17A-270 (3) City of Northampton
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DEPARTl OF BUILDING INSPECTIONS
j Zg ' -� 212 Main Street • Municipal Building ` \111, .b
I Northampton, MA 01060 3�"31�0
INSPECTOR Application for a Permit to Place or Maintain a Sign
Or other Advertising Device, or Marquee " _1
(Application to be filled out in ink or typewritten) Number . XI
Plans must be filed with the Building Inspector Erection ( )
before a permit will be granted. Alteration ( )
RECEIVED Repair ( )
Repainting ( )
Removal ( )
JUL 25 all
FEE PAGE PLOT
DEPT. OF BUILDING INSPECTIONS
NORTHAMPTON, MA 01060 Northampton, Mass. 20.....
To the Building ,,n nr1Issloner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME N t\cd\-' 6 4e0- �'
1. Location, Street and No. ...1. "iS6 OW.4--
2. Owner's nameT . SQ
3. Owner's address .. .. kG .(, .,.J 53 • • k .0. it 1. s'
4. Maker's name S' i ( C--4
TA
5. Maker's address ..... 1 i(>;' d-
6. Erector's name S . ......... (\')...:Qc(3,;ue .
7. Erector's address :_? C GL..b..
SIGN KIND OF SIGN
'' !' - ,„r (Designate)
1. Sign will be (check one) illuminated Non - illuminated '
2. Will sign obstruct a fire escape, window or door? ..C, Q. .. Marquee
3. L.-- -•• : - .. l .:: _ • _ - Projecting
4. :•- _ : :- :._ - .- Roof
_ 5. Height . 1, . ins Width .. 4 ..ft ins Temporary
7 -6. Face area ;1/4'..sq. ft. 1 a all
7. I- ..
: -.- ' fejt Ground.
8. e . - • • • r. , ..:. -. Other
9. Face of building or pole is .\ _ ;. ac from the street line.
10. S' = ' • - _ - ...' - - - line.
12. Of what material will sign be constructed? Frame 1.,00.0(.... Face.. .1,1...):3c4
13. Estimated cost $ t t 000
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
c. -- ( jkl.A04-
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I (Sign ure of Owner or Agent)
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Page 1 of 3
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maple Height Investments 313 Maple Street
S pringfield, MA 01105
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11. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
s(etd
12. ( This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage
Front:
Setbacks:
Side: L: R: L: R:
Rear:
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus bldg and
Paved parking)
# of Parking Spaces
# of Loading Docks
Fill: (volume & location)
13. Certification: 1 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 3of3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: C \"\\LI k, E 0 / U St
Address: 13 1, (f " Telephone: dk '3 1 J 4 I�
2. Owner of Property: �( V° O
Address: 3 (� V 1A <c � j � -(� Telephone: /'( �,) 73,4 (3
3. Status of Applicant: Owner Contract Purchaser Lessee
_Other(explain):
4. Job Location: t, c1 0 }�(M 5J E C'�Z G° V\Ar t. 5 of 04
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property: - l
6. Descriptian,_of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary)
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 DONT KNOW YES IF YES, date issued:
IF YES: Wa a permit recorded at the Registry of Deeds?
NO DON'T MOW YES
IF YES: Enter: Book `� Page and/or Docume• •
9. Does the site contain a brook, body' 'of,water or wetlands? • DONT KNOW YES
IF YES: Has a permit been, or need to be; opt.• ed from the Conservation Commission?
Needs to be obtained Obt ' ed ` N , Date issued
10. Do any signs exist on the prop ? YES NOS_
IF YES: Describe the ' e, type and location:
Are the any proposed changes to, or additions of, signs intended for the property? Y €S NO
IF ES: Describe the size, type and location: y.
Page 2 of 3
4
File # BP- 2012 -0085
APPLICANT /CONTACT PERSON MAPLE HEIGHTS REALTY TRUST /(
ADDRESS /PHONE 313 MAPLE ST SPRINGFIELD (413) 732 -1343 0
PROPERTY LOCATION 110 OAK ST D cca A
MAP 17A PARCEL 270 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out b�� ��,r�
Fee Paid ,J V
Typeof Construction:_ERECT NON -ILLUM GROUND SIGN - MAPLE HEIGHTS REALTY TRUST
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:
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
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.