30A-032 (2) as ,
. • S
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,/ A Citif i as Owner of the subject property
hereby authorize .1 t _. Y'L1. "C.' 4
.N to
act on my behalf, in all tters r ative to work authorized by this building permit application
Signature of Owner Date
/.... t !` .., .,__ _ ._.._ _ .. . . ........ ........ . , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
,..„ . - \-- ,k...._......— 10/2- 1 ) 1 / ____ _ ._, ,......, ____ , _ „ , _ ,
Signature of OwnTr /Agent Dat ,
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable I:1
Name of License Holder . ..:._ K i'S L1- Ct vi 6 ___ 4 5 $ 4 ... 1 5 2--
License Number
Z. 7 _,. "rot ' � z ;1. _.. .., e., w,!"." ' . .1. ,,, r . S._...` ' _ 4 .. / 9 ( -. Z- 9... i �?
Add ss Expiration Date
Sig L � Telephone
SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M .G.L. c.` 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No 0
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION' SERVICES FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR.116 (CONTAINING MORE THAN 3 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name Re �stran
( g )
- ( Registration Number
f , �^� Expiration Date
3.0 c
i f�'�� Telephone
9.2 ' -gistered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
•
V �
1. Not Applicable ❑
Company Name:
Responsible In Charge of Construction
, .dress
- taa . e Telephone
Versionl.7 Commercial Building Permit May 15, 2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear
Building Height —
Bldg. Square Footage % ._
Open Space Footage
(Lot area minus bldg & paved
parking)
# off Parking Spaces _..:
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW * ire YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO (3 DONT KNOW 0 YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO i� r DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
, Date Issued:
C. Do any signs exist on the property? YES Q NO 4
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO t
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO r
`
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs ❑ Additions ❑ A cesory Building ❑ 1
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs Roofing Change of Use [ Other 01
Brief Description Enter a brief description here.
, , , . i 1 i
Of Proposed Work:
YQ-- VIA-C1N 0 0 (04 i i/tuicu tr40-, re tmOLLe., tri- in - loc1/4,(A,6(
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
❑ A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A
E Educational ❑ 2B . r ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S-1 t S-2 ❑ 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify: .,F ..
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: Proposed Use Group: ,.._ .._._
Existing Hazard Index 780 CMR 34): , , ., ,_ ,___._ __ __ .._. ".. Proposed Hazard Index 780 CMR 34): _..
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 t
1 w,._ w A. �._
2 nd
2 nd
3rd .....,,... __._. „ . ..... ........_ 3d
4 U'
4 th ?
(sf) Proposed f)
Total Area (s Total Pro osed New Construction (s
Total Height (ft)
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone0 Municipal ❑ On site disposal system❑
s
1
Versionl.7 Commercial Building Permit May 15, 2,:0, 00
Dep artm ent use only
City of Northampton Sta o Perrntf
111,, � D a • sing Department Curb Cutf[ reway Permit
• 12 Main Street Sewer /Sept<cAvailabtlity `'
O Room 100 Water[Wefl A
V 2011 ort ampton, MA 01060 Two Sets of Structurat.Plans -
phone 4 3 -5 ;7-1240 Fax 413- 587 -1272 Plot/SIte P
of �SPECriOt Othe Spe
; -.. map _
APPLICATION TO CONSTRUC , ' PAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
_ _
9 Map Lot Unit
Zone Overlay District
�_.... va ., a.� Elm 2 St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address.
Signature , /_g,." Telephone
2.2 Authorized Agent:
Name (Print) C urrent Maili Ad:, dress
Signature _ Telephone / Ci
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1- ih+ing - 5 (a) Building Permit Fee
2. Electrical (b) Estimated Tota Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection C�
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
�d �+� �;✓�.
This Section For Official Use Only
Building Permit Number Date
Issued
Signature: ..,400•00010/,....,,e.„.„--,--"":,..7--- /""j,;) ---e-7.---/7
Building Commissioner /Inspector of uildings Date
10
320 RIVERSIDE DR BP- 2012 -0409
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A - 032 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INTERIOR DEMOLITION BUILDING PERMIT
Permit # BP- 2012 -0409
Project # JS- 2012 - 000654
Est. Cost: $2500.00_
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KRIS THOMSON 084152
Lot Size(sq. ft,IL Owner: CHALFIN ELIZABETH R & SHELDON R CARROLL
Zoning: SI Applicant: KRIS THOMSON
AT: 320 RIVERSIDE DR
Applicant Address: Phone: Insurance:
257 MONTAGUE RD (413) 549 -1027 0
LEVERETTMA01054 ISSUED ON:10/24/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REMOVE ROOF INSULATION & NON -LOAD
BEARING WALLS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/24/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner