31B-198 (3) r
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 0 No . : 4
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
C " - CM I I Di UG re l ? G -G 1
I, , as Owner of the subject property
hereby authorize VI k +'V''P to
act on my behalf ll m ers elayti� to work authorized by this building permit application.
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Signature of Owner Date
1 (A/g--1 ' T'r pie , as Owner uthorized
W Agen hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
elief.
Signed under the pains and penalties of perjury.
i A' ? - (Alcllt-
Print Name 8 /Y)- ///
1) e Li i I
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: �p��� — �y� ,1�e� p / '• Not Applicable 1:1 Name of License Holder: il is BV1 �Vvr�' /1 l► � lV�A -c (' G.�/ � t k / L "
' V• " ya
License Number
Address W Expiration Date / g 0
1 d
Signature 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 'f No 0
Versionl.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 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered 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 ,, ..,,
�t Ivo i r/ v(/ Not Applicable ❑
Company Name:
PA f' 1-ve4' -f-hG /bf g' 3 �
Responsible In Charge of Construction
Q ; N b `+ opf /14/v
Addre
F ARO' P. L on'rr ta. -
Signature Telephone
( N U re 9 .B C kAtg (tht I ) ( 0 I•Ph ' ta c I '
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Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled i..y
Building Departmen
Lot Size
Frontage
Setbacks Front
Side L: R: L:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking S.- es
Fill:
. ume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO ` DON'T KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained i0 Obtained O Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc. ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO ��∎
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.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 ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other ❑
Brief Description Enter a brief description here. �.�p.P,p,'�L SMA�u� S-7 I e r f & / i f-
Of Proposed Work: -}+p ,Q
Dep ?MI-1PP" eO /�• O ?a
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 0 R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING
j`
UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: (- � - *11/ 1' f O" Proposed Use Group: l' i Dom/ — d
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 b C4-141
1 st
1
2nd 2 nd
3rd 3rd
4 th
4 th
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
7. Wa er S pply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewa • e D' posal System:
Public Private El Zone Outside Flood Zone Municipal On site disposal system
n
i, erne
rr-- Versionl .7 Commercial Building Permit May 15, 2000
106) � Department use only
V e� � y of Northampton Status of Permit:
O
fo e Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water /Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other;, Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address: .3.41/1 ' -4 Map Lot Unit
s� S l'dNS � � � °�—^�
1 0 I €-M i Zone Overlay District
Mbf MA"
Elm St. District CB District
SECTION 2 - PROPERT /AUTHORIZED AGENT
2.1 Owner of Record: AT 5 1 C Sf t y -- Co ec
pb -M4 fm/v, Mk
Name (Print) CA. �.lM ��1/,��,U�bt b t rw .. CurrentMailingAddress:
Signature ANIL Telephone
2.2 Authorized Agent:
IN ' ; c sl A4 f - LV fr YK f -cr / Phi- ,i ero r�
Name (Print) Current Mailing Address:
rgt
Signature M I ' ` 4 1' — Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS M /Ai
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building �� 0 •'� (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection jilf0( 6. Total = (1 + 2 + 3 + 4 + 5) � air) 0 •�' "� Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0187
APPLICANT /CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 (116)
PROPERTY LOCATION 109 ELM ST - SESSIONS HOUSE
MAP 31B PARCEL 198 001 ZONE URC(100) / /EU
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ;�
Building Permit Filled out � js sj 8 "� "
Fee Paid V
Typeof Construction: REPAIR SMALL SIDE ENTRY PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 16370
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,RMATION 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
C Z' f II
Signature of Building Official Date
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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.
109 ELM ST - SESSIONS HOUSE BP- 2012 -0187
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 198 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0187
Project # JS- 2012- 000292
Est. Cost: $2000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 16370
Lot Size(sq. ft.): 7535.88 Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: URC(100) / /EU Applicant: WRIGHT BUILDERS
AT: 109 ELM ST - SESSIONS HOUSE
Applicant Address: Phone: Insurance:
48 Bates St (413) 586 - 8287 (116) Liability
NORTHAMPTONMA01060 ISSUED ON:8/25/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR SMALL SIDE ENTRY PORCH
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 8/25/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner