31B-231 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
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,. �� as Owner of the subject property
hereby authorize 5 F e is � d to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner
I, P- 1 , 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
- '.natu =Owner /Agent Date
SECTION 12 CONSTRUCTION SERVICES
10.1 Licensed Construction Superviso : Not Applicable ❑
Name of License Holder . 57
....— 1! /- ? t!
License Number
Address Expiration ate
( (/3 — s Sy- ! z y
igna a 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 0 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 Arch' ct:
// Not Applicable ❑
Nam J gistra 4 .
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
I i .
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
A -4 ✓- �.. 1 �''4� '
Not Applicable ❑
Compan Name
r / 0 .2...,0 a 0.) /.c. /-0,7
Respo ible In Charge of Construction
.)( eg
Address
ign. ,. e Telephone
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.
Of Proposed Work: , + / " de i
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 I ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I 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):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 st
1
2 nd
2
3rd ...._ 3r
4 th
4
Total Area (sf) Total Proposed New Construction (sf)
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 Zone❑ Municipal ❑ On site disposal system 0
% L` ,, -vim
o
Versionl .7 Commercial Building Permit May 15, 2000
8. NOR AMP ON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: - R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Findin ver been issued for /on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Regis of Deeds?
NO 0 DON'T KNOW YES
IF YES: enter Book Page an or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 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 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15, 2000 �y
OI�m�en 91119,,:77;,- in
i ii ,
City of Northampton St us of Permit , ` '
Building Department Cu ut/D way P rm tt
�rJSep#I �Ila
212 Main Street S
i ' ��
Room 100 Water/WeIl Aaddabil °� Northampton, MA 01060 ' ���� " ��
„ p �o Sets Of S#ru�I Plaft� '
APO - 8 LOl 587 -1240 Fax 413-587-1272 Plot/Stt Plane, : 'T
i Other ecify
APPLICATION TO CONS4RUCT; 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: This section to be completed by office
Property Address: .
r j e) jii e_ 5 Map Lot Unit
Zone Overlay District
`U�u y• 774R e)( 6 p
Elm St. District, CB District
SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: / / �
i e � -� -� /,-t4 �. . `) _ '7 , -T�'t • 5/.i. e.•c
Name (Print) Current Mailing Address:
SAC/ 6/
Signature Telephone ye/ 3 — 3 7 y — /Z34)
2.2 Authorized Agent:
74 —4. `- Imo, i d'SS.. 36 S- &/ / t -t.. ,x. ,f2 4 .
Name (Print) Current Mailing Address:
lt/ / o to d--el
Signature �' Telephone y/ 3 -- sQ j' —/ Z 2 , t
-
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building -, (./ U ,, (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
6. Total = (1 + 2 + 3 + 4 + 5) 43 d oe, , `'`' Check Number 7 ".6-5----
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
f '
File # BP- 2010 -0881
APPLICANT /CONTACT PERSON STEPHEN D ROSS
ADDRESS/PHONE 36 SERVICE CENTER RD NORTHAMPTON (413) 584 -1224 Q
PROPERTY LOCATION 57 GOTHIC ST
MAP 31B PARCEL 231 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 6'37
Fee Paid
Tvpeof Construction: REPAIR SIDE PORCH DAMAGED BY AUTO
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 079160
3 sets of Plans / Plot Plan _ A n16 Foo 1 'ai N i
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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 140
C71-rjs 4/ t
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.
57 GOTHIC ST ° f BP- 2010 -0881
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 231 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP -2010 -0881
Project # JS- 2010 - 001303
Est. Cost: $3400.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN D ROSS 079160
Lot Size(sa. ft.): 5967.72 Owner: 57GOTHICSTRRET LLC
Zoning: CB(100)/ Applicant: STEPHEN D ROSS
AT: 57 GOTHIC ST
Applicant Address: hone: Insurance:
36 SERVICE CENTER RD (413) 584 -1224 () WC
NORTHAMPTONMA01060 ISSUED ON:4/12/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR SIDE PORCH DAMAGED BY AUTO
(SAME FOOTPRINT)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: I [ e 4
Footings: - ( `
Rough: Rough: House # Foundation: '
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
1
Final: Smoke: Final: Q K f / 301 0 tcrt4
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. l iso z e A 4
Certificate of Occupancy 1 613 j 1 --ee Signature:
FeeType: ate Paid: Amount:
Building 4/12/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo