18D-055 (6) City of Northampton Map 18D Lot055 Zone
GB(100)/URA(0)/
Massachusetts Date issued 7/20/2020 0:00:00
Inspector of Buildings Permit # BP-2021-0048
Permit Fee$60.00
SIGN PERMIT
Business
Address 141 C DAMON RD
Applicant InstallerSIGN TECHNIQUES INC
Applicant Installer Address PO BOX 237
Work Description NON-ILLUMINTED ROOF SIGN - FRESH PAWS DOG
SPA
Estimated Cost $800.00
Building Department
Approval by: Q�
File#BP-2021-0048 \
(1�t�PLltiGl1�� ��X�SiI►�i(-�
APPLICANT/CONTACT PERSON SIGN TECHNIQUES INC /
ADDRESS/PHONE PO BOX 237 CHICOPEE (413)594-8886
PROPERTY LOCATION 141 C DAMON RD
MAP 18D PARCEL 055 001 ZONE GB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED . REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Tvneof Construction•_NON-ILLUMINTED ROOF SIGN-FRESH PAWS DOG SPA
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:
X 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
Lfin6t' S � TA '10�, aa
Sigifture 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.
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"1 DEPARTMENT OF BUILDING INSPECTIONS s�
y 212 Main Street • Municipal Building �fst`r
Northampton, MA 01060
JT.33Application for a Permit to Place or Maintain a Sign
INSPEC
Sidewalk Sign, Marquee or other Advertising Device
(Application to be filled out in ink or typewritten) Number A y�
Plans must be filed with the Building Inspector Erection..................(X)
before a permit will be granted. Alteration.................( )
Repair.....................(
Repainting...............( ) I
Removal..................( )
j646
FEE RAGE..!` .C"PLOT.......
Northampton, Ma j .... .�.t.........2 0
To the Building Commissioner:
Application for a permit to place or maintain a sign or other vertising device, or marquee.
BUSINESS NAME /...fi-rUf7� f �
1. Location, Street and No. ./l../ ...d— .. C/Lr� l
.................... . ............................
2. Owner's nam
!.S! .. ��-//•l.� t!.................................
3. Owner's address . �...K C S /1.� 1.CJ ...YA-616JY
4. Maker's name !.' ..../C .................................................
5. Maker's address ..Vl. .(....... e../.Cl�t ...C. x. v/..........
6. Erector's name�!.� .�../. ....!!.r�.^ 1.... .. ...//ele:..........................................
7. Erector's address ... . ..........
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated ....... Non-illuminated .......
2. Will sign obstruct a fire esc e, window or door? /V .. Marquee ...............
3. Lower edge will be ./�.ft.. ..ins above the public way. Projecting, :.. .....
4. Upper ed a will be �,�..ft..�0...ins above the public way. Roof�I... k� .
5. Height . ...ft./Uins Width /./..ftAP*.ins Temporary.........
6. Face area Z .sq. ft. Wall .....................
7. Inner edge will be .ins from the building or pole. Sidewalk....................
8. Outer edge will be .ins from the building or pole. Other.........................
9. Face of building or ole is .......ins back from the street line.
10. Sign will project .. ..ins b and the street line.
11. Sign will extend .. ...ft .. P..ins above the building pole;
12. Of what material will sign be constructed? Fra 144
...... Face ���/fYI!/�v�1
13. Estimated cost $...Ja. .............
The undersigned certifies that the above statements are tr \ / best of his knowledge and belief.
.. ... !..Y..................................................
(Signature of Owner or Agent)
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:
Address: [/ GCJ / Telephone:/��7y���t0
2. Owner of Propert .
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee�
XOther(explain):
4. Job Location:
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)
I
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 Y 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___-v_ 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:s�/�//Q.� ZZ) J? al-Cd&
i ob s
�2 AZ".
Are there any proposed changes to,or additions of,signs intended for the property? YES NO_K_
IF YES: Describe the size,type and location:
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.
7- Ja Ik
DATE:e7r-�Gz/�/ APPLICANT'S SIGNATld�Xl�'
C �
Applica is Ad ss (required)
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.
Page 3 of 3
The Commonwealth of Massachusetts
w1Sis'.
Department of Industrial Accidents
F_ Office of Investigations
Lafayette City Center
[`- ✓ 2 Avenue de Lafayette, Boston MA 02111-1750
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Sign Techniques, Inc.
Address:361 Chicopee Street
City/State/Zip:Chicopee, Ma 01013 Phone #:413-594-8886
Are you an employer? Check the appropriate box: Type of project (required):
IA I am a employer with 13 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
y p n'• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑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.® OtherSign
comp. insurance required.]
*Any applicant that checks box#] 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: Liberty Mutual
Policy#or Self-ins.
``Lic. #:WC531 S339284,0/38 Expiration Date:11/2020
//
Job Site Address;�7� ✓ � ��/�C,L City/State/ZipY YAtd& M U
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 for insurance coverage verification.
I do hereb�cerl �the pains and penalties of perjury that the information provided above is true and correct.
Si a e: Date: —
Phone#: 413-594-8886
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(check one):
1❑Board of Health 2❑Building Department 3LICity/Town Clerk 40 Electrical Inspector 51:]Plumbing
Inspector 6.00ther
Contact Person: Phone#:
-142 in
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