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32A-153 (14) 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 © No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, -c,>fA t/ bi? f A u-C( as Owner of the subject property hereby authorize S ��' ' a ST�y�<<"' to act on my alf, in all ers relative to work authorized by this building permit application. Signaturg of Owner Date —�G 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 CMner/Agent Date SECTION 1 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: tA 6 i q 36 q License Number � , w��� � "� Sv o n►3�5 e/1 -�f s€ Address �/ Expi—ra—ti�ov Date I Signatur4 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 cst?�1�Ct`2.i.�S C0�«�y5t�tl CN—� r Version 1.7 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 CAL" Not Applicable ❑ Company Name: ko6"4 sINck" `� Responsible In Charge of Construction _ �53 S. MAI0 -D '. I0I, ot3-1�' Address � G Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING j/A, 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/Finding ever been issued for/on the site? NO 0 DONT KNOW O 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 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtai"n"'e`d 0 , Date Issued: C. Do any signs exist on the property? YES ( ) NO 0 IF YES, describe size, type and location: D. D. Are there any proposed changes to or additions of signs intended for the property?YES � ) No � ) 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 ❑ 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: 6u I.1 d 0 Y-f d CP I�t�( A4141 l r11 U ' F ��-d� 2 bcc/ Z ba.K 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 ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ I-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) 1St S7 1St 7 2"d /Z 2nd 8 / 7. 3`d 812- 3n' 8!2- 4t' 41h 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 ZonejK Municipal a On site disposal system[:] Versionl.7 Commercial Building Permit May 15,2000 YV. 1 Department use only grthampton Status of Permit: 1l! l5 U v epartment Curb Cut/Driveway Permit 2 n Street Sewer/Septic Availability i _ 2004 100 Water/Well Availability JUL Northa pto , MA 01060 Two Sets of Structural Plans 124 Fax 413-587-1272 Plot/Site Plans n I; q1"s,INSPECT O1()60 Other Specify APPL 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 2t S�erj 4 ✓-P�'J t Map 13 / Lot /S � Unit 00 3 / Zone Co C� Overlay District Elm St District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lo L) 1 D THuE� �o T�aX 3Zy EatIl4P�-� h 6/0-z7 Name(Print) Current Mailing Address: y13 69s' 6o6 Signature Telephone 2.2 Authorized Aoent: © r�� PrckVZT '� 5, YN fit c��►a0(�CRC. r1f�;N1 -7 Name(Print) Current Mailing Address: q(2' (O19111 Signature Telephone SECTION 3-ESTI ATED CONSTRUCTION COST Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Building O (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of g 1 cn--c) Construction from 6 3. Plumbing ' U�—� Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date _ Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2005-0017 APPLICANT/CONTACT PERSON Sackrey Construction ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLAND (413)665-9995 Q PROPERTY LOCATION 24 STRONG AVE MAP 32A PARCEL 153 003 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: BUILD OUT FOR RESIDENTIAL CONDO New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 040714 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Commissi La Zov 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. jL /� 24 STRONG AVE BP-2005-0017 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-.Block: 32A- 153 CITY OF NORTHAMPTON Lot: -003 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.1.42A) Catezory BUILDING PERMIT Permit# BP-2005-0017 Project# 35-2005-0022 Est. Cost: $88000.00 Fee: $440.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Sackrey Construction 040714 Lot Sizes .ft. : Owner: BAUER DAVID zoninr„_CB. Applicant-. Sackrey Construction AT: 24 STRONG RVE- Applicant Address: Phone: Insurance: 83 SOUTH MAIN ST (413) 665-9995 O Workers Compensation SUNDERLANDMA01375 ISSUED ON.7121104 0:00:00 TO PERFORM THE FOLLOWING FORTE:BUI4D OUT FOR RESIDENTIAL CONDO 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- 7�' �r y, Rough: / ! !y/51 House# Foundation: �! l Driveway Final: Final: Final: 17,441q.1, `y� >r�6� � 6 Rough Frame:o(,� `�-1�—��`a' Gas: kiii D artme t Fireplace/Chimney: Rough:., - - � Oil: insuiation: G Final: Smoke: Final: Q K - O *30.D3 Y T&��,0C ANCy— — PEKING ELECTRICAL '& PLITA7BINf, r `'=E RES 5/28//05 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATIONS. , Certificate of Occupancy signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 7/21/04 0:00:00 1014 $440.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo r i z � a�� u2 Sr' 2J� .'� F � w a`` ^,�• K tx .m �. � a. �' '> ,_s f a ,M a a s s4 3 *� * 1, �r t Y[ �t �� sk r U 24 STRONG AVE BP-2005-0017 GIs#: COMMONWEALTH OF MASSACHUSETTS a :Blo k:32A- 153 CITY OF NORTHAMPTON Lot:-003 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit- Bulldi DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) t, o BUILDING PERMIT Permit# BP-2005-0017 Project# )S-2005-0022 Est.Cost:$88000.00 Fee:$440.00 PERMISSION IS IIEREBY GRANTED TO: Coast.Class: Contractor: License: Use Groff Sackrey Construction 040714 t Size(sa.ft.): Owner: BAUER DAVID y^_zon�n rB m __ Annlicant. Sackrey Construction 775 - - -_, - Agg scant Address: Poe: Insurance: 83 SOUTH MAIN ST X413) 665-9995 O Workers Compensation SUNDERLANDMA01375 ISSUED ON:7121104 4:00:00 TO PERFORM THE FOLLOWN—G WORK:BUILD OUT FOR RESIDENTIAL CONDO POST THIS CARD S4 IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: 7015rloy� '� Meter: Footings: Rough/o - Rough: fh"( House# Foundation: r1� f Driveway Final: Final: Final: /u, y yf6S" / �j Spt�IS�FG'c Rough Frame:OK l t'.. m 0q� Gas: i" art ei Fireplace/Chimney: Rough. jf�� 4i1: nsuiatoni_ Final: (t-, + Smoke: Final: i THIS.PERMIT-MAY BE REVOKED BY THE CITY NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATI S. f t re• Eee : Recei t No Date P 'd Check No: Amount: Building 7/21104 0:00:00 t 1014 $440.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo