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18D-001 (25) File#BP-2019-1033 APPLICANT/CONTACT PERSON SIGN TECHNIQUES INC ADDRESSIPHONE 361 CHICOPEE ST CHICOPEE (413)594-8886 PROPERTY LOCATION 122 NORTH KING ST MAP IBD PARCEL 001 001 ZONE HB(I00)/WP(16U THIS SECTION FOR OFFICIAL.USE ONLY: PERMIT APPLICATION CHECKLIST NCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid BuildinePermit illedout Fee Paid Tvnex,f Construction, ILLUMINATED W -PLANET FITNESS 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 PermiWith Site Plat dn turyj S-f T ZONING BOARD PERMIT REQUIRED UNDER: f C- r ' 4Q Finding Special Permit Variantte FSA Received&Recorded at Registry of Dads 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 infommtion. Titij of Nartltampton�assar4usetts (i)DEPARTMENT OF BUILDING INSPECTIONS212 Main Street • Municipal BuildingNorthampton. MA 01060 INFPGc I ON Application for a Permit to Place or Maintain a Sign Sidewalk Sign, Marquee or other Advertising Device nn p ^ /� y (Appewaon to be Oiled out in ink or typ•wda•n) NUmt>sf.OP.'SQ.....4.33 Plans must be filed with the Buildino I E C E I V E D Erection..................(0 ) before a oermit will be aranted. Alteration.................( ) Repair.....................( ) HR0 2019 Repainting................ ) Remomoval......9...........( FEE`P.PAGEI.R YPL& ..... OFPT OF 6NLDINf.INSPECTIONS NOnTHMIPiOPl bv.nl pap a11: • !7 amp n. Mass. .../( fC//.....(J...20%/ To the Building Commissioner: Application for a permit to place or maintain asisign or other advertising device,or marquee. BUSINESS NAME....Y.'�LG�Z�Gt.I..../..l.r I_ 51L.��......................................................... /' 1. Location, Streetand No. ...(vZ.vZ...N..u.: hJ....[?.L� .5�.......�f..z.-�...!V'.K!.lka..W..( IS / l 2. Owner's name 4A iaAwv--C....PMn�C../.1�?.. r5.�....��............... �..J.....................�.,... ........ CO 3. Owner's address NRI.L.C.5..0. ....5.4.4:?.I.S*...IRMl.�5.t... .(!.!.Vrl ?.[:Nd...'.�!t ...GTl1SJ.2,...... 4. Makers name .U., .11... r. cIKnG..........`..1...........n................................ 5. Makers address... (.P. ....4cy.I1t_rApeQ..�7.��:1.n. 1.l:D�J!PA..11AR...oio.1.5t............. 6. Erector's name ...�.in...Y.`fl(�1J.�1..r1F.!S�r................................................F.......... 7. Erectors address..... a�... 1ro�.ee..St,J ?.k�ta_....!V.1/C.�,!piz...... SIGN KIND OF SIGN lo•:is•al•1 1. Sign will be (check one) illuminated Non-illumin ted ....... 2. Will sign obstruct a fire escape,pe,window or door? Q. Marquee ............... 3. Lower edge will be ...l�ft.... ...ins above the public way. Projecting .............. I 4. Upper ad�ga will be .'&P.ft..l.4...ins above the public way. Roof ..................... 5. Height ..`.f..ft.Yins Width3.`fft.../..Ins Temporary............. 6. Face area IL.`.t.sq. ft. Wall .........a*....... 7. Inner edge will be .{YA,,;ns from the building or pole. Sidewalk.................... 8. Outer edge will be .......ins from the building or pole. Other......................... 9. Face of building or pole istaOW.ins back from the street line. 10. Sign will project .9...ins beyond the street line. 11. Sign will extend ...O.ft ..Q.ins above the buildingpr�pole. 12. Of what material will sign be constructed? Frame L4 .1!!?W..-J........ Face.. 13. Estimated cost $...1I41s.L.t5...... J The undersigned certifies that the above statements are true to best of his knowledge and belief. .... .. ..r. ........... .................... (Signature of Owner or Agent) Page 1 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 Sukhumi DeDartmal Existing Proposed Required by nno 11—U'1A6r1 Zonin Lot Size �97 QC/es Frontage of x `t Front: 3ba Setbacks: Side: YD L: YS R: L: R: Rear. Building Height as Bldg Square 20 coo Footage i cst'r'�t %Open Space: (Lot area minus bldg and Paved parldrg) #of Parking Spaces N #of Loading Docks �1/�' FIII: (volume a buuan) NA' 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: /S / I APPLICANT'S SIGNATURE 54r9r'7(�- lLI W II UA 1451!]r'ITQC:!11�1Ou�,1�[r Applicant's Email Ad ss(require ) 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 authodBes. Page 3 of 3 .�. � � ssl Par one Translucent Vinyl Paint pre-Finished Letter Coil Oscal 8800 Series We Nobel 24150 422 Mulberry Grip Guard 490-D6 ^"••^•• ^•,. .a••.� ■ 108C Avery UC900 Akzo Nobel .040 Yellow/5.3' A91 13-T Goo Guard 429-A5 m...a q�.»......� _ .......... ■ Avery UC900 Akzo Nobel BWCMC A9081-T Grip Guard 509-114 .040 Black 5.3' EEL LI Pr •...+a __ planet all v placement reference One on of front mW hob qt dwM bttere, rA eq ft lWyvut eea94 w anm. ••'. «',°�.sa.�.s ••••-••••, -3h6'aay4c fxeo. 1'trM Cap,9'Aeep.C)4O rttum,.040 wh2e backs �I Pentons Translucent vinyl Paint pre-Finished Lefler Coil ,,,,,.„.m..,�,...,,,,e., .�*wr.+uww ■ 24150 O2wI88005enes ANzo Nobel 422 Mulberry Grip Guard 490-06 —,e,��, �, ,,,,`., ■ 108C Avery UG W Akzo Nobel .010 Yellow/5]' A9113-T GripA5 Guard 429- - —""""`"'r ` ���� ■ BlackC Avery UC900 Akzo Nobel ,040 Black 15.3' A9081-T Grip Guard 509.114 planet fitness placement reference 'vs:,. « •--° -Ghe eet of front all halo IN;ward letters. 164 eq ft laywt ai �„ .......... -3W ac;r*faces.}'trim aT.9'Awl,D4O mbur ls..O4O wfita badm � n�geepn i�miqua.I� NrpM,raee.vetl. The Commonwealth ofMassaehuserts Department of Industrial Accidents Ogee of Investigations I Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 www.massgov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Leaibiv Busincss/Organization Name: cgne_ p�p1 � Address: c3(Q(f ('A&. U,IF UL. City/State/Zip: Phone #: 11(/3 �59cf-888/0 Are you an employer'Check the appropriate box: Business Type(required): 1.9 1 am a employer with /j/ employees(full and/ 5. ❑Retail or pari-time).• 6. ❑Restaurant/BulEating Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.®Manufacturing no employees. [No workers'comp. insurance required]' 4.❑ We area non-profit organization,staffed by volunteers, I I.[]Health Care with no employees.(No workers'comp. insurance req.] 12.❑Other 'My applinnt Wt checks box M 1 mint dw fill..,the satin.below showing Nei,workers' ..,tembob policy information. •9fthe coryonte omceo have elempted thiuveNes,but the arponaon hes nthv empinyvcs.n wahm'eompewtion polity n requited wtA such m areentnewu should check Ma al. lam an employer that lc providing workers'compensation insurance for my employees. Below A the polity,int rmatimr. Insurance Company Name: Ls�t.�^G�-/ GQ/nrLraziitee Cgp .,a91-at7b-k7 Insurer's Address: City/State/Zip: 20S7On 09d& Policy#orSelf-ins.Lic.# GlJCe5—$/LS-33928'1-D38 Expiration Date: (/�20/ZD/g' Attach a copy of the workers'compensation policy declaration page(showing the policy number and e.pintion 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 51,500.00 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 Mat a copy of this statement may be forwaided to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ttn/l , nder the fns and penaales of perjury that the information provided above 6 true and correct. Sumat,re. Date: ,/a4l? _ Offlclal use only. Do not write in this area,to be completed by city or town offlelat City or Town: Permit[License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.Citv/fown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other intact Person: Phone#: w„umna.govNio