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32A-271 (5) t ^'" �r ` ` .,, — ,.. j— ti _ - 4� ?"" `. ' ±; s--,- - _ , .c. °sue x . ,. * ` �` � wi 5:.. - ,-. _ .°°....rte i ts .. i •.. 3. '" � *-w t --# ' ,.._.... IMG_3965.JPG IMG_3966-JPG IMG_3967.JPG It 4 406 1 a a � „k= '4''''''4-1., 9 ,..,''t7;,,,,, r ' ,1 , t •s4€ '+. 11" x+ r ' ; . �- " " � k d L ' Ed e`' � 'r�" . 5 " 'i-.1.4.1-141 s Fr ¢ ' - 1.sas ` a- _ I s s .w 'Wd IMG 3968.JPG IMG_3969.JPG IMG_3970.JPG Cr 5 , h _ , L 1 Th,r , k- 1 �,-`�_ The Co»unonwealth of Massachusetts =.� Department of Lzdustrial.4ccideltts �. Office OfInvestigations - F: =_ ' =' 600 Ifashiiz ton Street - Boston, IVL4 02111 11'ww. mass.; oi/dia «Yorkers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Legibly GERRY SHATTUCK Nlp1e j Puniness /Organlzationilndividual) : _ 53 CIarI Avenue #11 Northampton, Massachusetts 01060 Address: (413) 584 -6265 City /State /Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 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 8 ❑ 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 10.0 Electrical repairs or additions q ] officers have exercised their 11. Plumbing repairs or additions re a 3. El I am a homeowner doing all work � P. 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.E Other comp. insurance required.] `Any applicant that checks box # I 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. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /State /Zip: Attach c1 copy of tiff lyllrlici - N' s'Prnp nsition Tolley de tgrptjgu (lase (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 pettaitie§ 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 against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi Juxderhe pains and penalties of pezjuiy that the information provided above is tr e and correct. Signature: Date: .17 1 Phone #: ( / t r -! v s! 1 ' i ` 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 Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Version 1.7 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 , as Owner of the subject property hereby authorize —10�T\ ( J 'tom �+r _ to act on my behalf , ' ers el ty to w rk authorized by this building permit application. , 'n al att 1 l [J,} 71, h t� Signature of O er � ( l Date , 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 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not DERRY SHATTUCK Applicable v � ❑ C J ._. . � Name of License Holder . _ - b Clark Avenue 4011 License Number Northampton, Massachusetts 01060 __._ . , L ' Of 58476265_ Z Address Expiration Date 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 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 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable Name (Registrant): Registration Number Address E pirotion 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 Not Applicable ❑ Company Name: _ _..._ -53 Clark "Avenue #I1_ Northampton, .Massachusetts 01060 -. .. Responsible In Charge of Construction (413) 584 -6265 -- Address / . - - Signature Telephone vosion17 Commercial Building Permit May 15. 2000 8. NORTHAMPTON ZONING | | �� °� �^.�in� Proposed Km4u-..6yZoning This colunin to be flhled in by Building Department Lot Size Frontage Setbacks Front - - ' - - - - -- Side L: R� � R: -__ Rear Budding Height --- 13 |0g- SQu8pFyotRg7 — Open Space Footage (Lot area minus bldg & paved n=u"u #ofParking Spaces ---- . Fill: (vol umn& Location) -- -- - ---- - --- - --_ - - - '- A. Has l Permit/Variance/Finding ever been issued for on the site? 0 /-� 0 NO DON7KNOYY YES \�� IF YES, date issued: IF YES: Ws the permft recorded at the Registry of Deeds? �� �� NO DON'T KN�YY YES \_� \� _ \^~� IF YES: enter Book Page � and/or Document# 0 YES �� B. Does the site contain a brook, body of water or wettands? NO X� �� KNOW \�� J DONTKNO�5 \_� ' IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained /~-\ Obtained Date Issued: - �--------- 7 \`~/ \~/ ' ' C. Do any d �� gnsexis�onthepruperty7 YES \+�~ NO � - '-- - IF YES, describe size, type and location. � �J \ 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, ex aUon.ur over 1 acre or is it part of a common pion that will disturb over 1 acre? YES �� / } NO V� 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 0 Existing Wall Signs ❑ Demolition❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ PriQf P t r ripti9n En a hrigf docriptinn hgrg, 4 1i r c i 1 r/ 0 ,Ac A r-' ct ,, Of Work: - Proposed > P _ p -- � f l p Y `� { � k it °A \ �- e�,.T • ( \ r, l.J+ C{ SECTION 5 - USE GROUP AND CONSTRUCTION TYPE 11 USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑ 0 ❑ A-5 ❑ 1B ❑ — B Business ❑ 2A ❑ E Educational ❑ j 2B ❑ F Factory ❑ F -1 ❑ F-2 0 2C ❑ H High Hazard ❑ — , 3A ❑ Institutional ❑ 1 -1 0 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ micl ntial R-1 R-3 [ 5A 0 S Storage ❑ S -1 ❑ S -2 ❑ 5B l ❑ 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 [X I STING PRi PORED NEW GQN §ThLICITIQN OFFICE USE ONLY Floor Area per Floor (sf) 1 51 1 2" 2 nd 3rd .._._....._ ....__ _. .. - . ._. _.......... 4 15 4 °i 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 Di Municipal ❑ On site disposal system Version1.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability G Room 100 Water/Well Availability v 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 1.1 tiro e Address: !! Tftis I oction to bo corpIot@d by offico PrT L{ i c0 �'1 vr+ orte Map Lot Unit / e t,.,1(A)Z" Zone Overlay District � Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: C C1 to V O (.) U e t r t Name (Print) Current Mailing Address: � n t /� b �x �4 Signature � .� �' ( ✓ _ Telephone 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature 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 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) Check Number -4 i This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0222 APPLICANT /CONTACT PERSON GERRY SHATTUCK ADDRESS /PHONE 53 CLARK AVE #11 NORTHAMPTON (413) 584 -6265 PROPERTY LOCATION 1 BRIDGE ST MAP 32A PARCEL 271 001 ZONE CB(48)/NB(52)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ‘156//.5 `� Fee Paid c > 3 Typeof Construction: ADD EGRESS DOOR IN BAR AREA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Ow ner/ Statement or License 058422 3 sets of Plans / Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: Approved Additional permits required (see below) «p00 PLANNING BOARD PERMIT REQUIRED UNDER:§ II �� ' UV 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 / ''''/- .0.1: .■": : 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. • • BP- 2010 -0222 GIS #: COMMONWEALTH OF MASSACHUSETTS 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 -0222 Project # JS- 2010- 000276 Est. Cost: $800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GERRY SHATTUCK 058422 Lot Size(sq. ft.): 14113.44 Owner: GUERRA CLAUDIO zoning: CB(48)/NB(52)/ Applicant: GERRY SHATTUCK AT: 1 BRIDGE ST Applicant Address: Phone: Insurance: 53 CLARK AVE #11 (413) 584 -6265 NORTHAMPTONMA01060 ISSUED ON:8/28/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:ADD EGRESS DOOR IN BAR AREA(DOOR ONLY) 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 8/28/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo