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31B-230 JAN-28-2010 11:00 From:RENAISSANCE BUILDERS 4138639712 To:4135871272 P.2/2 Jgewes -Bale 15140 PromiRENAISSANCE GUILDERS 4138639712 To:4137318015 P.1'1 Statement of Use Affidavit The undersigned swears before me this day of , 2010 that the renovation of the second floor et 64 Gothic $t. Sutte 3 will be for the use of employees of E,M,& A Dental only, and that no public or patients will be accessing the sew • floor. Signaturn _ - - - - - - - - -- Printed Name - COMMONWEALTH OF MASSACHUSETTS Count of •• 158 " joei , 20/0 Then personally appeared before me, the undersigned notary puOlic, the above- nem°. a ithat.„2/0- __max r) , the %2- , 0 4 .— of A A Ar. . proved to me through satisfactory evidence of identific - on w Ich laws [a current drivees license) tacurrent U.S. passp© i rsonal knowledgepW be the person p, e Oeme signed on .0 the prated no rumentancleolmowledged the fo Ing InetruA to be hle or her free act and deed and the free act and deedf - ublic - My Commission Expires: 1_ COLLEEN NADeA Commonwealh achusetts My Commission Expires April 26, 2014 JAN -28 -2010 11:00 From:RENAISSANCE BUILDERS 4138639712 To :4135871272 P.1'2 JA "' 2 2010 enaissance P.O, Box 272, Turners Faits, MA 01376 (413) 8634316, i7ax (413) 663 -9712 January 28, 2010 Anthony Patillo Building Commissioner 212 Main Street Northampton, MA 01080 Tony, Enclosed is a Statement of Use Affidavit for 64 Gothic St. Suite 3. Please include it with the permit application l sent you last week. Thank yo ', Carolyn Asbury Renaissance Builders JAN-26-2010 15:40 From:RENAISSANCE BUILDERS 4138639712 To:4137318815 P.1/1 Statement of Use Affidavit The undersigned swears before me this day of , 2010 21 that the renovation of the second floor at 64 Gothic St. Suite 3 will be for the use of employees of E,M,& A Dental only, and that no public or patients will be accessing the s,d floor. Signature ; Jr ,r3 Printed Name COMMONWEALTH OF MASSACHUSETTS County of , ss., jt (// ,20J) Then personally appeared before me, the undersigned notary puIic, th above- named ILy)&i/J ,jUr /jil 11 0 , the of it n (-A e) o j proved to me through satisfactory evidence of identific ion, which was [a current driver's license) (a current U.S. passport r) 1;LicTaersonal knowledgePto be the person whdie name is signed on the preceding instrument an d acknowledged the foregoing instru t to be his or her free act and deed and the free act and deed of My Commission Expires: com COLL:: j E Li- setts My Cc Expires Arsr:1 2014 _.= • j/23- ,223 /. Renaissance / Builders P.0713 272, Turners Falls, MA 01376 (413) 863 -8316, Fax (413) 863 -9712 January 28, 2010 Anthony Patillo Building Commissioner 212 Main Street Northampton, MA 01060 Tony, Enclosed is a Statement of Use Affidavit for 64 Gothic St. Suite 3. Please include it with the permit application I sent you last week. Thank you, ( Carolyn Asbury Renaissance Builders Permit Listing Report by Address Date Range: Issued between 01/26/2008 And 01/26/2010 Printed On: Tue Jan 26, 2010 SQL Statement: Street No. liko "64" AND Street like "GOTHIC ST" and ([Type of Permit] = "Building ") Address Address (Work Location) District Zoning Owner Work Category Est. Cost Proposed Use And Detail Permit Type Permit No Online Permit No Permit Status Date Issued Contractor (Phone #) Work Description Fees Paid Check # 64 GOTHIC ST 64 GOTHIC ST FIERST FREDERICK & KENNETH P roofing $82,160.00 NEIMAN Building BP- 2009 -1070 APPROVED Jun -18 -2009 ADAM QUENNEVILLE (413) 536 -5955 Q STRIP & SHINGLE ROOF $492.00 14910/14921 64 GOTHIC ST NORTHAMPTON ARCHITECTURAL renovation $10,900.00 Building BP- 2008 -0658 APPROVED Feb -20 -2008 RAYMOND R HOULE CONST INC (413) RENOVATE OFFICE ARE FOR NEW EQUIPMENT 547 -2500 0 (HEALTHCARE ARCHITECTS) $50.00 14619 Address ( 64 GOTHIC ST ) TOTALS: ESTIMATED COST: $93,060.00 NUMBER OF PERMITS: 2 FEES INVOICED: $542.00 FEES PAID: $542.00 BALANCE: 5.00 GRAND TOTALS: ESTIMATED COST: $93,060.00 NUMBER OF PERMITS: 2 FEES INVOICED: $542.00 FEES PAID: 5542.00 • BALANCE: $.00 • 1 � f G "4-: GeoTMS 2010 Des Lauriers Municipal Solutions, Inc. G1 / S(.46 Page 1 of 1 • AFFIDAVIT FOR DISPOSAL OF DEMOLITION DEBRIS Supplement to Permit Application As a result of the provisions of MGL c. 40, s54, I acknowledge that as a condition of the issuance of a Building Permit, all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c. 111, s150A. I certify that debris resulting from this demolition will be disposed of as listed below: Job Site Location: 64 Gothic St., Suite 3, Northampton, MA Name of Permit Applicant: Renaissance Builders Disposal Facility: F & G Recycling Address of Facility: Windsor, Ct IF SAID FACILITY IS OTHER THAN WHAT I HAVE LISTED, I CERTIFY THAT I WILL NOTIFY THE BUILDING OFFICIAL OF THE CORRECT LOCATION OF THE SOLID WASTE DISPOSAL FACILITY WITHIN TWO MONTHS OF THE DATE OF THIS APPLICATION. 1/19/2010 Signature of Applicant Date Move Suction Pump from Half Bath to new location on shelf above compressor CALF Sprinkler Head BATI -I li Sprinkler Pipes Existing Pipe i' • d \� I 1 new f ull height wa with pocket door � _ 9 s — x 4 • fi • • • — DEN AL 1 - — — I R One - q LATHE j i rrIlealt _ __ ___ RgMi r " 10 " "F" , _'LI I Smoke I I �_ ! -1 TRANS' - -- , Sr� 11 ___ 1 i (SIZE TBr .. ii 0.ii- -' F FICE ' ' WORGSNOF' I • ,I' STAFF ROOM -,-1- ; -- L ,. , • • T • �_ 60t`IPR ESSED � ' 1 • . _, , ,) ! = — AIR_ _ — I I �' 1 1 a , , , nFS tea - - -- 7 ,_, 1 New T nigh wall I � -- � � ,, - � �� - -�— New full height wall NAT AL COMPRESSED NAT —__ _ - - --- AIR ! ,' Access Panel 77 ,,/r- ���1 Access Panel 1 hO t .Ks 'INCA,...) 64 GOTHIC ST. 3/1(" = I. NORTI-- IAMPTON, MA Renaissance Builders Move Suction Pump from Half Bath to new location or shelf above compressor -- -4AL.F Sprinkler Head ISAT1 -1 - - -' i ,' Sprinkler Pipes Pi eing p • • • _ - _ —m— _ - - --- a -- -- r - - - -- - - i new full height wall - --9 new ful! Ilte' \ ,� wit pocket door I � p � glees door/ � � Er--- O T % �' i i 1 % 1 x 4 1 �1 • , - '� - DENTAL r T — i 1 7 PI. #0 - --- LATHE - 1 ' � � '� Smoke o r -- TRANS• � - - I . Smok>� �� e o ' SIZE TB A J v— i � � - - U ,�Oi�KS1 -10P 1, FF1C E I � �,� STAFF 8001"1 �_ _ _ _ _ -,!" , /�' r I GOMP �- /" /' - - _.i - 1 AIR_ I �- • III . 1 i r 1 11 t 1 • n ('( ill 1�' ,, New' high wall - -- -- L . � - —� ll '� �� w full Ines ht wa Ne 9 COMPRESSED NAT - AL I AIR (AS 1 Access Panel Ad IcaS ��vi Wa,11 Access Panel 64 C OTI -1IC ST. 3/16" = 1. NORTHAMPTON, MA Renaissance Builders Move Suction Pump from Half Bath to new location on shelf above compressor ( CALF pr.nkisr Head Ei,4TI -�; Sprinkler Pipes ,i Existing 1 •' Pipe • • • a I �1; • ., — II — — w ---- - t T� new 9 full height wall r-1_ __ I new full Iltq - 1 � I with pocket do p . b 9,866 dOOY i - _ _ X tl , O • }, -- • • • DENTAL 7 LATHE Smoke _ - - - i �� TRANS• -- J S ke - II I' Y_ ; is ,i' __ -- I� - - I ® J SIZE TB. l i ll 1 1 i 1 �� WORKSHOP - -; STAFF ROOM 1 I I C FFf CE _ L ✓aMPESSEV �_ - _ AIR_ _. ' - -- - I � • • I il • • J1 4 *'mil 1 L �fl �y � � � I j G; i New 7 hlgh wall �I �. ,?- 'K.__.-,1 �..- "— - --- -- -_ — AIR MPRESSED ��?WRAL N ew full height wall - I , 1 Access Panel Access Panel l Ad ► ca*5 rxeW wa,U 64 CsOTI -41C ST. 3/16 = 1 . NORTI- 4,4MPTON, MA Renaissance u i lders 01/18/2020 02:13 .413731,9815 EMA DENTAL PAIT 01/01 • -elifinSaliCe unders P.(1 Box 272, Turners Fans, MA 013`41 (413) 861-8316, Fa (413) 863,.9712 WAV w.mnbuild_ret To: Building Inspector Town of Northampton I, QMD Vincent iVierfario, certify that I am an Authorized Representative of the property located at 64 Gothic Street 6u r rE Y. We hereby authorize Stephen Greenwald of Renaissance Builders, 390 Mair Road, Gill, MA 01354 to submit a building permit application on our behalf for the construction of the Office Remodol. We agree to conform to all applicable laws of the town and state, and we believe the work proposed to be in compliance with all zoning regulations and the Massachusetts State Building Code 780CMR. Signature of Authorized Representative: Printed Name: Date: • The Commonwealth of Massachusetts • = Department of Industrial Accidents fl Office of Investigations =4:1---- ;% 600 Washington Street Boston, MA 02111 t`. `; . www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information /Y Please Print Legibly Name ( Business /Organization /Individual): '-,k ' * L 6* U% * CC - - 01) C, - 0 P.,, , 1' a CrL Address: ?.0 . 0C 211- V 1 City /State /Zip: 702,JJ s 7Z-, FALL, 4., / MA 013 ( e) 4 //3 • $ b 3 • 8 31 Are you an employer? Cheek the appropriate box: 1.23 1 am a employer with 2 1 _ 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub - contractors 6. 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 g, ❑ 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. ❑ 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 employees. [No workers' 13.0 Other 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. Tf the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: A i L4 tLh 1 5 '; t n , Policy # or Self -ins. Lic. it: LL,) M Z. '�C 6 j (4 6 1 Expiration Date: 12. • t I, • ] CD Job Site Address: �D `f GO th 1 L 5T City/State /Zip: //a✓` //,A ;f7i -e. 0 /C (o C 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 . aainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the ii ` for insurance coverage verification. e7 I d o hereby c e r t i f y 1 ` • s erns and pe (ties r perjury th : e information provided above is true and correct. > Signature: > . '' Date: j' — / • /19 Phone #: qi 3' S63 • 5 3 1 C Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • Version1.7 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 Ire; SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, __.. :. _ - ., __ e : _�`, 4 1, as Owner of the subject property hereby authorize act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date ,_..,... P 1 sA G .l r"oyA _..,., 1 , as Owner /Authorized Agent hereby de re that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under tfid dpenalti of jury Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : S __P / __ _ G ,. : L – .,___. 51..1 . 3,30 , Z- • _ .... ...... . .... ..___.,_ License Number i_..P•,,.b ►bx .2 7.Z... . vY „h� ° -r5 ` s - . 5,�,,,.. l - 5/3 ,F.�_.._ . ,� ,... /. 7 .. ,.,/ .......... ........._._ . I Address r Expiration Date s ayj [ V/3 &6 & 5 / Signa e 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 C. No 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 R_e_gistration Number � .N� _._.._. _ * " Signature Telephone Expiration Date l I— Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date _.,.., _ __,,, _ .,... _ .,._, _ ..., . ..,.,.__ ,.__ _._. ,_ ,..,_, _ _ _.__ __„ i I. Name Area of Responsibility . m_.,,.., _ _ Address Registration Number L.,... _..._ „___.._._,_,_ ___.I Signature Telephone Expiration Date 9.3 General Contractor €....... N A - {� `7Al.)l ..,.. SUIL1,7Grle- S i Not Applicable ❑ Company Name: . _______ fir, Pi ... Ge.-e Responsible In harge of Construction Address , / • f �l� r 13 ` 3 /Signat - 1 a Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTII MP'1� ON ZO Existing Proposed Required by Zoning This column to be filled in by NO C4- 1 Building Department Lot Size L ...__ . __.._...__._ ..,... I ___. 1 ? _..__ __._____ i Frontage 1 I ._ Setbacks Front 1 [. ` Side L:[ _ i R .y... ,_._i L: _ ] R:[ . E- .,V._I Rear 11 _ Building Height ^� Bldg. Square Footage 7_'1 % F.__._. i r (Lot area minus bldg & paved __.A E C ._. ° L t .. - -_ _ Open Space Footage }} o parking) # of Parking Spaces Fill: ffi (volume &Location) — _. ,.. __,,..,_. ...._.._.i__,_ _ _._ _.__. L A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW C YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES 0 IF YES: enter Book r - Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 1 : „0 DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: _ C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: L ' 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 Q NO rip 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 2 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. evildi fi 79°145 '‘n ak `124(;-57 % 5 s P 4 t i C Ctre e. p e Cu a .. .Kr S . e( " Wavy 4A-1d- y oa..Q 1h •.. L .e.0N 11 .. .�L5t»....kt. ,.,_.. 1 !�s4� ....�_Pet Of Proposed Work: � � � �te �? i J Gt h � �0�-1� Y 4144 o iG AreGC • 5;11k 1;154'1 .. � ..._. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE /0 0 CH -Ak.)6,.E USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly El A-1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business IR 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C I ❑ 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 ❑ S -2 ❑ 5B ( ❑ U Utility ❑ Specify M Mixed Use ❑ Specify: S Special Use ❑ Specify: 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): I _________ _1 SECTION 6 BUILDING HEIGHT, AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ©FFICE USE ONLY Floor Area per Floor (sf) ._ �- _ 1 5t 1st r 3 rd [ . _....._, 9 4 th th i to .._. Total Area (sf) _ Total Proposed New Construction (sf) N� ..,_._.__..Y.__._..__..,, Total Height (ft) L ' Total Height ft r. Public Private ❑ Zo ne oo .. d . 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zon e Information: 7.3 Sewage Disposal System: _, 1 Outside Flood Zone[ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Buildin: Permit Ma 15, 2000 In n rr 1111 r 4 ~' j rl� x yn 1 r ' I Id 'i"µ�m Y ul AM C M1 1 1 1 �InII���� �q i ���� : ��� �mJa�a�l �,��l:' � � u � �,�r��1� y��1 I " y 1 °i 1�I1 ' 11 G� ' 1 � I 1 1 1 Ili 1 III a 11 vI City of Northampton �i� �1 �, tl1 1� 1 �1 r 1 i �,� 1, n 11r , r i, �� 4, , � n � 1 1 I 1111 1 1 1 i a il ° I � Ir A te �' 4� 1 , 4 i 1 1 41 1 I „r 2 =4,, Building Department d pi, . , ; 1 tl i14�1) ,_' �'Igluw9i �r r 1 1i l Y 1 1 1r ;, �� 212 Main Street i1,° ti , , i,fti l r 1. Th W 11 i I fi 1 I limo , "I 11 , ,I N Ii 1�'1 Room h1 ji r 1 E ' oll I, 1 I t1i b 1 d d * r :, 4 II tl " Room 100 I i It 1Iu�id 1 , rF p' 1 X11041, 3 u l tlr l0l � 7 ,y s "J1., r r u ,1 1 r 11 1 11 �� iN 1 11 1 P 1 1 1 11 r i {1 g 1,iV 11� o (��� a 1 M d 11 ,� r�+ r j. U ,c u r y�1 , Itl t, i r tip.. ��11 ±' 1 � Northampton, MA 01060 r , .r - 1,,, '4 1 ,1,.1 1 1 1 01 ° 1 y r � ,� °1 q 11 t � In ��, ., '" ',I' III11 11 ,' 11 111i11 r 1ld f� E r«I' r f�� y tl 1 , . 13 -5 -1240 Fax 413- 587 -1272 � �a `� * ' '' '' 4 ')I i� fi ,ri ulrlti r t^ 1I p hone � +. 111 � 1 1 Ii+. Aa � �m �w4r r�,. Ifi�Ia l'°,1 44 1 11 11 "i 1: — a 1111'1' rI w^ru m r 'S 1„ M q 1 d " ,'1,t 1 r 14tl ti- v'`Y 1 1 , �, da 1 u o1 a r Iy y` - M� ' � � o, a ��l� 1j 1 1 Iu 11 1 1 1 r 1 Ilwu tl � 1 ��w� � k 1��� r 1 f� l 4yr, � u.11F9'�111� .� 11 _,utlu11,1"4.z.,1V�IId1.r:, _.� 1 w.i4 ir,','',"tih tl� w ,t" �� r, 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 1.1 Property Address: Thi$ section to be completed by office Map Lot Unit (o `I CzorH Ic ST. S vi 3 Zone Ov ?rlay District _.., ___..._ _.. _,... __..._., Elm St. District GB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: i Name (Print) Current Mailing Address: i Signature A- (1Cu24 CkA1 ^ 2 ,4 --41 1 -" Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ( a) Building Permit Fee E ._ i ________......___,_ _,..,, 2. Electrical l (b) Estimated jel t' Construction Total from Cost (6) of _.. 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection w °" ` "... .. ' 6. Total =(1 +2 +3 +4 +5) ! (9 . ( 32'O Check Number / / 9 / 5 This Section For Offic Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0678 APPLICANT /CONTACT PERSON RENAISSANCE BUILDERS ADDRESS /PHONE P 0 Box 272 TURNERS FALLS (413) 863 -8316 PROPERTY LOCATION 64 GOTHIC ST - SUITE 3 MAP 31B PARCEL 230 000 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1 36 q , ter l � i �� l � Fee Paid 7:► jj Typeof Construction:_RENOVATE INTERIOR - SUITE 3 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 013302 3 sets of Plans / Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN MATION 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 alerb Signature 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. • 64 GOTHIC ST - SUITE 3 BP-2010-0678 GIS #: COMMONWEALTH OF MASSACHUSETTS a. Map :Block: 31B - 230 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit_ Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0678 Project . JS- 2010 - 000991 t st. Gast: $41632.00 Fee: $184.15 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENAISSANCE BUILDERS 013302 Lot Size(sq. ft.): Owner: MARIANO VINCENT Zoning: Applicant: RENAISSANCE BUILDERS AT: 64 GOTHIC ST - SUITE 3 Applicant Address: Phone: Insurance: P 0 Box 272 (413) 863 -8316 Workers Compensation TURNERS FALLSMA01376 ISSUED ON:2/2/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE INTERIOR - SUITE 3 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: FeeTvpe: Date Paid: Amount: Building 2/2/2010 0:00:00 $184.15 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo