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23B-046 (284) City of Northampton Map:Lot 23B-046-001 Massachusetts Date issued 08/12/2022 Inspector of Buildings Permit # BP-2022-0944 Permit Fee $100.00 SIGN PERMIT Business Address 30 LOCUST ST Applicant Installer AGNOLI SIGN CO INC Applicant Installer Address P O BOX 1055, PRINGFIELD,MA 01105 Work Description ILLUMINATED GROUND SIGN- E-23- MASS GENERAL Estimated Cost $39000 Building Department Approval by: Jonathan Flag 0 0 II Z JDK File #BP-2022-0944 APPLICANT/CONTACT PERSON:AGNOLI SIGN CO INC P O BOX 1055 SPRINGFIELD, MA 01105(413)732-51 11 PROPERTY LOCATION 30 LOCUST ST MAP:LOT 23B-046-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED# EQUIRED DATE ZONING FORM FILLED OUT Cb ' J Building Permit Filled out Fee Paid $100.00 Type of Construction: ILLUMINATED GROUND SI -23 -MASS GENERAL New Construction Non Structural 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 FORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR S ecialPermit With Site Plan Major Project: Site Plan AND/OR Sp cialPermit 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 ApprovalBoard of Health Well Water Potability Board of Health Permit from Conservation Commission Permit lfrom CB Architecture Committee Permit from Elm Street Commission Permit PW Storm Water Management Demolition Delay v • v .42 TJP,t6 I I I/ Signa re of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's bur en 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. , S► E- 0�3 City of Northampton ogs"3 ;ro y s S,S SAC Massachusetts ��� _ !t� c. � 2 DEPARTMENT OF BUILDING INSPECTIONS x ' 212 Main Street • Municipal Building 1 , Northampton, MA 01060 srNh, .1004 Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee ��� r^9 ,r` (Application to be filled out in ink or typewritten) Number `i7 Plans must be filed with the Building Inspector Erection ( J before a permit will be granted. Alteration ( ) Repair ( ) Repainting ( ) if %loyal ( ) FEE lUvPAGE 0,PLOT Q ct& Northampton, Mass. %\.5 20.aa Application for a permit to place or maintain a sign or other advertising device, or marquee BUSINESS NAME 1 . ....Ce() x.QI...ar.S8hcm Calf. zn...)-: ;-40.1 1. Location, Street and No. 3 wv ....acee.-V 2. Owner's name C ,P.4. 52 A'O-� 3. Owner's address T30 LOC.?.3Y 3 1\1o0:hccepkO ...( ....Q1aw0 4. Maker's name t-- -D i30 mmom.C;c-1ic 5, 1- kb 5. Maker's address 5.. .(a)0.1..Skc .i ca3aa 6. Erector's name ..... `�.... .i �... c1..If�C 7. Erector's address .3aa1...l 0r.tL•10, 5k . .H 01101- 1055 SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated ..✓.. Non-illuminated 2. Will sign obstruct a fire escape, window or door? a.. Marquee 3. Lower edge will be ..a.ft.... ...ins above the public way. Projecting 4. Upper edge will be .5...ft....ti0i.ins above the public way. Roof 5. Height ... ..ft..1...ins Width .4...ft.1/...ins Temporary 6. Face area i 5..sq. 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 Qt1 ...... 13. Estimated cost $ The undersigned certifies that the above statements are true to the best of his knowledge and belief. op (Signa r of Owner or Agent) Page 1 of 3 aiLT THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING (INFORMATION PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Agnn`., ; (� C . 4.Address: 1Pc c). II�yc' 5 �pt;nj-te . MA CCII01 Telephone: I-I13- `k3a• 5ft 2. Owner of Property: L,CCAP.l i c' c'ecf) 1-f i 1, Address: ,b Sk• Icc l(1Gcc,c-Y0-) , ( A Telephone: k113- 5c.'a. a3)3 3. Status of Applicant: Owner Contract Purchaser Lessee 1Other(explain): 3T 0 \n\ec 4. Job Location: \-0C, j 4c 5ioree c Parcel ID: Zoning Map# Parcel#a36- District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: ti o ;--n 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) l-bspA cal- nc:m e o horse. 5 aac e' 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: Are there any proposed changes to, or additions of, signs intended for the property? YES NO h(` IF YES: Describe the size, type and location: e e ex ts-V\() C'ii ob e- }(�GrPc nen- ►11om,cc cc maoOTelenl cz46nets Icas - ee S15e4ch �oc aeka,13, � Page 2 of 3 3;sn E- a3 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 Rio i41 q AcyP. 3 O• N11 ACreS Frontage j' � Front: �O }ad Setbacks:(for sign)Side: ocd Rear: fJ�I 5 OO' Building Height Façade 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: APPLICANT'S SIGNATURE 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 4. Site r Recommendation book -- 16-001 Signage Recommendation E-23 Context Recommendation Notes Existing Location: Main Campus Entry Type: Sign Box Quantity: 1 Responsibility:Sign Vendor Permitting: Required Illumination: Internal Attachment: Footing Overall Height: 98 1/2" - " � r 7 Overall Width: 109 3/4" t.' Height: 72 1/2„ .*_, - . f ' ra COOLEY DICKINSON cy AlatWidth. iry »S4at»aSfrnf[Mf». »Dann. .« rid . Sign Depth: ♦EM[RGfMY •� - E- EMERGENCY . j- i wns eM.+noe i` i a EMERGENCY Mounting Height _I. .. ♦,wm e"nr. Existing Notes: *cur• {(eft. E- North Entrance North Entrance ' 4 Main Entrance 4— Main Entrance t. _ urgent care o,x T Urgent Care �..' ' ` .l ' Recommended Action Action: WiliM Approach'Remove existing sign and install new. Existing-Image 1 Existing-Image 2 Existing-Image 3 • -4 Make Good:Repair landscaping after removal and install. lc'bii Pr - • 1=21 'Ilt7 { tm Mass General Brigham lm Mass General Brigham Cooley Dickinson Hospital Cooley Dickinson Hospital s A... . tMf»raE NCY ,-:f ice,; .. _ ___ -11 4- EMERGENCY 4 EMERGENCY 30 Locust St. 30 Locust St. New I 111.0000.411 6'1' Type: D/F Illuminated Monument x.. . Quantity: 1 Illumination: Internal SIDE 1 SIDE 2 Attachment: Direct Bury Sign Code: MN.C.E.70.1 "', `, x w- 4-for;," Asset Height: 49"(face),70"(overall) kp, sK Asset Width: 95" ,- Mounting Height: 70" Concept Rendering Sign Artwork The contents of this document are for the sole purpose of determining design intent only end are not intended for construction purposes.®2021 Brandactive International Inc.All rights reserved. / (g) DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE k...-i 6/27/2022 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 The Dowd Agencies, LLC PHONE Suzanne R.Mlinarcik FAX 14 Bobala Road LAIC.No.Eat1 413-437-1042 ,(A/c,No):413-437-1442_ Holyoke MA 01040 ADDRESS: smlinarcik@dowd.com INSURER(S)AFFORDING COVERAGE 1 NAIC# INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Agnoli Sign Co., Inc. 722 Worthington Street INSURERC: _ PO Box 1055 INSURERD: Springfield MA 01101-1055 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:824472810 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. 1UE POLICJEFF POLICY EXP LTR I TYPE OF INSURANCE INSD ADDL SWVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY A0130589003 6/21/2022 6/21/2023 EACH OCCURRENCE $1,000,000 _ DAMAGE TO RENTED I CLAIMS-MADE 1 X OCCUR PREMISES Ea occurrence) $500,000 MED EXP(Any one person) $5,000 PERSONAL 8ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY X JERCOT X LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A0130589004 6/21/2022 6/21/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ I-- OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I (Per accident) A X UMBRELLA LIAB X OCCUR A0130589006 6/21/ 022 6/21/2023 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$n $ A WORKERS COMPENSATION I A0130589005 6/21/2022 I 6/21/2023 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER •ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 _ If yes.describe under - - - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence of Insurance AUTHORIZED REPRESENTATIVE 9 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts �; Department of Industrial Accidents 9; 4{' Office of Investigations ==i'I= Lafayette City Center =� ,/ 2 Avenue de Lafayette, Boston, MA 02111-1750 t =� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builderi/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization:'Individual):Agnoli Sign Company, Inc. Address:722 Worthington Street/ PO Box 1055 City/State/Zip:Springfield, MA 01101-1055 Phone #:413-732-5111 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 20 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions m self. [No workers' comp. right of exemption per MGL YP 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.2/Other 38 comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc 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. lithe sub-contractors have employees,they must provide their workers'comp.policy number. t 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:06/21/23 Job Site Address: 3r3 �CCL f A Sk City/State/Zip: Ida borop WI 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 ca lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penaltie 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 st tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi '\nd/the airs and penalties of perjury that the information provided above is true and correct. 4 Signature: ; ' Date: 44 Phone#: 413-7 2-51 1 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): I 10Board of Health 20 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 5�ludtbing Inspector 6.❑Other 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 Department From: Amanda Pfeffer RE: Mass General Brigham Cooley Dickinson Hospital Date: 8/8/22 Enclosed are the sign permit applications for the proposed signage at the above location.I have enclosed the sketches for each sign along with check#2588 in the amount of$280.00. Can you please review and process these applications?Please let me know if any additional information is needed.I have enclosed a self-addressed,self-stamped envelope for the permits to be mailed to us upon completion. 1