Loading...
18D-070 (5) File #BP-2024-0368 APPLICANT/CONTACT PERSON:MASS SIGNS LLC 988C SOUTHAMPTON RD WESTFIELD, MA 01085(413)642-2175 PROPERTY LOCATION 971 BRIDGE RD MAP:LOT 18D-070-001 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 GOOD WILL WALL 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 v Additional permits required(see below) For all projects that need additional reviews 7A-x0 as checked below,please see the Office of Planning& Sustainabilitv Permit page or scan here - PLANNING BOARD PERMIT REQUIRED UNDER:§ ❑* ..o.: 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: § 350 - *7, L Finding V 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- 8 Zozw Signature of uilding 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. IF'6j City of Northampton aa<nAMpr S «" S j ,�.`:� ', Massachusetts ��'<te ( i A f.-I tt 6 i 1 ' .A' DEPARTMENT OF BUILDING INSPECTIONS a T'� 212 Main Street • Municipal Building y'.) C! \+:air: North 'Pi , ,.',�° Northampton, MA 01060 '. `" Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee �Q / (Application to be filled out in ink or typewritten) Number `�p• 'Z e - 3652 Plans must be filed with the Building Inspector •- --.^Li' ; , , Erection ( X before a permit will be granted. Alteration ( ) Repair ( APR Repainting ( 1 2024 emoval ( i FLIP) PAGE PLOT C,'Gf 116M, i it r.•a.7!Mgpi-c+:IO 1S ^ rnA of , Northarrgp�t3�t,Mass. ;3/C)/ 20 211 Application for a permit to place or maintain a sign or other advertising device, or marquee BUSINESS NAME SOCA) J t.l 1 1. Location, Street and No. 91......9g..ibot'ri....A.....N(1rth1.7.fvirx Aii4 O(c4e 2. Owner's name LLC/. .�.D at-1 .C:LC / 3. Owner's address l 20 £'-- V jP 4' .4'!11 U..Q ....A14 Cil 1 " l 4. Maker's name \'S ..1).1113 LLC 5. Maker's address cl?e, ) .. ..0114 pi-en '1)....W€JIX1.E1 M ©roeS 6. Erector's name Al Pt6 5. S i 1 N L/L 7. Erector's address t� s c ��� S ►�.u:�.�.�.�.2.p ���`I�* 1) 4114©cam SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated .. Non-illuri inated 2. Will sign obstruct a fire escape, window or door? ....e'.. Marquee 3. Lower edge will be .1. ..ft..P.....ins above the public way. Projecting 4. Upper edge will be .I. ..ft...2 ..ins above the public way. Roof 5. Height .3..ft.ce..ins Width ..23.ft ( ins Temporary 6. Face area .$1...sq. ft. Wall X 7. Inner edge will be .O..ins from the building or pole. Ground 8. Outer edge will be ..11...ins from the building or pole. Other 9. Face of building or pole is23 l ins back from the street line. 10. Sign will project ..Q..ins beyond the street line. 11. Sign will extend ...Q..ft ...O..ins above the building or pole. 12. Of what material will sign be nstructed? Frame .At31 (11.11\ Face..A.Ct...I•IC ... 13. Estimated cost $..g,.CO.(a(v• . The undersigned certifies that the above statements are tru o the best of hi kno ledge and belief. (Signature of Owner or Age t) Page 1 of 3 :s1 1 MG LA/HUM/le"M(4 LIS IV lI1LLJJKL/{KJCtia Department of Industrial Accidents Ira =� + Office of Investigations 600 Washington Street Boston,MA 02111 -,' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Mass Signs L L C Address: 988 C Southampton Road City/State/Zip: Westfield, MA 01085 Phone#: 413-642-2173 Are yoy an employer?Check the appropriate box: Type of project(required): 1. II am a employer with 1 4. ❑ I am a general contractor and 1 6. El New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑ Building addition [No workers'comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.1=1 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 employees. [No workers' 13.t other Sign 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. tContractors 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: NGM Insurance Company Policy#or Self-ins.Lic.#: WCJ2639H Expiration Date: 01/29/2025 Job Site Address: q1-4.1 bRiJYi.- . City/State/Zip: AjOr/I r M 1A:V 1 M 4 c/cO 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 nde the pains and pe a 'es erjury that the information provided a ove 's true and correct. Signature: ` /tiG(r Date: 7 j 47 Phone#: q/3 &y2 — 2/ Att O ( ((JJ Official use only. Do not write in this urea, to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia +a 'mac- 'g ID E-- TT9b,1 r — — — . _ J Goodwill ii goodwill •^� 23ft l in 1 .t Front Lit Channel Letters (Raceway) Faoni V 3ft 6 in ---_ tv. 23ft 1 in _r I —� '`.- I IMPORTANT:Please review the attached proof for size,layout,and content.Colors displayed in the proof are not representative of the finished product due to individual display settings. Upon output,we use the CMYK color values supplied in the file.If a color match is required,a Pantone(PMS)color number must be provided with the artwork.Please reply to this email for your approval or any changes that need to be made.Your approval acknowledges that the proof is correct and that we may proceed with production. This design and drawing submitted for your review and Name: Company: t -4 A S S s I G N S approval is the exclusive property of MASS SIGNS Phone: Fax: E-mail: It may not be reproduced,copied,exhibited or utilized for any purpose,in part or in whole by any individual Comments: without written consent of MASS SIGNS. File: Date: