................
2. Owner's name ....5.fL--).e.. .....Q....!!i.v... ........IJ..../..............................................
3. Owner's address ......�..3.. .....� urt..G C7.G�..4L... ..t..,.....��,�.u.�..N...�- ( ( 1-41-4
4. Maker's name ...../.4-5. . / �� N C v p
5. Maker's address .....�. .......... .o. .... �?..�aT Z1.N... �........ .1..14.1 N 6
6. Erector's name ... .. ... ..!`......4!.............( l.) C�
7. Erector's address^1 a:;�-...1.��a.� j..!�?�?.} �.!u s� g P !�-?.� (5��--D
SIGN KIND OF SIGN
(Designate)
1. Sign will be(check one)illuminated /Non-illuminated .......
2. Will sign obstruct a fire escape, window or doors O..
9 P . .... Marquee ...............
3. Lower edge will be J.°..ft........ins above the public way. Projecting .............. ® S ��
4. Upper edge will be ...tft...(a....ins above the public way. Roof..................... d �� P
5. Height . ..ft. ...ins Width .`f3.ft......ins Temporary.............
6. Face area,;?Ysq. tl
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 ..q...ins back from the street line.
10. Sign will project e.....ins beyond the street line.
11. Sign will extend ®....ft .......ins above the building or ole.
12. Of what material will sign be constructed? Frame
13. Estimated cost $...l.S.ra.ca.cr...
The undersigned certifies that the above statements are true to the 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:ro P O t-(
-7� NA
Address: KI-H 161 vr Telephone:
e 21 r- G>G t £ t,O t Imo(
2. Owner of Property: S rt32 :4t c t2v .0 o
Address:k3 S (TQ^n f v NTelephone: tP ( 7 �70 ^ 6 -71 �.
3. Status of Applicant:_Owner _Contract Purchaser _Lessee
✓Other(explain):
4. Job Location: ?,- N 6 S
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: 4/--,le o CG Lit.-y {- S S r s¢-77 0 N
6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary)
b v, 1,--4 ,,, r- Ips -
V-� 0V 0 I sr i„1s 4 (-e pl4LC-e V) e w
< afe-P 134t&J�20f n n-e (A.> /2 It) 1/p a
7. Attached Plans: _1/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 V�- 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 L,'� NO G /
IF YES: Describe the size,type and location: (3 U t L-0(N G> r R O!J i - l> ( 0 M -'
C' 4' 1U low
Are there any proposed changes to,or additions of,signs intended for the property? YES NO
IF YES: Describe the size,type and location: L 6 I S( Co N y wyl «S
q
CL-S C u-V� n �d Vl
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:
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. 1
DATE: I Z V APPLICANT'S SIGNATURE
C-tt-? 5-n06C Ab t S( & r� , Cotit
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
IMF
_ Retail Business 1385 Hancock St
Services Quincy, MA 02169
A Company of Ahold Delhaize USA
January 21, 2020
Christina Moreau
Agnoli Sign Company, Inc.
722 Worthington Street
Springfield, MA 01101-1055
"Retail Business Services is the agent for its affiliate Stop & Shop
with respect to signage and other matters. We hereby authorize
Agnoli Sign Company, Inc. to file, on behalf of Stop & Shop,
permits and approvals necessary to perform the installation of
proposed signage"
Sincerely,
William C. Ercolini
Manager Architectural Engineering Standards
Retail Business Services an Ahold Delhaize USA Company
The Coinmonliv alth of Massachiisetts
l _ = Department of Industrial Accidents
( 1 Congress Street, Sivitc, 100
Boston, ,'YIA 02114-2011'
www mas:s.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
Applicant Information TO BE FiLED WiTH Tiff( PERMITTING AUTHORITY.
Please Print Legibly
Business/Organization Name:Agnoli Sign Company, Inc.
Address: 722 Worthington Street /PO Box 1055
City/State/7ip:Springfield, MA 01101-1055 Thune 413-732-5111
Are you an employer'Cheek the appropriate box: Business Type(required):
.Q I ant at emplover with . employee,(t'.tll and/ 5• ❑Retail
or har(-time}."
c, Restaurant, lanFating hstablishment
? [] f
Ma sale proprietor Or partnership and have nk)
employees working for mt: in any capacity ❑ORice und/Or Sales(incl, real estate, auto. etc.)
[No workers' Collip. insurance requiredl h. [] Non-profit
3.❑ We area corporation and its ul'ticers have exert i,,d
� Q. ❑finlcrtainmrn(
their right ht of exemption per c. 152, IN),and we have
no employees. [N0 wurket;s' comp. insurance required]*.I ► N1aratfaclw'ing
4.❑ We are a non-1)"011(nrganiza(ion,staffed by volunteers. I I.� Health Care
with no employees. [No worker,' ccatnp. insur;ur, rzq.] 12.0 Other
'Ally,u,plicant that check,liox#I mutt als,,till out tltc section bciov,.huaau;g tkwr%%vrkers'cornpens,u,nn poli,y ini'mmulion
**It tile corporate officer,have exempted tht:m,,;hes.but the c„rporatton h;,.,other c,npluy.es.;t worker,'
organ-zattun shot-d cltcck box ,u,no-icy
rcqutrcJ and rmvh a;,
inn an einployer that is proi4ding wurkcrc'compell.vatirnr insurunce for my c=»rpl(fl•ec..j. Relow A the palir"/r►/urmation.
Insurance('utttpany N.antr. Sentry Insurance
Insurer's Address: PO Box 8048
01y;ylalei/.11): Stevens Point, WI 54481-8048
Policy 401-Self-in.. Ltc•. ii A0130589-05 Expiration 06/21/20
Attach a COPY of the vvorkers' COn,pensatioll policy declaration page(shuwiag the policy uun,ber and expiration date).
Failure Insecure uwcrage as rzquircd under Section 25r\ of ikl(ii. c•. 15.2 can lead t0 the intpa,sincm of criminal peva}ties ul',
tine up it)1;0.01)OU and:or one-year irnprisoament,as w 11 a,etc it penalties in the firm Of a S I(P WORK ORDER and it line
of up it)'+25U.t)O a day against the vtolalor. Be advised l at a copy of this staletuent may he ti,r�tardad to the Ofaire cif
Invrsli_�afinn. of th; I)1 for in. Ince coverage ceriliralion.
1 do hr;rha: certif i, it rdc r N( ,anti and penalties of perim),that the inJorinatiurr provided above is true and correct.
Uatt:-
httt,l,e tt,413-73 -5111
Official use ottlr. Do not write in thic area, to be compietcd hl�city or town n/ficial.
City Or 7b►�n:— Pcrtnit/I,iccnse#
Issuing Authority (circle one); – -
1. Board of health 2.Building Deparlrnent 3.CityiTown Clerk 4. Licensing Board 5.Selectmen's Office
(i.Other
('ori It Person;
--- Phone#•
www m•t,,%um,..d,a
AGNOLI SIGN COMPANY, INC. - 722 WORTHINGTON STREET, SPRINGFIELD, MA 01105 TEL. (413) 732-5111 FAX (413) 787-2169
ACRYLIC
L.E.D. CHANNEL LETTER RACEWAY METHOD
METHOD OF METHOD OF OF
ATTACHMENT ATTACHMENT ATTACHMENT
.040'ALUMINUM
&WED ENAMEL RETURN
BRICK WALL
WALL
,ANG,HOLE WALL JEWELITE TRIM
R 3/8•STUD WHITE JEWELfIE 3/8
11
Pa
PLASTIC TRIM a•X 3/8• PLEXIGLASS
HANGER BOLT FACE 13„ 4„
ELECTRICAL - HANGER BOLT ACCESS COVER
HOLE OR FASTENERS
\ 3/M•PLEX FACE 3/8•X T BOLT ARCYLIC
OWOFF �.?� LETTER
SWITCH �1
• WHrtE GE LE.D. T UOUB)TIGHT
3/8"X 3"LAG BOLT
BACKER ALUMINUM AS NEEDED
POWER SUPPLY
5/8'PLYWOOD 12 3/811STUD
BACIONG 5"
LIQUID TIGHT-1"
'UL APPROVED&
DRAIN HOLE LABELED WIRING
ss DRAIN HOLE
FRONT VIEW LETTER SIDE VIEW LETTER
POWER SUPPLY 1/2"SPACER
WITH THREAD
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