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32C-014 City of Northampton Map:Lot 32C-014-001 Massachusetts Date issued 09/21/2023 Inspector of Buildings Permit # BP-2023-1300 Permit Fee $60.00 SIGN PERMIT Business Address 102 MAIN ST UNIT A Applicant Installer NEW CC SIGN INC Applicant Installer Address 259 QUINCY AVE, QUINCY, MA 02169 Work Description ILLUMINATED SIGN - SMOKE SHOP Estimated Cost $4340 Building Department Approval by: Jonathan Flagg ( z-6k File #BP-2023-1300 APPLICANT/CONTACT PERSON:NEW CC SIGN INC 259 QUINCY AVE QUINCY, MA 02169 PROPERTY LOCATION 102 MAIN ST UNIT A MAP:LOT 32C-014-001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST - ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Building Permit Filled out Fee Paid $60.00 Type of Construction: ILLUMINATED SIGN - SMOKE SHOP New Construction Non Structural Renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans/Plot Plan Driveway Grade% 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 '‘! 6 I/?- Signa 1 re 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. Application ror a rermir to dace or iviaintain a owl Or other Advertising Device, or Marquee nt (Application to be filled out in ink or typewritten) Number ...! r J-3' ( U V Plans must be filed with the Building Inspector Erection ( ) before a permit will be granted. Alteration ( ) Repair ( ) R E(�t.J E I V E D Repainting ( ) R/ Removal ( ) �( r} F . ,�..PAGE........PLOT....... �j✓ SEP 1 9 2023 Northampton, Mass. 20..... DFPT.OF r: ioOtrb r a •ermit to place or maintain a sign or other advertising device, or marquee NORTHAM ? N.MA 01060 BUSINESS NAME .NNQrtharnpton.Smolce.$hop 1. Location. Street and No. . ........................................... 2. Owner's name Ballybunion Realty LLC..do.Keystone Properties 3. Owner's address 1.02.Main.St.Morthampton, MA 4. Maker's name .New.CC.Sigrt Inc 5. Maker's address .259.Q.uincy.Ave..Quincy,.MA.021.69 6. Erector's name .New.C.C.Sign.Inc 7. Erector's address 259.Q.uincy.A.ve..Quincy,.MA.021.69 SIGN KIND OF SIGN (Designate) 1. Sign will be (check one) illuminated V Non-illuminated 2. Will sign obstruct a fire escape, window or door? .NO... Marquee 3. Lower edge will be .1.1..ft...0...ins above the public way. Projecting 4. Upper edge will be .13..ft..1.0...ins above the public way. Roof 5. Height ..2..ft..10.ins Width 1.2...ft..0..ins Temporary 6. Face area .34..sq. ft. Wall 7. Inner edge will be ins from the building or pole. Ground 8. Outer edge will be 4Q...ins from the building or pole. Other 9. Face of building or pole is ins back from the street line. 10. Sign will project ..6...ins beyond the street line. 11. Sign will extend .0....ft .6 ins above the building or pole. 12. Of what material will sign be constructed? Frame ...aluminum Face....acrylic.. 13. Estimated cost $.4.340 The undersigned certifies that the above statements are true to the best of his knowledge and belief. (Signature of Owner or Agent) L, Page 1 of 3 1 Name of Applicant:New (.U sign inc Address:259 Quincy Ave. Quincy, MA 02169 Telephone:617-210-7982 2. owner of Property:Ballybunion Realty LLC. c/o Keystone Properties Address: 102 Main St. Northampton, MA Telephone:413-695-9280 3. Status of Applicant: Owner . E 'Lrchaser V Lessee _Other(explain): 4. Job Location: 100 Main St. Northampton, MA 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) Remove the existing PVC sign on the wall and install a new channel letters sign to the wall. 7. Attached Plans: V Sketch Plan Site Plan Engineered/Surveyed Plans 3. Has a Special PermitNariance/Finding ever been issued for/on the site? NO DON'T KNOW V 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 V 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:Existing the 3/4" thick PVC lettering sign painted in gold, height of the sign 24" by 84" wide. Are there any proposed changes to,or additions of,signs intended for the property? YES_ NO V__ IF YES: Describe the size,type and location. Page 2 of 3 tsuuaing Department. Existing Proposed Required by Zoning _ Lot Size Frontage Front: Setbacks:(for sign)Side: L: R: L: R: Rear. Building Height Façade Square 34 SF 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:8/28/2023 APPLICANT'S SIGNATURE iei U 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 3 144" IT Cr; S M 0 l< C M SPECIFICATION ALUMINUM PANEL 4"RETURN 1"TRIMCAP *040 Matte black aluminum panel on welded 1"x1"aluminum tubing frame. auue..ea*, 171 *040 Matte Black aluminum letter boxes 4"return w/1"black trimcap. a minumbecks___ a WHITE LED *3/16"White acrylic faces and green translucent vinyl applied on 3/16"white acrylic. . a„ ,,;s,eo. II *Internal white led lighting illumination, UL Listed. Flex Wndull connecld-- 0ACRYLIC FACE *Letter boxes to be mounted on the panel. Sign installed in location shown on attached photo e caueee seem. I ALUMINUM ENCLOSURE This sign is intended to be installed in accordance with the requirement of Article LED Mumneoon------ ""'�' 600 of the National Electrical Code and/or other applicable local code.This includes 1 LED POWER SUPPLY proper grounding and bonding of the sign. FRONT VIEW 1/4"DRAIN HOLES Channel Letters Sign This image is for general reference only,and may not accurately represent the actual product. Customer: Ketankumar Patel Address: 100 Main St. ?heundersignea NEW C C SIGN the quoted prices.des,gns sees kawns terms.aro an tons are accep o Company: Medford Smoke Shop City: Northampton cCSgnisau orzedteperformtheworasspe" 259 Quincy Ave. Quincy, MA 02169 Phone: 201-238-9140 State/Zip: MA 02155 TEL: 617.479.85521617-210-7982 Original: 8/29/2023 Revision: File Name: X Date Fax: 617.479.4852 ccsignbostonagmail.com Estimate($0 Means No Price): Job No: Print Name L NEW CC Sign ALL RIGHTS RESERVED 1 0 A41.4 , ii,dik 4, it:1111, .16. Ai ; a) 11, ill, ; ni X r s ..„ ._ . V)• 40+ rf (0 ,....,,....„. hw Unil Z M .,. A N :: , : _ . O � ''% _ 0 �R 1 -r. i S 3: Mil , !rt.,. _' a ,3, � tea. k t ... Z �e CI) ii ' .._.ate ca • j 0 t Ailii Ilir 101P1 \ The Commonwealth of Massachusetts Department of Industrial Accidents 9.-dt, —� Office of Investigations �. ' Lafayette City Center _., 2 Avenue de Lafayette, Boston, MA 02111-1750 —11wlyM , i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): New CC Sign Address:259 Quincy Ave. City/State/Zip:Quincy MA 02169 Phone #: 617-210-7982 Are you an employer? Check the appropriate box: Type of project(required): I.111 I am a employer with 2 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. [' New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P Y 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 Sign employees. [No workers' 13.❑■ Other g 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: Travelers Policy#or Self-ins. Lic. #: UB-2W596558-22-42-G Expiration Date: 12/24/2023 Job Site Address: 100 Main St. City/State/Zip: Northampton MA 02155 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 certify under the pains and penaltiesof perjury that the information provided above is true and correct. Signature: �1¢ - Date: 09/01/2023 Phone#: 617-210-7982 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): 10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: i�..111441 NECCS-1 OP ID: PH ACORN CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �� 09/01/2023 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(ies) must have ADDITIONAL INSURED provisions or 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 617-338-8168 NRgeCT Richard Soo Hoo Insurance Richard Soo Hoo Insurance PHONE 617-338-8168 FAX 617-338-1148 123 Beach Street lac,No,Eat): (NC,No): Boston, MA 02111-2511 !- s.pearlh@soohooinsurance.com Richard Soo Hoo INSURER(S)AFFORDING COVERAGE NAIC# I INSURER A:Travelers Insurance _ INSURED New CC Sign Inc. wsuRERe: Ricky Zeng INSURER c 259 Quincy Avenue Quincy,MA 02169 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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. INS LTR RT TYPE OF INSURANCE ADDn SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS 1Mvn (CAM/nnWYYYI IMMIDn1YYYVj A COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 1 CLAIMS-MADE 1 X OCCUR I E TO RENTED PREMISES(Ea occcurrence) $ 300,000 X Business Owner BIP-002W590486 12/24/2022 12/24/2023 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY jp& I I LOC I PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ _AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO SEPARATE BODILY INJURY(Per person) $ AUTOSOR ONLY _ SCHEDULED BODILYO INJURY(Per accident) $ AUTOS ONLY _ AUTOVV ONLY ((Perr acEcRdnttAMAGE $ $ X UMBRELLA LIAB I X OCCUR EACH OCCURRENCE $ 4,000,000 X EXCESS UAB CLAIMS-MADE CUP-2W659088 '05/11/2023 05/11/2024 AG_GREGATE $ 4,000,000 DED I X RETENTION$ 10,000 $ A WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY Y/N STATUTE ER�- ANY PROPRIETOR/PARTNER/EXECUTIVE UB-002W596558 12/24/2022 12/24/2023 E.L.EACH ACCIDENT $ 1,000,000 I OFFICER/MEMBER EXCLUDED? NIA 1(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Sign Contractor 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. City of Northampton 210 Main St Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ...(*iles...-1.040.111 4015#4.11, ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 4,6 *VIP ."Ii 1 p 1. • a {r P.114 x 4. __ 1 , ii, 1... • . . , .. ... , . „ .. . • • CI, 0 a, ki,tk,44 Pr' 411, _III ''L1 1 .... , , I tin 1 i „...? i t l II , i .. E a � .. , iii b .....k. -4:111Ir # w- • IN, ''' t 1 j , (2 qm. Ull C V) X W 0' fit iii . 11111 73 'ip 4s • / 4 V t. 0 ..._ NC . RTHqMP A N I , - ' op5 , . S. ',; . ' 0 I< C i Ji SPECIFICATION 4" RETURN ALUMINUM PANEL 1"TRIMCAP *040 Matte black aluminum panel on welded 1"x1"aluminum tubing frame. Alterman,emrns *040 Matte Black aluminum letter boxes 4"return w/1"black trimcap. Minimum becks _____-_, WHITE LEE *3/16"White acrylic faces and green translucent vinyl applied on 3/16"white acrylic. . N * Internal white led lighting illumination, UL Listed. ACRYLIC FACE * Letter boxes to be mounted on the panel. Rea conduit connector-... Sign installed in location shown on attached photo end ca den seams ALUMINUM ENCLOSURE This sign is intended to be installed in accordance with the requirement of Article chD���,n�,e�n--.---.. Lob 600 of the National Electrical Code and/or other applicable local code.This includes Dra ae, _ LED POWER SUPPLY proper grounding and bonding of the sign. FRONT VIEW 1/4"DRAIN HOLES Channel Letters Sign This image is for general reference only,and may not accurately represent the actual product. The undersigned,in his or her individual and official capac ty,hereby certifies NEW C C SIGN Customer: Ketankumar Patel Address: 100 Main St. the quoted prices,designs specifications,terms,and condiaons are accepted ", CC S Company: Medford Smoke Shop City: Northampton gnis�,>trorizedtopertormtheworkassp�ifed. 259 Quincy Ave. Quincy, MA 02169 Phone: 201-238-9140 State/Zip: MA 02155 TEL: 617.479.8552/617-210-7982 Original: 8/29/2023 Revision: File Name: X Date Fax: 617.479.4852 ccsignboston@gmail.com Estimate($0 Means No Price): Job No: Print Name NEW CC Sign ALL RIGHTS RESERVED