24D-119 (12) City of Northampton Map:Lot 24D-119-001
Massachusetts Date issued 03/23/2023
Inspector of Buildings Permit # BP-2023-0358
Permit Fee $100.00
SIGN PERMIT
Business
Address 206 KING ST
Applicant Installer ACE SIGNS, INC
Applicant Installer Address P 0 BOX 3374, SPRINGFIELD, MA 01101
Work Description ILLUMINATED GROUND SIGN - ADVANCE
PSYCHOTHERAPY
Estimated Cost $3000
Building Department
Approval by: Jonathan Flagg
File #BP-2023-0358 `�K
APPLICANT/CONTACT PERSON:ACE SIGNS, INC
P O BOX 3374 SPRINGFIELD, MA 01101 (413)739-3814
PROPERTY LOCATION 206 KING ST
MAP:LOT 24D-119-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $100.00
Type of Construction: ILLUMINATED GROUND SIGN-ADVANCE PSYCHOTHERAPY
New Construction
Non Structural 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
INORMATION 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
It
; 3 a3 a3
Sia ture 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
Planning&Development for more information.
&- 3 " ---7
City of Northampton
" ,, ..t dJ EIVY� �;, Massachusetts a?S. f_ '`�'e-
Or ' -7 :cC.
DEPARTMENT OF BUILDING INSPECTIONS �1
s pp 2023
�Afl 2 2 212 Miin Street • Municipal Building -P. :cam
Northampton, MA 01060 'Pi."'..'%a
Applicatign for a Permit to Place or Maintain a Sign
DEPT.OF Milt DING INSPEor gher Advertising Device, or Marquee q
Iq
NORTHAMPTON,MAO
-• AC} lication 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 (g/) fncf cig/Ivr6%C
Repair ( )
Repainting ( )
removal ( )
IT I
FEE%' PAGE PLOT
Northampton, Mass. MRr2N as 20441
Application for a permit to place or maintain a sign or other advertising device, or marquee
BUSINESS NAME / y4w' pIycsiurN/Ea.D/y P/,cIiGe-
1. Location, Street and No. OM / ' G' rr
2. Owner's name ..in C A ""--(9 CA44)(k- y
3. Owner's address C., IC, S �T NJ7! ,,-.4 'J / ~4-
4. Maker's name .../.ke-.... .d..n /r 0 G 11
5. Maker's address PO i X 3y 3' f�l�'�C , /h/'}; d//Q1"
6. Erector's name /4c-e SF A I (, c_
7. Erector's address/4) 4a A- ,7751 1//24474( /17/9— v //O l
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated Non-illuminated
2. Will sign obstruct a fire escape, window or door? Ai.Q.. Marquee
3. Lower edge will be .1.0.ft...a...ins above the public way. Projecting
4. Upper edge will be .efe..ft 0 ins above the public way. Roof
5. Height 6 o...ins Width 0. .ft a ins Temporary
6. Face area 6U sq ft. Wall
7. Inner edge will be ins from the building or pole. Ground I.
8. Outer edge will be .34..ins from the building or pole. Other
9. Face of building or pole is.2YP..ins back from the street line.
10. Sign will project 0 ins beyond the street line.
11. Sign will extend c ft r ins above the building or pole.
12. Of what material will sl n be constructed? Frame .4/u'i.I/Pf�( Face x `"`�
13. Estimated cost $ a dqo" '"
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
U �A
• (Signature of Owner or A
Page 1 of 3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING (INFORMATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ev) (M ' n f� c.t__
Address:Po rh.k 3(77 7 cr," "t mil- did(Telephone: 4'1? a"�4
1 0 r 4fL
2. Owner of Property: /f. fi CJ rr,, �/ Q
Address: //d /t 4 J towfT h1'rDl(,� m r Telephone: *3 fD 7 -73C�) xloj
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): .T' -'! Co"i 19 c -7
4. Job Location: 2,c) c �' � f Sr- Air /"
lTh
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: Ill£7• C7-<
6. Description of Proposed Use/Work/Project/Occupation:(Use additional sheets if necessary)
Gtryt Age-es /r7 . e%/fr/N? /Po%L Sij
7. Attached Plans: 'Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special PermitNariance/Figding 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: (I) G /X G Ipi% fir/rit
Are there any proposed changes to,or additions of,signs intended for the property? YES' NO
IF YES: Describe the size,type and location: /i (.2 C4 s.h 5 L i t p��h+
S
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:(for sign)Side:
L: R: L: R:
Rear:
Building Height
Facade Square
Footage
# of Parking Spaces
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 3/A9/ 2 3 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
The Commonwealth of Massachusetts
-a Department of Industrial Accidents
Office of Investigations
—s `
_1.7181 .
_ ii Lafayette City Center
—'f 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): Ace Signs, Inc .
Address: 477 Cottage Street P.O. Box 3374
City/State/Zip: Springfield, MA 01101-337$hone #: 413 739-3814
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with -7 4. 0 I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. El 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 8. 0 Demolition
working for me in any capacity. employees and have workers' 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.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13.0'Other f G
employees. [No workers'
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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AIM Mutual Insurance Co.
Policy#or Self-ins. Lie. #: WM Z 8 0 0 8 0 0 2 9 512 0 2 2 Expiration Date: 0 4/O 1/2 0 2 3
Job Site Address: L'Cr "•.• S I City/State/Zip:A1)7 /m A'//—
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 hereby ce ' under the pa' and penalties of perjury that the information provided above is true and correct.
•
Signature: Date: !l o a 3
Phone#: 413 7 3 9-3 814
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 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5lalumbing
Inspector 6.0Other
Contact Person: Phone#:
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THE ABOVE QUOTATION MAY BE SUBJECT TO ADJUSTMENT AFTER 60 DAYS FROM THE DATE LISTED BELOW.THE ABOVE PRICES MAY BE SUBJECT TO SALES TAX WHERE APPLICABLE AND PERMIT FEES IF REQUIRED.ANY SHIPPING AND HANDLING
CHARGES APPLIED AT TIME OF BILLING.UNLESS STATED ABOVE,INSTALLATION IS NOT INCLUDED IN PRICE.ABOVE PRICES DO NOT INCWDE ELECTRICAL SERVICE FROM BUILDING TO SIGN,BUT DOES INCWDE CONNECTION IF SERVICE IS AT SIGN LOCATION.
ACE SIGNS, INCORPORATED Phone: 413-739-3814 NOTES:
477 COTTAGE STREET Fax: 413-732-5653 QTY: 2 LEXAN PANELS ACE SIGNS
P.O. BOX 3374 Date: 03/20/23
SPRINGFIELD, MA. 01101 Email: jmanzi@acesignsinc.com THIS DESIGN IS THE ELUSIVE PROPERTY OF ACE SIGNS.INCORPORATED.ALL RIGHTS TO IT'S USE OR ANY REPRODUCTION OR DUPLICATIONS OF THIS DESIGN ARE RESERVED
DUE TO THE PHYSICAL LIMITATIONS OF THE PAPER AND INK-BASED PRINTING PROCESS THIS CUSTOM ARTWORK IS NOT INTENDED TO PROVIDE AN EXACT MATCH BETWEEN INK,VINYL,PAINT.OR LED COLOR.ARTIST'S RENDITION OF BRICKWORK,
MASONRY AND LANDSCAPING IS NOT INCLUDED IN THE PROPOSAL.ALL MEASUREMENTS SHOWN ARE APPROXIMATIONS.DIMENSIONS OF FINAL PRODUCT MAY VARY.
. Quality Sign Service Since 1945