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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