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PERMIT APPLICATION CHECK LIST
P GE . j IBS .... `; a.. S NO DATE"ZONE
ICATION
a r
2
3 . OWNER OCCUPANT STATEMENT / LI 4 T 0
3 SETS OF S PLAN
5 , NEW CONSTRUCTION
6 . CURB CU
7 WATER IL I I FORMS
8 , REMODELING INTERIOR
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 SIGN AWNING
2 , PERMIT FEE ONLY O ORDER
3 , SPECIAL I ED WITH DEED IF APPLICABLE
14 , UNDER SECTION 27 — CMR 780
15 , FORM A
16 , - ILL
COMMENTS
►r°4� ���"s No......_.....
....�..__....._...........»..»....
a Erection...........................( )
Alteration......................( )
Plans must be filed with the Building Inspector, Repair..............................( )
Repainting '
before a permit will be granted, Removal..........................( )
Tit� of Xort4amptvu, Aass, 04
Application for a Permit to Place or Maintain a Sign
or other Advertising Device
(Application to be filled out in ink or typewritten)
FEE.......... PAGE.......... PLOT..........
Northampton, Mass................1/h. v..............................19 3
To the Building Commissioner:
Application for a permit to place or maintain alJsign or other advertising device, or marquee.
BUSINESS NAME.... .e.....41S. .���7.. .................................................I....................
1. LOCATION, STREET and No. ..3...1... ..........1.:..n. ena3. :. .. .... . .......... `� h
2. Owner's name...... ............ ! ............ ....... ... ................... ..
3. Owner's address...... 91.,.......... .............�..........I.......°..............................
......
................................................
4. Maker's name.........EE gk.V. �........ .................... . .. ... ............ ...................................................
5. Maker's address...x291 kl..� P � ..
6. Erector's name..........: E12i"i��.4� ... .�. �'
.......... ........... ...... . .........................
7. Erector's address..................G.Pff�NE.............................................................................................................................................................
SIGN KIND OF SIGN
1. Sign will be (check one) illuminated..................non-illuminated.................. (Designate)
2. Will sign obstruct a fire escape, window or door? Marquee..........................
3. Lower edge � Projecting..
ge will be ..1.0..ft. .�..ins. above the public way. "'
4. Upper edge will be......�. .....ft........k.....ins.above the public way. Roof.................................................
5. Height ,J*... �d ..ins. Width.........L..ft........®.....ins. Temporary.................................
g ll rr�� :�
6. Face area...l.l.�.../.. q. ft. X 2* er so,' S�. �. Wall................................................
7. Inner edge will be.......�....ins from the building Ground. .. ..
g g or pole.
8. Outer edge will be..> �ilins.from the building or pole. Other..............................................
............
9. Face of building or pole is......./ ....+ns back from the street line.
10. Sign will project..................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....... XL �. Face....... . .....
-7
13. Estimate cost.... .20.•.O 0
The undersigned certifies that the above statements are true to the
best of his knowledge and belief. �
(Signature( r o r Agent)
NOTE: In order that this application may be accepted, the data called for above must be set forth P iNt P
CLEARLY and FULLY.
Dai,e Filed -- - d Tile
ZONING PERM-TT AhPLICATION 010 . 2 )
1 . Name of Applicant : - L
i�ddress : -- -� one leti,hone
2 . 0",ner of Pro per_ ty : i c
ddress ' -- - =-- ---- ------Telephone : 36
3 . Status of i�pplicant : Ort�ner �� it.� act Purchaser
Lessee Other (explai.n : )
4 . 'arcel Identification : ZOni; i,a}_ She et,--_ Parcel# l z
',Oning District (s) -
- - 7 1� - -------- - ,
)t?-eet Address r2
Required
Structure/Property 5 . Existing— Proposed by Zoning
Use of Structure/Property
( if project is only interior work, skip to #G )
Buildin g height
- Bldg . Coverage (F'ooL—,- t_ )
Setbacks - fr_ ont
- i -
de ��: . -- - I� - L :
---t—
e a�-
o t size - '= ---------- - --1----- ---- — —
Frontage
floor Area Ratio
Opep Space (Lot area mint.S
dina and parking)
Parking Spaces - -- — -
-:o a d I n q - --- - ----- — —
�igns
(vo-L-,,me
- - --- -
6 . ':arrative Descri t]' On Of Promo=r -' ; , ec ( U;e additional shr et-
i f necessary) --- GEC - Ex
7 . Attaciled Plans : — Sketch Site Plan
8 . Certification : I hereby cer�. t�; Ll;�� l_ '_} �� il�Torn�ation coat,-Iined herein
is true and accurate to i_he h� s' ; <ledcre .
Date : {
I � ��/;
hppC-11 i AAA, �� ��✓"✓'
THIS SECTION FOR USL ONLY :
as presente /}D asec3n
as presentee]--Reason :
Permit and,or Site Plan
Re _rc
- -- ---- -- --
------- ------- -
1e,,a _uI- of u spe ` Date
NOTE ;raunnce of n z0nir19 permit does nct relieve nn applicnr�( inrl requirements and oNnin nil required permits
from tl)e E',•nrrl of M lanllh, Conv�rvnl on (.ornmi •ion, i�cl�-„rn�•r,J r,' !'r,�, nl l,i n:,ic Ix nail r7rnrLn(1 n,rlhoritir:s.
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