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32A-121 (4) N l i .0 e._ V \ l Qq�pl fo VVI 611m, _..._ 6 I c Ib ci IS 7 Y2- LA 5 - r � � L c rte. r � �� of U-7 rb ti X -lo --)o 77, Jt, FC A tel or jk j 'l yl 55 61, Wli a �, to i 4c) I c%rA.1 c CS r Iz-v I' C L oJT 7 5-5 I� b um C) I CA I f IF( 1 54 A 0 L ► r ti a cr,4 A( 54c,"-k �yA 5`1 i P, Hcl.Y1 it VA City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 �'sy. INSPECTOR Gerard Stordeur November 6, 2014 Keith Graham 16 Corticelli Street Florence, MA 01062 Subject Location: 71 King Street Map Block: 32A-121 Mr.Stordeur, Your building permit application and plans dated 11-6-14 have been approved. Please follow up on the following items: These items will need to be addressed before a permit is issued; 1. All components must meet typical requirements or R311. 2. Post fasteners must meet code requirements typically bolts, lags or ThruLoks. Note:July 1 begins enforcement of the 2012 IECC with MA amendments and fire protection for non- dimensional lumber floor system frames,the new Stretch Code is pending. As of August 4th 2011 the 8th Edition MA code is the 2009 IRC with MA amendments. In the following are some generic requirements which seem to be problematic. This is not intended to be comprehensive, nor is it a substitute for purchasing and reading the MA codes. Read only international codes are available on line at http://publicecodes.cyberregs.com/icod/one must also consider the MA amendments to these codes which can be found at www.mass.gov/dps/bbrs . The current relevant building codes are: 2009 IBC, 2009 IEBC, 2009 IMC, 2009 IRC, 2009 or 2012 IECC,AA115, MA amendments. Relevant items must be submitted to the building department for approvals before inspections and or Certificates of Occupancy can be issued. Feel free to call if you have any questions. My telephone number is 587-1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting we close for walk-ins at 12:00 noon on Wednesdays. My email address is: cmiller(a)-northamptonma.gov Thank you for your c eration on these matters. Chuck Miller City of Northampton Assistant Commissioner and Zoning Enforcement Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership., association, corporation or other legal entity,or any two or more of the.foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax# 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print I.,effibl Name (Business/Orlganization/Individual): ( ,/' Address: N O n u b t'' PA— City/State/Zip: PUT el1C e i c` CG Phone #: 3, 1— 6 Are you an employer? Check the a propriate box: Type of project(required): 1.❑ I am a employer with 4. E] I am a general contractor and I ployees (full and/or part-time).* have hued the sub-contractors 6. New construction 2.M I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. E]Demolition working for me in any capacity. employees and have workers' insurance.: 9. F-1 Building addition [No workers comp.comp. insurance required.] 5. F-] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 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 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 certify,iViderthepa i a penalties of erjury that the information provided above is true and correct. i Signature: `. . Dater C Phone#: Z. 3 C3 a , 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#: KEITGRA-01 NCURTIS CERTIFICATE OF LIABILITY INSURANCE DATE(M 11!3//201201YYY) 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1001090 CONTACT NAME: Commercial Insurance.NET PHONE g77 907-5267 Fnx (405)366-8817 2420 Springer Drive (A/C.Lo Ext:( ) A/c,No Suite 100 Norman,OK 73069 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Preferred Contractors Insurance Company RRG INSURED INSURER B Keith Graham INSURER C: 16 Corticelli St INSURER D: Florence,MA 01062 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE I OCCUR PCIC5026-PCA526020 07/22/2014 07/22/2015 DAMA E T RENTED 50,00 PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,00 _ PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 X POLICY F] PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,00 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED (BODILY INJURY Per accident $ AUTOS AUTOS ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident _4UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ' OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $_ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Whalen THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 71 King St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD +f �e�pomyno'ruaecc�i o�UV[aa�ac,leu�a Office of Consusaer Affairs&Business Regulation kjME IMPROVEMENT CONTRACTOR egistration: 176031 Type: E01p,r a tion: 7/ 72p15 Individual KEITH GRAHAM 16 CORTICELLI ST. -�°�-- FLORENECE,MA 01062 Un ersteretary *� Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-075895 KEITH M GRAHAM 16 CORTICELLIST FLORENCE MA70104 �-� Expiration 07/02/2015 Commissioner - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F Registration: 171634 Type: Office of Consumer Affairs and Business Regulatio x" < Expiration: 4/3/2016 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 GERARD STORDEUR FINISHING GERARD STORDEUR 32 PARADISE RD. NORTHAMPTON,MA 01060 - -- t.ndersecretary Notydlid without signature CONTRACTORS SPECIAL POLICY DECLARATIONS PAGE New Business Declaration UTICA FIRST INSURANCE COMPANY CONSTITUTED IN OHIO AS UTICA FIRST INSURANCE COMPANY(MUTUAL) Direct Billed- Insured Home Office-5981 Airport Road,Oriskany NY 13424 Mail Address-P.O.Box 851,Utica,NY 13503-0851 Policy Number: ART 5056866 00 Renewal of Number: NAMED INSURED AND MAILING ADDRESS(Number unity,State,Town ode ay.� Agent 2750000 GERARD STORDEUR FINISHING WHALEN INS AGY INC GERARD STORDEUR DBA 71 KING STREET 32 PARADISE RD NORTHAMPTON, MA 01060 NORTHAMPTON MA 01060-9999 POLICY PERIOD:12:01 A.M. Standard Time at the Location of Designated Premises. 07/30/14 07/30/15 From To Item Prot. Rate Cons't Description and Location Number Class Group of Property Covered 1 PR F Description: CARPENTRY Location: 32 PARADISE RD NORTHAMPTON, MA 01060-9999 County: HAMPSHIRE AGREEMENT In return for your payment of the required premium,we provide the insurance described in this policy. LIABILITY INSURANCE COVERAGE LIMITS ANNUAL PREMIUM Each Occurrence Limit $ 1,000,000 /per occurrence Medical Payment Limit $ 5,000 /per person General Aggregate Limit (other than Products/Completed Work) $ 2,000,000 Aggregate Limit (Products/Completed Work) $ 2,000,000 Fire Legal Liability $ 50,000 /per occurrence Personal and Advertising Injury $ 1,000,000 /per occurrence Property Damage Deductible $ 0 Included PROPERTY INSURANCE COVERAGE DEDUCTIBLE LIMIT AUTOMATIC REPLACEMENT ACV PROTECTIVE ANNUAL INCREASE% COST DEVICES PREMIUM Building Business Personal Property Loss of Income Business Personal Property- Off Premises FORMS AND ENDORSEMENTS SEE FORMS INVENTORY PAGE ANNUAL FORM NUMBER DESCRIPTION PREMIUM $150 Minimum Retained Premium ANNUAL Name and Address $1,067.00 of Mortgagee: $ 0.00 POLICY TOTAL $1,067.00 Our uthorize epresentat" Countersignature Date 08/05/14 INSURED COPY Keith Graham Construction 413-210-7717 November 3, 2014 Dear Sir or Madam: I request that you grant a modification to waive the requirement for control construction for the project at 71 King Street in Northampton because the work is of a minor nature,will not affect health,accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. Respectf y, Kei Graham Keith Graham Construction 16 Corticelli Street Florence, MA 01062 . The Cormnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , 600 Washing ton Street Boston,MA 02111 I ,:1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): _ Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.� I am a sole proprietor or partner- listed on the attached sheet. 7: ❑ Remodeling ship and have no employees These sub-contractors'have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 1.❑ I am a homeowner doing all work ❑ myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.K Other SA comp.insurance required.] It, S" *Any applicant that checks box#1 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 narne 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 er the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 7 - 0 7/ 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#: 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 No SECTION 11 -OWNER'.AUTHORIZATION-TO!BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �7`... LL.. _ _. __ _. M _ _........ .. as Owner of the subject property hereby authorize' . .... _..._. .. ..._..____ .._ .__ ._. _. . � t..[�.._ _�M. C/ 44- .._..._._�dr ��'l�. _...._. ._.=to act on my b n r rel 've to work authorized by this building permit application. Signa a of OwnerV Date _. _ I, L-t%![_ 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 und�eythe pains and penalties of pequry Print Nam -�y gnature of Owner/Kent-` Date SECTION 12-CONSTRUCTION:SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder: `� n 1.�...._. .1 ..._.._ License Number AA Addre Expiration Date q1?._.aJou. ' _ .._._...._ .._ ._ Signa r 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 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 ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility i Address ...,_.__ _..., Registration _... Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date .._.. _._.. .. .... _ ._ .. __. .__..M.. ... _..,., r__. ._.............. .. ........ ..._.._... ._.... _....... ._.,_.._...__ ......._. ,__.... .__._..., Name Area of Responsibility Address Registration Number j Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Compan Name Responsible In Charge of Construction ....... fic .. .�_ w Address Sin ure Telephone Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON.ZONN Existing Proposed Required by Zoning This column to'ge filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L R J 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/Find jiny ever been issued for/on the site? NO 0 DON7 KNOW YES 0 IF,YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON7 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 DONT KNOW 0 YES C) IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: 0 C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: ................ ......................... .................-........... ....... 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, excay6tion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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 brief descri tion here. Of Proposed Work SECTION 5-USE GROUP ANDCONS.TRUCTION 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 ❑ 213 - ❑ F Factory ❑ F-1 ❑ 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 ❑ 513 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify r S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATIONS, ADDITIONS AND/OR.`CHANGE IN USE Existing Use Group. Proposed Use Group: 1 Existing Hazard Index 780 CMR 34):."- „_..._ _ ___..m Proposed Hazard Index 780 CMR 34)::__ ...M . _.? SECTION.6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so _.._..__. . ......... St 1 St . . . 2nd 2nd 3rd 3rd .... w._... _ ._.._ _.. th i- 4t” 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 Zo-pe Information: .3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Ft, unicipal E] system[]On site disposal system Versionl.7 Commercial Building.Permit May 15,2000 .� Departure tuse,ortf� City of Northampton Stati�is cf Permit �� ,�a � ( Building Department curb Gut/Dnveway Perniit� E' 212 Main Street Sewed-/SepticAvatfaf3Cii#y Room 100 WaterIWell Avaltablfif teetric, Plumbing&Gas Inspections 0so orthampton, MA 01060 Northampton, MA 01 Two'Sets of StructiiraC Plans 13-587-1240 Fax 413-587-1272 Plof/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 Property Address: This section.to be completed by office "71 1�l _._/ ¥ Map Lot Unit Zone Overlay District Elm St:District CB District SECTION 2-:,PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) �S Current Mailing Address: Signature Telephone 2.2 Authorized Acient: Name(Print) Current Mailing Address. Signature Telephone SECTION °-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (15tEstimatedTotal,Costof Construction from- 6 _.._... _..,....... 3. Plumbing ; Building Permitfee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Nummber This:Section For'Official Use Only Building Permit Number Date Issued _Signature:__ Building Commissioner/Inspector of Buildings Date File#BP-2015-0524 APPLICANT/CONTACT PERSON KEITH GRAHAM CONSTRUCTION ADDRESS/PHONE 16 CORTICELLI ST NORTHAMPTON (413)582-6890 Q PROPERTY LOCATION 71 KING ST MAP 32A PARCEL 121 000 ZONE CB(100)/ 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: REPLACE REAR EXTERIOR STAIRWAY New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included: Owner/Statement or License 075895 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFqRMATION 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 Demol' ' ay re of Buildifrg 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. 71 KING ST BP-2015-0524 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 32A- 121 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catego :r renovation BUILDING PERMIT Permit# BP-2015-0524 Project# JS-2015-000989 Est. Cost: $9000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH GRAHAM CONSTRUCTION 075895 Lot Size(sq. ft.): Owner: J W INC C/O WHALEN INSURANCE Zoning: CB(100)/ Applicant: KEITH GRAHAM CONSTRUCTION AT. 71 KING ST Applicant Address: Phone: Insurance: 16 CORTICELLI ST (413) 582-6890 0 NORTHAMPTON MAO 1060 ISSUED ON:111712019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE REAR EXTERIOR STAIRWAY 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: FeeTyne: Date Paid: Amount: Building 11/7/2014 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner