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at columns to remain. • a `�"J 1:1 .,
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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 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,1 .t
r�
flu 4.7 `'%, as Owner of the subject property
hereby authorize „, � ,, k.*w ,,:, to
act on my behalf, in all matters relative to w authorized by this building permit application.
,„,.
Signature of Owner Date
fi 3 a to fit. 8 O 'l.7': a:€ T ti 4�''
=ter c .g� 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 .ains and penalties of perjury
F 7 14 0*, T"=
Print Name O
4�
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder. _ .xs. -C :.° a. J
License Number
*, 9-P "' ':r M >. fl3 ice' ,� .a 'it;� s r �c ,t a
Address Expiration Dat
Si.. 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 0
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 ❑
F xrr.
Name(Registrant):
Registration Number
' '
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
t� !,4a. .,,��z r! �',. ^__°�_-.. ,. �•�_.... «max'"�, ..41 4 ��t,"'°
�. , . .k
Name Area of Responsibility
�� � a �" �� . ,
rplad' 5;!TA' fir ' -ar a9 �;x a hr' °'r¢�tr, P 't 4 xr e`'t"'` •'r' 9
Address Registration Number
Signature Telephone Expiration Date
fa. '
.. w�,.rff� `x�'�3ta'��.n..�'", w�, =,9,. .,. �4, ... � ,<<. �.Wt.,s. r�.
Name Area of Responsibility
{`
Address Registration Number
Signature Telephone Expiration Date
�!.�
Name Area of Responsibility
,.r �.."- a �#
aN a r 4
!r r 4",r14 a,1,04010410:'
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
9si '
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
r
.' Not Applicable ❑
Company Name:
Responsible In Charge of Construction
4:., , , ,? 7u"*,' „ u,t .,, ,
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
ta a " . . s 2 ! M 4
Frontage � .
Setbacks Front
Side L. R: L. R: .
Rear
Building Height rcA
Bldg. Square Footage
u aa�
Open Space Footage %
(Lot area minus bldg&paved s Zti" "f�` r
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 0 YES C)
IF YES, date
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T 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 g DON'T KNOW 0 YES
0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES C) NO C)I
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES O No t
IF YES, describe size, type and location: , `
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 1V, Existing Wall Signs ❑ Demolition Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign;❑ New Signs❑;]y Roofing❑ Change of^LUse D Other❑ j jj
Brief Description �� � , � 1 55
Of Proposed Work "� # � " 5 R� � � �t- � o'-,.J.,,-
.
: . .t ' l, .A d c ^ =',' /3 ' .
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business til 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ Si- ❑ S-2 ❑ 5B [ ❑
U Utility Specify: ?, 4), t_
M Mixed Use ❑ Specify
S Special Use ❑ Specify ' ,
°a. -,a era.a r
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
s '# a" s "�' i r;�"?, hG z''x fai.+t'.h, tTy is� ;$-;. '"+»'�. h 7
Existing Use Group: ,: Y° 124: LL:. Proposed Use Group: � � _� L.,___ _j___,_
Existing Hazard Index 780 CMR 34) ;;;111";:(-.-4 41 E'i ` ____
t 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)
(V .Q,
, ,,,I. d 4 st uti 'v t "
1st it } � r 4.,s a- P. '9:, 1 r,z,,,,,,:,',„ F 1 1fi. ,
(j
2 1-43:*WiAliMt4474::,,,7.#.
3rd ' 0 3rd 0
4th [ r h e '�[ n4'uyu�' 4th i '� "'•'
� ti4
4 s `:�'ar� r {ai`a5wu3n ;���' ��I
Total Area(sf) r A ` Total Proposed New Construction(sf)
Total Height ft ' ,14
Total Height ft' 4.f„_- 0
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Private ❑ Zone '1 , }= Outside Flood Zone Municipal J On site disposal system D
� � 7 : ( Version1.7 Commercial Building Permit May 15,2000
'',\4 lb �� ! Department use only
i I � C t�y� f\Northampton Stetus.of Permit:
AUG - 200
uilc�ira. Qepartment curb C tJ nveWayoerro►t _
\, 2 in Street svVerf,SepticAvailabl
i Roo 100 Water/Well Availabilly„ „ .,.—,
Dt o f l��i l4G " F �I ampto , MA 0411036-5087- Two Sets of Str�lctural Plans,..,,________
'� t " phb le 4i - Fax 1272 Plot/Site F'lartis„ -__ __
Other eci
p fY- --------
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: This section to be completed by office
fmss "" r `' Map Lot Unit
f i"� li�A' V,�; �t , � i j Zone Overlay District
s � �r �� mra" t� �', +i �r k a �, .�?„ a,� - ram
t "fir +` , 7t a rr as m
-,4,4a.---;--.5,- � „ r a Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e.. 4 a, t ,:,,,i„on "i"' `
Name(Print) Current Mailing Address';
Signature (ey i2LY- ld_,1 -. Telephone
2.2 Authorized Apent:
x
g fir ^a ak " wa,r.&Eh f' x'+ �' t { a,k
Name(Print) Current Mailing Address:Signature �' - -- -l Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 7'a f �.-::a " " '+ (a)Building Permit Fee
: r. a `
2. Electrical , �, 4 ,, , (b)Estimated Total Cost of■, r. +v" .a . Construction from (6)
' � ms ,-,,,,I, #��': "'''
3. Plumbing r , ` � tr11 �i Q;s,4. Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection «�� ��-
6. Total=(1 +2+3+4+5) V(y c.',ppp $0.00 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/I pector of Buildings Date:
File#BP-2006-0116
APPLICANT/CONTACT PERSON City of Northampton Central Services
ADDRESS/PHONE Memorial Hall NORTHAMPTON
PROPERTY LOCATION 42 GOTHIC ST-JAMES HOUSE
MAP 31B PARCEL 311 001 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /'�A
Fee Paid ('�`�'�
Typeof Construction: DEMO 2 EXISTING WALLS INCLUDING 2 DOORWAYS&INSTALL
TRANSACTION COUNTER W/SLIDING GLASS WINDOW&CONSTRUCT NEW CONF RM&DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 089537
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 Co scion
0/749
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.
2 I13-- 31 (
42 GOTHIC ST-JAMES HOUSE BP-2006-0116
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Black: 31B-311 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2006-0116
Project# JS-2006-0175
Est. Cost: $5000.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: City of Northampton Central Services 089537
Lot Size(sq. ft.): 16814.16 Owner: NORTHAMPTON CITY OF
Zoning: CB Applicant: City of Northampton Central Services
AT: 42 GOTHIC ST - JAMES HOUSE
Applicant Address: Phone: Insurance:
Memorial Hall
NORTHAMPTON MAO 1060 ISSUED ON:8/2/05 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO 2 EXISTING WALLS INCLUDING 2
DOORWAYS & INSTALL TRANSACTION COUNTER W/SLIDING GLASS WINDOW & CONSTRUCT NEW
CONF RM & DOOR
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 8/2/05 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo