39A-020 (2) i \(1NO1-I SIGN (()MI'r\NY, INC. • 722 \V'OI: 11 IIN(, 1( )N ti I RLL I ti1'I:IN(;IILLU, N1,1 H05 • II I_ (11 >1 7 12 'i11 I • Ii 1X r�I II' 7i 7 ? I(1`)
Baystat .� Melicat Pract cez
NOW ACCEPTING eay,ia. Meauawracuas
NEW PATIENTS �� ., CEPTI N
LW 413 4100 NOW ACCEPTING
NEW PATIENTS
•
•
' .mw.e�w.e..a 'z.d 1413 387 -4100 '
RP
Baystatej. 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 ORIG. $-7-10 REV. 0-0-00 SCALE
280 CHESTNUT ST NORTHAMPTON, MA SALESPERSON: PETER DRAWN BY INIT. DRAWN BY: INIT
DRS : BAYSTATEMED /2007/118 CONZ.PLT . O — O — OC REV. AGNIXIAGN ova Auico L raaN�
SPFLD., MA DRAWN BY LANCE REV
i RICHES
BAYSTAE/2005-2007 118 CONZ.CDR 0 0 0 ID RS USE OR REPRO 1/EI1CN ME RESERVED
_ _ DRAWN BY: 0 — NI _ DRAWN 8Y: WIT.
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: 11 I S;sn (rr; • 1cC •
Address: 107°j r PIC{ (Y1R c v i - I( - )5.1 Telephone: H t3 - 541
2. Owner of Property: be, y 3rC {R Hea I +h
Address: c W6 (' he k nA 3L. )(, u i pU. f') f Telephone: ' 1? � Q 4 - 50 O
3. Status of Applicant: Owner /Contract Purchaser Lessee
_Other(explain):
4. Job Location: ► I $ CA->n 2 3}(Pe 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)
3' Ac.' 1pnnner ()Pr ) D -Ich.
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 • 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 f 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
' Massachusetts � : . {t.‘
DEPARTMENT OF BUILDING INSPECTIONS %
, 212 M St • Municipal Building v1 ,r ° b
o �. Northampton,
Application for a Permit to Place or Maintain a Si n
INSPECTOR g
Or other Advertising Device, or Marquee v D�
(Application to be filled out in.ink or
Number . ��
Plans must be filed with the Building inspect r (�� C� \1 a,,! Erection ( )
before a permit will be granted. 5 Alteration ( )
,, 1 ; Repair ( )
201Q Repainting ( )
gA{ 2 Removal ( )
rea5 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 . Ea.51 4\e..C( �cal. Piac3; C. ea..r2iMeer VQli y..TomiAy..medt1.G.0e,
1. Location, Street and No. ......... .....ia.....e.,b0i 5‘ree
2. Owner's name QC. .5. \a e, New .41
3. Owner's address a c CY: }(1o} SCE'.
4. Maker's name ... (\3O ...59n..... •
5. Maker's address .a. AzDah.osi ,o..a..l ( Oil.5....5pc,c6 ) .',.ela,.A ..0.1.1.01 :.A D5
6. Erector's name . 080:A. ay cx, - \r ee.
7. Erector's address : m 166 1oo... :.. ...&,x..lcs5...sp6c?,Pk., ('rlA
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated Non - illuminated ✓
2. Will sign obstruct a fire escape, window or door? ..T ... 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..a..ins Width ..`d..ft...o.ins Temporary ✓
6. Face area .aA..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 A If .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 $ ,3W. ,.a....
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
File # BP- 2010 -1046
APPLICANT /CONTACT PERSON AGNOLI SIGN CO INC
ADDRESS/PHONE P O BOX 1055 SPRINGFIELD (413) 732 -5111
PROPER
T4 9A` : 01' ' 001 ZONE GB( e O/ .
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ^
Fee Paid ct3 1136 _
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
INFORMATIONPJSENTED:
Approved A dditional 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
7,4&)6,1)
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
i /4 Garg.c.0 S /ag /jo
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.