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32A-271 (3) 43 . -o •• 50' "2 u I f —. -. - _.. - - _ -_. - -_. - -__ — __ —... - -. —� _..— -e Ibr th lMt ix f 48' -9' existing feeling dimension -- _ L- . eX sir .1 a r _ rmP Zmk .. Ref . � I M - -. T I x banquette • f -- I L_ ._,s -_, cooking line _ -. • J ' n 1 feat links w/- " I Xn.>ro bell., .._ -.- Lei la users — 'r - -:._ - -- 7 �� t• i ' -. - .. _ . .. ON wen ... .. . 1 men om 1 n rf l� n 1 , , y r 4 / y et r , 65" s - � rt _ _ r3 i- —_ '--5'.' - .' j` �. �+' ' ..sr ewe ... l l ` 16 a,. Embankment : • -- ' Ti 22 $, 1- a I, • One Bnelqe St 5 m er 0 sr.. -- •- - -•--_ pa., ct 1 2s[ory b r k k Ist _ "• Cf, 'If : - e8 • • 3 story Onck .. - : Waking f__ _____ ,_ °,r. _ — ___.._ _— @ Site Plan - - - - -- 1/16 _ �,_ �ra 1 Wwky scre[ • narking Access ■ 1 1 , t , - .. t t\,"-- . _ ; -. -. . 92 •2 ext.,. hmsheci ennonwon '- - - ' 1.9 I t• s srs.stSkk stall shed wen _ - P I : • . bench/ banquette . 1-3 . _ —_-_ i _ __. _ - _ _.,------ _......,-, : .•• .. . - I ---- - -, .....1----------I-----w. • • • 1 .3_ _ •‘3 _ _ . . .• I - - ' I • • - , I - ' ,-- - ' I I ' I . I I = . -Cow hooks sr, I I • • • / I - • ON 1 5 risers . , t ==1- -.1 .=- 111. ■IIION■ MN . 1 . : . '. _ . . , IN . : rnen women . . , 1 4 / . , ri --- h n _ . . . , . .. _ . , . . ,. • / , / - ..--- -- ---- 7 .• , „ i 1 13"..tga Street . I rrmarFen Cate 3averrn i / 2 4 ' _ ' _ r 1.1 " . ' . ' . . .2 • . . . .• , . . .• . . . . ; .• .• S / . I . - 31-• r•s Ex.shnorlanroso . . . . emeartwen. . . : ---- - _ . . . : .• . P. I 1 ' .• . : . . . : ! ! Pi • i 1 1 Ourroster Restaurant I It t • . Pawing wr I I . ---.------------. : 2 story bnce . -.....-... --..--. -.- . 2 story bode . • huidong 3 . , __ -_ - - --- --- --- - - — i Site Plan I Parking Access I , , v 1,-,.., ___ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations W ' 600 Washington Street Boston, MA 02111 . `�� www.nzass.gov/dia Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Ap plicant Information / � r � Please Print Legibly U Nam (Bt siness/Organization/IndividuaI): , �. a. Address: C f . . k. :." l City /State /Zip: Arsc ,1 M A q(c)Lo Phone #: L f (J i — 25 c" Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4 0 I am a general contractor and I have hired the sub - contractors employees (full and/or part- time). * 6. ❑ New construction 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling and have no employees loyees These sub - contractors have. 8. 0 Demolition ki capacity. employees and have workers' working for me in any p t'• 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 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 appiicant that checks box #1 must also fill out the section below showing their workers' cornpensation 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. IContractors that check this box must at 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 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 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 under the pains and penalties of perjury that the information provided abov is tr a and correct Signature: Date: (9 I IT Phone #: - Official use only. Do not write in this area, to be completed by city or town offciaL 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 #: 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 1 C 16V U ` + 0 as Owner of the subject property hereby authorize i fp- cAz to act on my behalf, in a rs relat ' to work authorized by this building permit application. Signature ne " Date I, , 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 Applicable ❑ Name of License Holder : ,r 0\ License Number C �. E, ors' - 6 ` r d Address ��1/yy Expiration Date IS '2 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 b ilding 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 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 Lti�.c xlt .. t( i i S c% � ,, <<�. r Not Applicable ❑ Company Name: ` Responsible In Charg of Construction f., C \tl 1 `ca_. - Address --r• qJ 23'1-cil'ZO Signature Telephone Version1.7 Commercial 13uilding Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by A[ Building Department Lot Size ,2.3 U A Frontage Setbacks Front i Side L: R: L. Rear Building Height /7 Bldg. Square Footage 75 1/ Open Space Footage /-1( ', (Lot area minus bldg & paved (• , parking) # of Parking Spaces 7 Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO W 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 i►.4 NO Q IF YES, describe size, type and location: �� v K,1A , ( �/ 1-‘ D. Are there any proposed changes to or additions of :signs intended for the property ? YES do NO 0 IF YES, describe size, type and f location: K I , f �. a,1 �' a 6\ Jp, l ,K ID 1 1 . trC k \ E. Will the construction activity disturb (clearing, grading, exc.vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO f4 IF YES, then a Northampton Storm Water Mana•emen': 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 ❑ p brief description here. ee,Nf t. ` - t , Bri Description Enter a br el , \-T4'31 n- ts, J1-_'` Of Proposed Work: f r�Q Yrfrt G '. ` ivy. (} � '" 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 0 F -2 ❑ 2C ❑ 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 I ❑ 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) / /' 15t 2 15-D CF . �, 2 , R 4 � .. 2nd ` ` Std 3 0 LT\ VV 7 Z7 4 m Total Area (sf) 1- V Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water upply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sew a Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal] On site disposal system • Versionl.7 Commercial Building Permit May 15, 2000 D epartment use only City of Northampton Status of Permit: �''\ wilding Department Curb Cut/Driveway Permit 212 Main Street Sewer /SepticAvailabifity i Room 100 Water/Well Availability 2 5 2008 ampton, MA 01060 Two Sets of Structural Plans jUIN1 phon 13 7 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans Other Specify T,4;' 1 PAIR, 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: • p e 1X - . J-% 1 (6aL e_ Map Lot Unit r - _ Zone Overlay District / Y Eim St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: C /Gilt LIa ,Tf�f. "P'"' Name (Print) Current Mailing Address: Signature y�i! - 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 )2 ( (a) Building Permit Fee • 2. Electrical //p (b) Estimated Total Cost of "j Construction from (6) 3. Plumbing 3 6116 Building Permit Fee 4. Mechanical (HVAC) Fire Protection 6. Total = (1 + 2 + 3 +4+5) Check Number //3 tJ This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2008 -1174 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/NB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out // car_ Fee Paid / 7 `✓ Typeof Construction: REMODEL RESTAURANT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 058422 3 sets of Plans / Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 Signature of Building Official D. to 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- 2008 -1174 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- 2008 -1174 Project # JS- 2008 - 001736 Est. Cost: $19000.00 Fee: $95.00 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/NB Applicant: Gerry Shattuck AT: 1 BRIDGE ST Applicant Address: Phone: Insurance: 53 CLARK AVE #11 (413) 584 -6265 NORTHAMPTONMA01060 ISSUED ON: 6/26/2008 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL RESTAURANT 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 6/26/2008 0:00:00 $95.001134 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo