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31B-159 L-\\. CHURCH f PROPOSED SIGN LOCATION \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\\ St. Elizabeth Ann Seton Parish 99 King Street, Northampton, MA ` 1 1 1" =20' < -N I --.....N \\ 7 I I U m I I C...l Z CO ® -'1 SHRUBS WI 4 Iv z. 0 I NI 1 I 1 1 1 1 1 1 1 1 1 -e/L" 1 0 L 1 1 1 t I 1 I i "" 0 I PROPOSED 1 s° SIGN MAPLE - 024" I II —1 r N. MAPLE c 1 ® -�-= X 10' e� +I a 1 8 M LL e N LL �� L . SIDf1NALK cm r- U PROP. LINE GI ® PO � ■■■ G 1 V KING s T o Th R EST POLE w /GUY Be rkshire Des 0 Group , Inc. 4 Men Place, Nalhampta►, Massachusetts 01060 Note: Dimensions are from center of pole to center of sign post (413)582 -7000 • FAX (413)582 -7005 0 Contact 1- 888 - DIG -SAFE prior to excavation 0 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DO /YYYY) 6/3/2010 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(les) must 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 James J. Dowd & Sons Inc NAME: PHONE OE 19 Bobala Road IC . EXI) 913 -538 - 7949 (A 3- 536 -6020 Md IL P.O. Box 10300 ADDRESS: Holyoke MA 01091 PRODUCER CUSTOMER I D 1(: INSURER(S) AFFORDING COVERAGE NAICR INSURED INSURER A : Travelers Agnoli Sign Co., Inc. INSURERB:A.I.M. Mutual Insurance Company 33758 722 Worthington Street PO Box 1055 INSURER C Springfield MA 01101 -1055 INSURER INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1353177599 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP 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. INSR ADDL SUBR — POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD /YYYY) (MM/DD /YYYY) OMITS A GENERAL LIABILITY 6309496A367 6/21/2010 6/21/2011 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY D S f RENTED 100, 000 PREMISESfEaoccurrence) $ CLAIMS - MADE X OCCUR MED EXP (Any one person) $5, PERSONAL OADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREGATE OMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 POLICY JE T LOC $ A AUTOMOBILE LIABILITY YA08106567C813 6/21/2010 6/21/2011 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ X $ A UMBRELLALIAB X OCCUR CUP6567C813 6/21/2010 6/21/2011 EACH OCCURRENCE $5,000,000 EXCESS UAB CLAIMS -MADE AGGREGATE $5,000,000 DEDUCTIBLE _ $ X RETENTION $10,000 $ B WORKERS COMPENSATION WMZ8003518012010 6/21/2010 6/21/2011 X WCSTATU- OTH AND EMPLOYERS' UABILITY Y / N TORY OMITS ER ANY PROPRIETOWPARTNEFUEXECUf I E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? l N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe urger DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) *20 Days on Automobile and 10 days on Workers Compensation for non - payment. 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. AUTHORIZED REPRESENTATIVE R,.i+.t w - tt ® 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations l , ***** 600 Washington Street Is le . Boston, MA 02111 •1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly d Name ( Business /Organization/Individual): (� �y,t, ,�, L , k)c Address: 1 da (,� lh,ne c) J\ c e<,x \c,, 3 City /State /Zip: - lt ` , , �li� _ < r Phone #: j 3 ` ?) 5111 Are you an employer? Ch • k the appropriate box: Type of project (required): I. on I am a employer with cw, 4. ❑ I am a general contractor and I 6. New construction employees (full and /or part- time).* have hired the sub - contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in aci employees and have workers' g any capacity. 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 11.0 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 employees. [No workers' 13.0 Other 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: (i) Ci) C; (IC � ��, . 0 >c C.- Policy # or Self -ins. Lic. #: t p' �j 1 k�C 1 f-, Expiration Date: lc) sa 1 ac Job Site Address: C I C ) 1 fl(' p y i ft: \- City /State /Zip: N c, �hC41 �Gy�, ((1F1 c':; 1Cxr -C~ 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 f• surance coverage verification. 1 do hereby certif nde a pains and penalties of perjury that the information provided above is true and correct Si nature: Date: t'Q Phone - 5 111 Official use only. Do not write in this area, to be 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 #: AGNOLI SIGN COMPANY, INC. • 722 WORTH STREET, SPRINGFIELD, MA 01105 •TEL (413) 732 5111 • FAX (413) 787 -2169 ,� ! � St. Eliza thAnn S etoh ROMAN CATHOLIC PARISH -11/4 _ 4 ROWS OF L. 72" 4" CHANGE COPY 20 " s m s �li Ann Se St ton ROMAN CATHOLIC PARISH 48 4 ROWS OF 4 CHANGEABLE COPY 36" 2 23 DF ILLUM. SIGN W /TRANS BURGUNDY & BEIGE VINYLS SIGN P BEIGE, B URGUNDY & SAN DSTONE CUSTOMER: LOCATION: STORE NO: CONTACT: FR JOHN CON NORS DRAWING C ODE: DATE 10 DATE 0 - - 10 SCALE: FATHER JOHN CONNORS ST ELIZABETH DESIGN INIT DESIGNER: IN 3 ELMST 99 KING ST #000 DESIGNER: LANCE ST ELIZABETH.PLT y2"-1' NORTHAMPTON, MA NORTHAMPTON, MA DESIGNER: ST ELIZAB ANN SETO PARISH.CDR REV. D ATE DESIGN 0 0-10 REV. DATE 0 - 0 - 10 DESIGNER: IN D INIT. NOTES; I THIS DESIGN IS THE EXCLUSNE P ITS u V OF AGNOLI SIGN COMPANY INCORPCRtAfF AND ALL RIGHTS TO 115 USE OR REPRODUCTION ARE RESERVED 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: 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: I '3 �kn APPLICANT'S SIGNATURF9( 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 Page 1 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: ��eCy' , t_, �,() \ O( ICfj:3 Address: (', ,3-,X ‘ (-). 3 r ) � . f)( rtlla Telephone: ki 13 - 739 - 3I 2. Owner of Property: 3 \. E \, ?.(.b( A o+--o Address f( �� ter h(;, L; Telephone: 3. Status of Applicant: Owner ✓ Contract Purchaser Lessee Other(explain): 4. Job Location: ��j 111 ,� _ k 1, (YICa J 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) ( \C,; - a00 ) Tfll G' V 111"cci nC`:kt ;,c l ), kk) -40°5 -(16 an (A tw;3 4 v , -)\3 5. � �r.,��A�� t'�� . ((\(.\ &r:nA3‘ C,c!'i1 e 1ch 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 ✓ nd 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 7 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: _C.1 411 kt j. L1^*+ # 06 n. - /r-W &t to-m-t Are there any proposed changes to, or additions of, signs intended for the property? YES NO / IF YES: Describe the size, type and location: (Jil> of NnrtlTttmptun sK — 3 2010 iRttssttrt7usptts r , � : DEPARTMENT OF BUILDING INSPECTIONS \� - 212 Main Street • Municipal Building iv Northampton, MA 01060 TNHT('TOR Application for a Permit to Place or Maintain a Sign Or other Advertising Device, or Marquee 6�� /Sj (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 ( ) Removal ( ) FEE PAGE PLOT Northampton, Mass. ...... 20.11 To the Building Commissioner: Application for a permit to place or maintain a sign or other advertising device, or marquee. BUSINESS NAME St- E.‘A.2,(':b< <. Ah....l .can... 41° 1oc�...l�cxn� 1. Location, Street and No. � Y1,.()C ;.)1s. 2. Owner's named �`�.� c � .1c,,a.....C:c 3. Owner's address � ... EAnS. No; A V (= mp 'Fl (1) 4. Maker's name t�.t.',.;:)C .■.ti .....C.;: \c 5. Maker's address .7C` ..t ax 'C) Dp;:,.5>.0 {1�.0.01.,.... Y J 6. Erector's name ( \c c . .1 c 1r\c • 7. Erector's address ... C:.a7s. x...l�:`� j ....: JQ�' .�.�X . 0(.1 Cf J.5 SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated Y 2. Will sign obstruct a fire escape, window or door? ..C.. 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 ft .1- .ins Width ft.:7.ains Temporary 6. Face area .,o2^i.sq. Wall 7. Inner edge will be .r / from the building or pole. Ground V 8. Outer edge will be . /....ins from the building or pole. Other 9. Face of building or ole is/Vt.' ins back from the street line. 10. Sign will project . 7 .ins beyond the street line. 11. Sign will extend L./ ft ins above the building or pole. 12. Of what material w l sign be constructed? Frame 0.10.:f.") Face... p\e. 13. Estimated cost $...yet= The undersigned certifies that the above statements are tr to the be of his kno dge and belief. (Signature of Owner or Agent) File # BP-2011-0517 11 Oa) NCO S'tte PIA0 APPLICANT /CONTACT PERSON AGNOLI SIGN CO INC S 13t d< S ADDRESS/PHONE P 0 BOX 1055 SPRINGFIELD (413) 732 -5111 PROPERTY LOCATION 99 KING ST C t t O i �I C) MAP 31B PARCEL 159 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: © l O i r PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 30 Fee Paid Typeof Construction: ERECT ILLUM GROUN SIGN - ST ELIZABETH ANN SETON 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 0./ / 1 3 //e. 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. City of Northampton ' 101159 Zone LIRC(100)/ Massachusetts Date issued 1/13/2011 0:00:00 Inspector of Buildings Permit # BP- 2011 -0517 Permit Fee$30.00 SIGN PERMIT Business ST ELIZABETH ANN SETON 4 Applicant Installer AGNOLI SIGN CO INC Applicant Installer Address P 0 BOX 1055 Work Description ERECT ILLUM GROUND SIGN - ST ELIZABETH ANN SETON Estimated Cost $7000.00 Building Department Approval by: