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23B-046 City of Northampton Map:Lot 23B-046-001 Massachusetts Date issued 03/19/2024 Inspector of Buildings Permit # BP-2024-0268 Permit Fee $60.00 SIGN PERMIT Business Address 30 LOCUST ST Applicant Installer AGNOLI SIGN CO INC Applicant Installer Address P O BOX 1055, SPRINGFIELD, MA 01105 Work Description ILLUMINATED WALL SIGN - AMBULANCE SIGN Estimated Cost $5400 Building Department Approval by: File #BP-2024-0268 APPLICANT/CONTACT PERSON:AGNOLI SIGN CO INC P 0 BOX 1055 SPRINGFIELD, MA 01105(413)732-5111 PROPERTY LOCATION 30 LOCUST ST MAP:LOT 23B-046-001 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 WALL SIGN -AMBULANCE SIGN 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: Approved Additional permits required(see below) For all projects that need additional reviews p ;+t}xiD as checked below,please see the Office of Planning& Sustainability Permit page or scan here 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: § Findings 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 Y/72 I 2 � Zo 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. AmbLA cnce aSn City of Northampton gyp ,..... .�,.. �S •� / L. Massachusetts 4�r ,� It , _ 11 DEPARTMENT OF BUILDING INSPECTIONS St, ?f re, „' 212 Main Street • Municipal Building 13, :� y>af Northampton, MA 01060 scNW Al Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee o- 31r 26 V-7 Jf (Application to be filled out in ink or typewritten) Number Plans must be filed with the Building Inspector Erection before a permit will be granted Alteration ( /) Repair ( ) Repainting ( ) 4 a5o1 ( )FEE PAGE PLOT �/ Northampton, Mass. ..0(Cb1 Ji N' 20p .4 Application for a permit to place or maintain a sign or other advertising device, or marquee BUSINESS NAME .. ..Cener.al....,t'[.6.)G`ro Code.4..70. c.li,(.l.:z..:;l.. •-•‘.;`..0,\Ci1 1. Location, Street and No. ...&...L00.3.5.l....S ce.elk 2. Owner's name ...AC.3 8enero I ar i hCim 3. Owner's address ...3gq...Zeq6.t2Ai.00 ;fie.... `( r.u'i.1.\P.,. .....0.D..I45.... 4. Maker's name ....O.SOD\; 5:►sf) :..Iac., 5. Maker's address ..4..4. Yc....“)55 396.0plEAC ,.M Pi G11G1- 1.0.3.5. 6. Erector's name ..... .. nla),....5.�c5n. J. .c• 7. Erector's address ..Pc*)..Bo)(...1.05 5 3011 .Xi.elri.,. 1')...C,I10.►:.1.O.J.5 SIGN KIND OF SIGN / (Designate) 1. Sign will be (check one) illuminated Non-illuminated �/ 2. Will sign obstruct a fire escape, window or door? .N.0... Marquee 3. Lower edge will be .3(4.ft...O...ins above the public way. Projecting 4. Upper edge will be .1 ..ft I ins above the public way. Roof 5. Height ..1...ft..l...ins Width .15 l..ft..' ..ins Temporary 6. Face area 13r3'i.sq. ft. Wall .,l 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 .4 ..ins beyond the street line. 11. Sign will extend ...Q..ft ins above the building or pole. 12. Of what material will sign be constructed? Frame Face..A lim.i.n.am..... 13. Estimated cost $.c .5•,ct The undersigned certifies that the above statements are true to the best f his knowledge and belief. .0p , „.„..... (Sign to e f Owner or Agent) Page 1 of 3 THIS FORM IS PART OF THE SIGN PERMIT APPLICATION File No. ZONING IINFORMATION //�� PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: A8(1Q I; S;rn Address:--Pc) j)( Ins 5 Sc,I,` 'ela, rn Telephone: 13" 433 - 5)) 1 2. Owner of Property: me 3 CWner -8c,,Cshnin Address:Aq �F�i(��,��„� —0(• ` mOr Ato, M A Telephone: t\1• 1- t -01,�Gal 3. Status of Applicant: Owner ContracttI Purchaser Lessee .Other(explain): S\ (1 rt)ch or ! .Sistl \n31,ci\\ec 4. Job Location: (.0.3 tr ee- Parcel ID: Zoning Map# Parcel# District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: 1--\n5p-, c 1 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary) Ire}CIICk,c0 �, ncc,- itkm 9Cbr; cG-lerl in+4-Qc3 pe‘Nrea COCA_ h • 7. Attached Plans: Aketch 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 ` 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: 140 i k;p\e .5 sn5 Are there any proposed changes to, or additions of, signs intended for the property? YES ✓ NO IF YES: Describe the size,type and location: Deis nto- 11ksn;C>c rl ,Sian C5 pec 5ne Bch• A rc bu once Ecykonce 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: ,S111 )1 APPLICANT'S SIGNATURE api 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 ----RN ACGR� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 6/15/2023 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: The Dowd Agencies, LLC PHONE Catherine Palazzo FAX 14 Bobala Road IA/c.No.Ext):413 437-1042 (A/c,No 413-437-1442 Holyoke MA 01040 E-MAIL cpalazzo©dowd.com INSURER(S)AFFORDING COVERAGE NAIC It INSURER A:Middlesex Insurance Company 23434 INSURED INSURER B: Agnoli Sign Co., Inc. INSURERC: 722 Worthington Street PO Box 1055 INSURERD: Springfield MA 01101-1055 INSURERE: INSURER F: _ COVERAGES CERTIFICATE NUMBER:1343537788 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. ILTR INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE ( O /YEFF (POLICY YY) A X COMMERCIALGENERALLIABILITY A0130589003 6/21/2023 6/21/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $500,000 MED EXP(Any one person) $5,000 PERSONAL 8,ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 3,000,000 POLICY X JECT X LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY A0130589004 6/21/2023 6/21/2024 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS X HIRED I v NON-OWNED • PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA(JAB X OCCUR A0130589006 6/21/2023 6/21/2024 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTIONS n $ A WORKERS COMPENSATION A0130589005 6/21/2023 6/21/2024 X ;MUTE EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? 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 AUTHORIZEDTHRI RRREEPRRESENTATIVE 9I' ©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 � I Office of Investigations s i '� '' Lafayette City Center =r'.', 2 Avenue de LafaY ette, 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 I 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 22 4. Li I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor in aci employees and have workers' me any capacity. 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no i employees. [No workers' 13.Ef Other S:Tc'J e, 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 are 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. 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 A0130589005 06/21/2024 Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 30 O Ct St 3\c'e. City/State/Zip: )\I nh-Thrmp cl, )-IA 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 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 e ins and penalties of perjury that the information provided above is true and correct Signature: Date: 3I 11 iag-1 Phone#: 1-11?1- V0- 511 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): 11:1Board of Health 20 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 50"lumbing Inspector 6.DOther Contact Person: Phone#: Commonwealth of Massachusetts lip Division of Occupational Licensure Board of Building Re ulations and Standards Cons on CS-113467 v' E, pires:03/15/2025 JOHN G MAvORNm tc,,1 ', ; A. 281 PINEWOOD DRIVE LONGMEADf I MA 041NN ' r.".::TiuSivi�2r w,.e 'c /1. v'd;; " w%",n_. Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this!:cease Call(617)7273200 or visit www.rnass.gov/dpl 722 Worthington Street P.O.Box 1055 Agnoli Co. Springfield, MA 01101-1055 � Sign (413)732-5111 fax(413)787-2169 Memo To: City of Northampton,MA—Building Dept.Jonathan Flagg From: Amanda Pfeffer RE: Cooley Dickinson Hospital—Emergency Letters Date: 3/11/24 Enclosed are the sign permit applications for the new proposed signage for the Emergency Department and the Ambulance Entrance sign at the above location. I have enclosed the sketches along with check#1020 in the amount of$120.00 for this application.Can you please review and process these applications?Please let me know if any additional information is required or if you have any questions or comments. I have enclosed a self- addressed,self-stamped envelope for the permits to be mailed to us upon completion. - 175" - AMBULANCE ENTRANCE NON-ILLUMINATED, FABRICATED ALUMINUM LETTERS PAINTED TO MATCH PMS I86C (SATIN) I" DEPTH WITH STUDS FOR MOUNTING - 159" - 1 0 E VI E R G E N C \i N I ILLUMINATED (FACE LIT). FABRICATED CHANNEL LETTERS ' 37-30 3M RED TRANS VINYL ON WHITE ACRYLIC FACES 1,6•114-I�� SILVER TRIM AND RETURNS '-." I l *NOTE- ELECTRICAL WIRE FROM EACH LETTER WILL PENETRATE WALL TO REMOTE POWER SUPPLY T AMBULANCE ENTRANCE -T 1{ 'r EMERGENCY P.m em I. I ' 1 ..,1 ' 1 EAST ELEVATION ChannelcetteraPluohedivteut ted ORIG. DATE: 1-24-24AM REV. DATE: 2-6-24AM APPROVAL: DJOBS/A THRU Z/M MISC/MASS GENERAL BRIGHAM-NORTHAMPTON, MA 30 LOCUST ST.PLT 0 REV. DATE: 1-25 24AM ❑APPROVED CDR/MASS GENERAL BRIGHAM-NORTHAMPTON, MA 30 LOCUST ST.CDR 1�`� Company REV. DATE: 2 1 24AM DATE: �i� Inc. CUSTOMER: LOCATION: CONTACT: ❑APPROVED AS NOTED SALESPERSON: PROJECT MANAGER. APPROVED THIS DESIGN IS THE EXCLUSNE AGNOLI COMPANY,INC. DATE: NOT FOR PRODUCTION ® PROPERTY OF INCORPORATED SIGN EXTERIOR 722 SIGNNGTON STREET MASS GENERAL BRIGHAM MASS GENERAL BRIGHAM MARK JORDAN HARRY •ADAM ELECTRIC SIGN COMPANY INCORPORATED 399 REVOLUTION DR 30 LOCUST ST ❑REVISE & RE-SUBMIT � a«� �ff��. AND ALL RIGHTS TO ITS USE SPRINGFIELD,MA 01105 STORE#: DESIGNER: TEL.(413)732-5111 SOMERVILLE,MA NORTHAMPTON,MA DAB` ADAM NOT FOR PRODUCTION """ EA°"�°`armnesoa wuaw OR REPRODUCTION ARE LETTERS awmrx wrF uaw morn wnrac wor won *w w-wF.,rnorm rmanG wo mo�c rc�.wx