18D-066-002 City of Northampton Map:Lot 18D-066-002
Massachusetts Date issued 09/14/2023
Inspector of Buildings Permit # BP-2023-1272
Permit Fee $60.00
SIGN PERMIT
Business
Address 24 NORTH KING ST
Applicant Installer KINGSTON SIGNARAMA
Applicant Installer Address 1 ROYSON DR, KINGSTON, MA
Work Description ILLUMINATED SIGN - CHEECH AND CHONG'S
DISPENSORIA
Estimated Cost $7200
Building Department
Approval by: Jonathan Flagg IT
File #BP-2023-1272 ZJ��
APPLICANT/CONTACT PERSON:KINGSTON SIGNARAMA
1 ROYSON DR KINGSTON, MA
PROPERTY LOCATION 24 NORTH KING ST
MAP:LOT 18D-066-002 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $60.00
Type of Construction: ILLUMINATED SIGN -CHEECH AND CHONG'S DISPENSORIA
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
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
lor
• cV)
Si at e of BuildingOfficial 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
Massachusetts
tif *
DEPARTMENT OF BUILDING INSPECTIONS
212 Mean Street • Municapal Building t:
..., "....
N 1.;.:^0,_ Northarapton, MA 01060 4*-W
Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee
(Application to be filled out in ink or typewritten) Number
,--
before a moil .. eL CEIVED AlteratiOn ( }
Repair (
Repainting (
i SEP 1 3
oF.p.T.oF I3UILDINC IN
2023
0 N rthampton, :LL Removal
rs'AKUP.PAGE PLOTMa :. )
20 er-/&/.039V
_._._._._2LORTHAMPTON'.MSAPOE1C067.01 NS
Application for a permit to place or m • sign or other advertising device, or marquee
BUSINESS NAME UACC C V\ ct,-‘ 461's bispcin5orta.
1. Location, Street and No. ....2m....A1,....1(1rxj...5:-.1re.< I
2. Owners name Ecluid.ra A j-&reA
I 3. Owner's address PO. gOA 5-37 1.041 1444'9 , Mil 0(c)7 .--
4. Makers name is///6i
5. Makers address
6. Erectors name Kt 154zyt SI cc,a a otek.
, ,
7. Erector's address I 61.1a.\/) l Ve- i NAV.) 114 4
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated .J.... Non-illuminated
2. Will sign obstruct a fire escape, window or door? ..N.a. 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 ile .ft '''' ins Width . ...ft ins Temporary
6. Face area H.q...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 ..i=kA^.t.4.1.‘0:1....... Face. f.k>ll ( A43St,
I13. Estimated cost $ i 49-00
l The undersigned certifies that the above statements are true to the bestnof his knowledge and belief.
6i,t--filA4-1- —
(Signature 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: KAI/1: )� t Sftp11/4 YYtl�
Address: K Ut U r' 1't 't n Y1 MTelephon : 'I ' S3 d ( 3 5'5-
2. Owner of Property: C1 Q� VY41I�/1 ' Y'f f hc='1 t. let
-
Address: p L{ 1t 7 70
Telephone: � t"� � �-—
3. Status of Applicant: Owner ✓Contract Purchaser Lessee "r
Other(explain):
4. Job Location:,, ! t S lcre e
Parcel ID: Zoning Map# -7 Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: t/4<a+1-h
6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary)
(,£ tIiuM'eta(-cl( Sijnhcx t din rtn"( (e(ltr3 u'I re11r bt aPt Ince 5 w1 frnnsttittr.,f'
ViA I ('k�c5 ' —tc �L� Ssic,141 : LEA Ptd✓ ,r)Pp►l-t"rtnti"(4l P-014046-t2.-EC 10-30VftC
.S(eci-rica.( T199Ic $wt tG� 1 1a I-.0 V Pr'eiAhrc 4 if,/ je4.40 4 idne-hti bcy.r 5
7. Attached Plans: Sketch Plan Site Plan _Engineered/Surveyed Play 5+0I(C(
fro of
8. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO DON'T KNOW V 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: e„-t-te Pri s rc►L}A 1 / l lr!, crn.n.I (oir¢,c howl
lbjec S UP I6vV
Are there any proposed changes to,or additions of,signs intended for the property? YES NO ✓
IF YES: Describe the size,type and location:
Page 2 of 3
{
11. ALL_INEQRMATIONMOST BE GQtitli'LE] D > IM T CA _SE D_ENLED QUE TO LAt 1(0_, 1NF_O_RMATION,
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: f 02 3 APPLICANT'S SIGNATURE j /7 za1/L ✓1+�7
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
•
The Commonwealth of Massachusetts
Department of IndustrialAccidents
� 111t= 1 Congress Street,Suite 100
.mul�s Boston,MA 02114-2017
11.10111, ' tvwru m ass.govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING At r/BORITY.
Applicant Information Please Print Legibly
•
Name{Business/Organization/Individual): 1 , 7 Y
Address: j 1))6(,)S 11 df l V<
City/State/Zip: K l 9Sfi0 MA 0 Z-34 I Phone#: 7 8 t 5-tc,
Are you au employer?Check the appropriate box: Type of project(required):
l. arn a employer with_S employees(full antl'or past-time).• 7. New construction
2.01 am a sole proprietor or partnership and have no employees working for roe in 8. Remodeling
any capacity.(No workers'comp.insurance rewired.)
9. El Demolition
301 am a homeowner doing all work myself.(No warken'comp.insurance required.)t
10 Cl Building addition
4.01 am a homcowucr and will be hiring contractors to conduct ell work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with to employers.
12.0 Plumbing repairs or additions
501 am a general contractor and 1 Have hired the sub-contractors listed no the attached sheet 1 3.�Roof repairs
These sub-contractors have employees and have workers'comp.insurance?
6.�We era a corporation and its officers have eurrised their right of exemption pa MGL c. 14.21Other
152,§1(4),and we have no employee.(No workers'comp.insurance required.)
*Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information.
homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such.
;Contractors that check this box must attached an additional sheet showing the mane of the tub-contractors end 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: Tivi fr-t,✓e 1 iY'$ 1 C6
Policy#or Self-ins.Lie.#: UP, — > 7 9 02 312 1 — L Z r"1°4'Ki Expiration Date: L(/Z Z/2 'f
lob Site Address: -)‘ , N f l t'l G 3?` City/State/Zip: N 1c=. r1 rv111 C t O 6
Attach a copy of the workers'compe.sation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains
and penalties of perjury that the information provided above is true and correct
Signature; CL J"�r t/ "`— � 1 Date: 3 C
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone II:
216"
,r4444,111%
• -- / # ' /
/ . i
t I,/ .0,..._„,.„,,„,
36"
' • ft
i *op AV -4(16
ISPENSO IA ii•or
(1 ) LED signbox
----------
N . , , 4.
i
,.... . . . .
It S4I - .,
. .
KINGSTON S Customer Contact: INVOICE #ignarama Designer: KR 9/12/23 000
781-585-1355
www.signarama.com/ma-kingston File: Cheech & Chong.ai Page 1 of 1 PROOF #3
Please examine this proof for errors or misspellings.The colors in this proof may not be an exactnatch of the actual print or vinyl colors on the final product.
Once approved,you assume all liability for incorrect sizing or design.Any changes made from thimint on is subject to additional charges.
C2023 KINGSTON SIGNARAMA.THIS DESIGN IS THE SOLE PROPERTY OF KINGSTON SIGNARAMA AND IS NOT TO BE USED IN WHOLE OR IN PART WITHOUT WRITTEN CONSENT.