SIGN PERMIT APPLICATION
Date submitted to Planning Board: ___________________
Company Name or Owner
Owner’s Address:
Sign Location Address:
Telephone # Nearest Intersection
Square Ft. Area of Proposed Sign(s) Single or Double Face
Free Standing: Yes No Attached to Building: Yes No
If Free Standing: Height Above Ground Level to top of sign:
Projection, if any
If attached to Building: Does sign project over pedestrian or vehicle way How much
Set Back from Street or Way: Distance to nearest side line:
Distance to top of sign above vertical wall: Illuminated Non-Illuminated
Is Proposed Sign: Permanent Temporary If temporary, # of days
FROM TO
Total # of existing Signs Total square ft. area of Existing Signs
Total # of Proposed & Existing Signs Total square ft. area of Proposed & Existing Signs
THE SIGN WILL BE ERECTED WITHIN THE CONFINES OF THE ZONING BYLAW
Applicant: (print)
Signature:
Estimated Cost of the sign:
Planning Board Approval: _____________________________ Date ________________
Planning Board Fee: $50 Paid: Yes No
Date Submitted to Building Department:_____________________ Building Permit #________
Building Permit Fee $75 Paid: Yes No
Worker’s Compensation Insurance Affidavit must be completed and submitted with this application. Failure to
provide this affidavit will result in the denial of the insurance of the Building Permit
Signed Affidavit: Yes No
This is to certify that a permit is hereby granted to erect a sign at the above location.
Building Commissioner/Zoning Enforcement Officer Date Issued
ATTACH A SKETCH OF THE PROPOSED SIGN INDICATING COLOR, SIZE, SUPPORTS, ETC.
WORKERS’ COMPENSATION INSURANCE AFFIDAVIT (M.G.L.,§25C (6))
click to sign
signature
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