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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