39A-020 AGNOLI SIGN COMPANY, INC. • 7"22 \V'C)I: I I IIN(, LON ti II<LL I SI'KINGIIELI), NIA (111(15 • ILL. ( —}13) 7',2 —5111 • FAX \X (� }1;1 7I)7 -2"1(f
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Baystare Medical Pracl ces
NOW ACCEPTG 4 '. Baystar NOW Hetb Mea cat Praames
N W PATIENTS "^, A CE 3
7.7. ... (.M 11413 -381 4100 ....,.. W ATIENTS
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Baystate LPL. Medical Practices
Pioneer Valley Family Medicine
NOW ACCEPTING
NEW PATIENTS
Call 413 -387 -4100
3' X 8' BANNER W /SHADOW BLUE COPY
CUSTOMER: BAYSTATE HEALTH LOCATION ° 118 CONZ ST CONTACT: DRAWING CODE BAYSTATEMED /2007/118 CONZ.PLT OR G. 5-7-10 REV. 0-0-00
280 CHESTNUT ST NORTHAMPTON, MA SALESPERSON: PETER DRAWN BY INIT DRAWN BY INIT SCALE
MS SPFL DRAWN ., MA DRAWN BY LANCE REV 0 - 0 - 0f REV. AOrao o
DRAWN BY em «aA a go ALL vrs
BAYSTAE /2005 -2007 118 CONZ.CDR 0 - 0 0
INIT DRAWN BY MIT.
TO rs USE OR REPRODUCTION ARE RESERVED
: :
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:
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: 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
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: \ \nr.) V, 5 n ( ■t».
Address: C) 0`=X Ir.,S: i 'r �f1C F4. ()A In,5, Telephone: 1 -113 - 13 - 511
2. Owner of Property: bn 4 e Ile() 1 4h
Address: air) (' .4)01 A• SPr,(Ya i; pCl, (11q Telephone: ull : " ( 4 1 .4 6o 5 n
3. Status of Applicant: Owner /Contract Purchaser Lessee
_Other(explain):
4. Job Location: 1 i% Cora 3 Mre e r
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property:
6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary)
( cr hnncpc c per f3Yp Ch •
7. Attached Plans: f 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 f 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 r 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
IF YES: Describe the size, type and location:
Page 2 of 3
• City of Northampton
M assac h use tt s ,4 4 5 , . , .+c cr
3 ' „s PA
( DEPARTMENT OF BUILDING INSPECTIONS a1
212 Main Street • Municipal Building 'XA .I t'
- .,,- ' Northampton, MA 01060 s ~ S"
� ��
Application for a Permit to Place or Maintain a Sign
INSPECTOR pp g
Or other Advertising Device, or Marquee
P1v o/(
(Applicat._i .to b pait iropk r. pewritten) Number ,
t vi 4 t'
Plans must be filed with the Building Inspector J _= ^_ — Erection ( )
before a permit will be granted. Alteration ( )
Reair MAY 2 2.010 ,'• Repainting ( )
�_-1 Removal ( )
fr r r'( FJ FEE PAGE PLOT
Northampton, Mass. .20.....
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME . -ES Q4e,...CicaA...PCO a ces.. . 'tacleP.c...q jPi...raritl.i..
1. Location, Street and No. I .I: b .....Coni.... .5\ r.eQ 4
2. Owner's name S q.54.31e....r QO I +h ((�} f,
3. Owner's address .. o....0 - nOk...5.kce Q t ..... .r.�. t' Rd. MA
4. Maker's name Pty.ICAt. .3.8.0 C. i 0C. (?
5. Maker's address . .dol....k. h�n4
rar .A-. n :
.. .. C....eRX ..ID5S.... .irn..�,.el8a..fa:1.0110l low
6. Erector's name n j f (k7.li...3 Cc...4.oc •
7. Erector's address - .4. aa.. I ... 451 -..... Pc . eox. ..IIJ.: .r.
S.... c i Q Id,.p(I.R .Q.i.loi :.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? .1.0 ... 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 ..,3..ft...c>. ins Width ...$.ft... b ins Temporary..../
6. Face area .d!k.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 .WA .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 Face
13. Estimated cost $ ,,,.c:?. .it,0
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
r '
File # BP- 2010 -1045
APPLICANT /CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P 0 BOX 1055 SPRINGFIELD (413) 732 -5111
PROPERTY '1 �. ,90` % rxf
MAi P EL 020 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 603 Fee Paid
Typeof Construction: ERECT 3 X 8 TEMPORARY BANNER - NOW ACCEPTING NEW PATIENTS
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
Approved V 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* ✓ -7 ' -T ()(2')
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
SIZR) I 0
Signature of Building Of is al 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.