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24D-157 (2) City of Northampton Map 24D Lot157 Zone HB(100)/ Massachusetts Date issued 4/1/2021 0:00:00 Inspector of Buildings Permit # BP-2021-1092 Permit Fee$100.00 SIGN PERMIT Business Address 166 KING ST Applicant InstallerAGNOLI SIGN CO INC Applicant Installer Address P 0 BOX 1055 Work Description ILLUMINATED GROUND SIGN - BOTTLE-0 Estimated Cost $1500.00 Building Department Approval by: III. • I, • Z -0k File#BP-2021-1092 APPLICANT/CONTACT PERSON AGNOLI SIGN CO INC ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413)732-5111 PROPERTY LOCATION 166 KING ST MAP 24D PARCEL 157 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHEC ST ENC ED R UIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 4D 6 ° Fee Paid 5/ Typeof Construction: ILLUMINATED GROUND SIGN -BO - 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: X 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 q‘ lei/1 Sig ture of Building Official I 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 Northampton atHgMpio 0 'e. Massachusetts / S.. 'fig 14 �,� ,QP-- 7/ioQz tjIr t i-( ;S 0 4 DEPARTMENT OF BUILDING INSPECTIONS r rag 212 Main Street • Municipal Building yJd, � '<'�`" Northampton, MA 01060 rsV ... ;16� ~ Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee K,li A (4 g ( nation to be filled out in ink or typewritten) Number n it wi h h CE- r, .0 Erection..................( ) before a permit will be granted. . Y ..r Alteration.................( ✓) Repair.....................( ) MAR 3 O l Repainting...............( ) ! 2021 Removal..................( ) L____ DFP249 oF�ui F4E\P PAGE LOT NOT OLD, iNSP n "T-N'M-=oso.._ Northampton, Mass. NOtch..a .....20.021 Application for a permit to place or maintain a sign or other advertising device, or marquee BUSINESS NAME b4 t.-..c) 1. Location, Street and No. ...1 1D.LQ...K1O8...&....I0.or 1 apit,,,..MA 2. Owner's name l !-AAR.-.0 / Cel....t\l;t'.6b1C3..71. 664.1 3. Owner's address IlanINN..t , A• I )car.--horn ...H.A...0I0I00....1..to rar vied A oioD1 4. Maker's name .... .�0.61..3160...C.�o, Inc. 5. Maker's address . !. , caX..►Q``,5....Sp.r.i.(#.6d..}-1A..QIlA1:1OJ`O 6. Erector's name ...................T80..(,',p...Icc.. . r . .7. Erector's address . .Q ...f<���J.., e�.. .�..©��0�.'.1O>5.5 c) SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated Non-illuminated 2. Will sign obstruct a fire escape, window or door? ..i\}.t .. Marquee 3. Lower edge will be ..S..ft...C...ins above the public way. Projecting 4. Upper edge will be .....ft...C...ins above the public way. Roof 5. Height .t:\..ft..C.ins Width ..•D..ft..)..ins Temporary 6. Face area .91.Aq. ft. Wall 7. Inner edge will be ins from the building or pole. Ground ✓ 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 pole. 12. Of what material will sign be constructed? Frame .O\CCSIOlocf..... Face...I.P.I.M 13. Estimated cost $....) .',.,cc The undersigned certifies that the above statements are true to the best of his knowledge and belief. (Sig a re of Owner or Agent) Page 1 of 3 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING (INFORMATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: /43nni; 55,0 (_p /Inns Address: PO AC 1655 S4 ';n ,�eIV I1� I )°,Tefoe: ��,3 ' -Jr 112. Owner of Property: 9prw NY'hp ! ) 8+4/ Address: C(nrrIv i r-w 1/1- (rtictimmpMn)M A Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee �Other(explain): 5 c I.A5-"I)er 4. Job Location: )to W n).0 54re 4 Parcel ID: Zoning Map# 2'Ihv Parcel# /51-t j District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: (.1()/Y)07P(60 I 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) ikI Pm - pnce,3 toe pm-5.t 3tOu(dsjn tz-th 117Ynr A, 05 poth�d ,Ee 7. Attached Plans: V Sketch Plan Site Plan Engineered/Surveyed Plans 8. Has a Special PermitNariance/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 •v/ 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: C xis J71 yri.viC7 55n )r) flon4 nP bv1 I d 08. . Are there any proposed changes to, or additions of,signs intendeden for the property? YES / NO IF YES: Describe the size, type and location: I"Pc4 Pace -For PA i3)-;;)C1 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:(for sign)Side: L: R: L: R: Rear: Building Height Facade Square Footage # of Parking Spaces 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: c29/2/ APPLICANT'S SIGNATURE (ip/".t.... 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. FILE # Page 3 of 3 1 /N ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) 6/12/2020 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 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 The Dowd Agencies, LLC PHONE Suzanne R.Mlinarcik FAX 14 Bobala Road .ANc No.Extl:413-437-1042 UM,No):413-437-1442 Holyoke MA 01040 ADDRESS: smlinarcik@dowd.com PRODUCER CUSTOMER WI: INSURERS)AFFORDING COVERAGE NAIC N INSURED INSURER A:Middlesex Insurance Company 23434 Agnoli Sign Co., Inc. INSURERS: 722 Worthington Street PO Box 1055 INSURERC: Springfield MA 01101-1055 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:80762849 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 ADDLSUBR, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR,WVD POLICY NUMBER ,(MM/DD/YYYY) (MM/DEVYYYY) LIMITS A GENERAL LIABILITY A0130589003 621/2020 6/212021 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $500,000 CLAIMS-MADE X OCCUR M ED EXP(Any one person) E 5,000 PERSONAL 8 ADV INJURY 51,000.000 GENERAL AGGREGATE S 3,000,003 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PF�T X LOC S A AUTOMOBILE LIABILITY A0130589004 6212020 6212021 COMBINED SINGLE LIMIT $1 000000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) S X NON-OWNED AUTOS S S A X UMBRELLA LIAB X OCCUR A0130589006 6212020 8r212021 EACH OCCURRENCE _ S5,000,003 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ _ X RETENTION S 0 $ A WORKERS COMPENSATION A0130589005 6212020 6/212021 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,003,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,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 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD t7\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ? Lafayette City Center =Las/ 2 Avenue de Lafayette, Boston,MA 02111-1750 �` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Agnoli Sign Company, Inc. Address: 722 Worthington Street/ PO Box 1055 City/State/Zip Springfield,MA 01101-1055 Phone #:41 3-732-51 1 1 1 Are you an employer? Check the appropriate box: Type of project(required): 1.© I am a employer with 28 4. 0 I am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors 6. Q New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.: 9. ❑ Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.Q Plumbing repairs or additions 3.❑ I am a homeowner doing all work [No workers myself. ' right of exemption per MGL Y comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.M Other s`Gt 5 comp. insurance required.] J• *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t t lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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: Middlesex Insurance Company Policy#or Self-ins. Lic. #:A0130589005 Expiration Date:06/21/21 Job Site Address: nip Kl 3Iroef City/State/Zip: //Or�j(1 1(), ga Attach a copy of the workers't pensation 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. I do hereby certify ;der the ain.• Ind penalties of perjury that the information provided above is true and correct Signature: Date: , 1a3/nz I 413-732-5111 Phone 4: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: 722 Worthington Street P.O.Box 1055 Agnoli Sign Co. Springfield,MA 01101-1055 (413)732-5111 fax(413)787-2169 Memo To: City of Northampton,MA—Building Dept. From: Amanda Pfeffer RE: Bottle-0 Sign—166 King Street Date: 3/29/21 Enclosed is the sign permit application for the refacing of the proposed sign at the location above.I have enclosed the sketch along with check#2438 in the amount of$100.00 for the application.Can you please review and process and this application?I have enclosed a self-addressed,self-stamped for the permit to be mailed to us upon completion.Please let me know if you need anything else or have any questions,comments. Thank you. Amanda Pfeffer Amandac agnolisign.com AGNOLI SIGN CO., INC. 1