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17A-054 (3) A (rIf-�) 13f PortIlaIIlpfoil - A(�l E -ql4JfAchnsctla' - DEPARTMENT OP BUILDING INSPECTION'S _ 212 Main Strect ' Municipal DuildinG Northampton, Mass. 01060 �YO RICE It'S COWIPENSA-MN, MSURANCF' Al=AY11- ' OwV 0 (ti ccns�Jperm�ttcc) p) do hereby certify, under Lfie puns 2nd penalties of pcgury, :hit O I an an employer providing file following \�,orker's comnchsaLlo, coverage for lny empl'ovees worlang on this job: (Lasur---n=Coou=- y) (PCUC-, Nu—,Jl�cr) --- (l ,piraon D2i-) ( ) I am a sole proprietor, general contractor or homeow-nes (ci:cie oee) and have hired the conuactors listed below wbo have the following workers cocDtns26on policies: (`+HID: 01 Coninctos) (1nR rangy Colnoarl)-i-0hc-i Datc)' - (Name of Coouzcior) -- (Insw-anc; Comoa.av/?otie,, \umcrr) (—Eivir.uion Date) (Name of Coorraclo:) (Ibszuauc; Compa.oy/Pobq- Nwnbe.r) (Expimdos Date) (NamC of Coatmctor) (Insurancz Comc.- y/PoUcy Numbcr) - (Expim6oa (aaac336h0=l tScC if oocr _,v to mcu wronn--Z a paZaiaing to.n ooar-_CLO:-s) (✓f I am a sole proprietor and have no one woridng for me. ( } I am.a home owner performing all the work myse.1f. NOTE:plesc be.-wt ttx v.L_je 6emrAV nm.rbo employ p,=c eo w o—,ZC:Joo c rcp�Lu kOfk oa.d.•ciLL of not man th a --U w wt ch the bOmoowi)cT rr ep.a oa the -oun zpp�utcast thceo 4-r OCe malty w-didvcd LO be e�rployc�undo the..r z —.•:cn Au(GLS52.=!(5))rpplim6ou by.bommwva far c Ge _cc permit n_y eiEcace tie levi c—'xu of=c= loyx under dr.o woctoes Cooapomation Ast- i undcrrL. d th.a a copy of this cmi®c t m.y be focw. ted t.o tho Dapertaacna of Acndcmy oc'.of 4.�—foe the covcca sc vaZc:tioa a.'1d Uu U=c to secure bovtrasc uodcr saxioa 15A of l.(GL 15,2 C=I'd to tba v uoa of ei�pcna wr:3 oomisi3S of a Gne of up to S 1 X00.00 a Wcc mspi iypa> S of up to ooc year end a%il pm 1ua is dx focm of n Stop Won Order and" f=of 5109.00 1 d:y a&aiaA me For dcp_tm=-.j u.c only Permit Numtcr Lot Sim-,lure oiLiccnscclP ucc ce - A X Version 1.7 Commercial Building Permit May 15,2000 SECTION 10=?STRUCTURAL PEER,REVIEW`{78Q CMR 110'11 , _. Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11-=OWNER AUTHORIZATION-TO•BE:COMPLETEQ,WHEN OWNERS AGENT,OR'CONTRACTOR APPLIES FOR BUILDIINQ PERMIT i I, as Owner of the subject property J hereby authorize! to act on my behalf,in all matters relative to work authorized by this building permit application. i C'nn----- Date ,.lam........,... 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. 4 Print Name Signature of Owner/Agent Date SECTION.'t -CONSTRUCTiON;SER\/ICES. 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �"`�►� -( � )1S S ©��-7 , License Number Address TT Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE"AFFIDAVIT{M.G.L.c.t52si§: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 r Version 1.7 Commercial Building Permit May 15,2000 - SECTION 9-PROFESSIONAL,;DESIGNANDQNST 1/IGES EQRBUILDt�CGSANDS�RtJG'FEItESt1B;IEGTO CONSTRUCTION CONTROL PURSUANT`T0 780.CMR 116(CONTAINING MORE:T C.F:69'A LOSEDSFACE) 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 i Address Registration Number � � f 1 � i Signature Telephone Expiration Date Name Area of Responsibility i i t Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility 4 Address Registration Number Signature Telephone Expiration Date f I E Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ._,/ Not Applicable 0 Company Name: E f Responsible In Charge of Construction r i Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by N O Building Department Lot Size i -a 1 PC, k i I Frontage Setbacks Front t Side L:;`�S i R:.ryo L:= R:i I T� , Rear top i i I-Buflidffig-Heftghr--' 2j j E i i Bldg. Square Footage s % Open Space Footage r % (Lot area minus bldg&paved parking) #of Parking Spaces ti Fill: ' (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book 1 Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: j ) E. Will the construction activity disturb(clearing,grading,excavation,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 SECT10`N 4-COi05TRUGTION SERVICES FOR PROJECTSESS THAN 35,000 CUBIC.E ETQ ENCLOSED SPADE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building E3 Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description ;Enter a brief description here. Of Proposed Work: /U i �0 (A-A2 SECTION 5-US E GROl1RANQ�CONSTRUGTION'TYPE^ USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 A-2 ❑ A-3 ❑ 1A r ❑ _ A-4 ❑ A-5 ❑ 113 ❑ r, 2A ❑ E Educational ❑ 2B ( ❑ 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 ❑ 5B ❑ U Utility ❑ Specify:9 j M Mixed Use Specify:5 f S Special Use Specify _ j COMPLETE TkIS SECTIOIy tFE7CJSTINGBUlLD1NG-Ell�[DEE2GOl G RENQ�/A © IS,ADDITIQNS'"Af�lD10E CHPIVGE 1N USE - r . Existing Use Group: 1 Proposed Use Group: 1 i Proposed : I Existing Hazard Index 780 CMR 34):' Hazard Index 780 CMR 34) SEC-T<tON'"6 B�7IE:DING}E1GHTANQ AREA. ."Y BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION t Floor Area per Floor(sf) - m St "- 1s1 "21 5-00 1 � 2nd 2nd rd 3rd i 1 3 { 4'" I Total Area(so 2 56 0 7 Total Proposed New Construction(so a `* Total Height(fta-L--2,,�S- /- Total Height ft 7.Water$upply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public El Private ❑ Zone " Outside Flood Zone Municipal J�T On site disposal system❑ R Versionl.7 Commercial Building.Permit May 15,2000 f•- e. City of Northampton Building Department e, _ 212 Main Streets Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING : SECTIONS _SITETNEORMA"�ION- °s - N-Prooerty Addles : Tttls sectron to be compfefedb�C office — r 1 .-1 t` t ... C3 RIE � 7 nt tl In�fi N 2 PROPERTY OWNERSHIP/AUTHORIZEDJfiGENT 2.1 Owl finer of Record:''�yl.u.4 ,S il1C� .ol,c Iv € Name(Print) LA) (-(yVja,0rrent Mailing Address: d �� . , `�Telephone C�1�� ' t �(� Signature p 2.2 Authorized Aoent: Name(Print) E?C!_(�f c> zt Cup rrent�Mailing Address: Signature L?� - o d c�-\ Telephone --SECTION 3.-:ESTIMATED CONSTRUGl`ION:COSTS Item Estimated Cost(Dollars)to be Official Use Offaly completed by ermit applicant 1. Building [ db j �a),Bulldiog;Per(nit Fee k) 0 L 2. Electrical i I (bj Estimated7otal Cost of i l ! Cons,u on"from: 6 3. Plumbing Build ng.P6ff4 Fee t 4. Mechanical(HVAC) i i i 5.Fire Protection 6. Total=(1 +2+3+4+5) (210 0 -t�0 Check Number This-Sedon For:Officiak Use Only 'Budding PermltNurnl;e Dsfe'^- _ Signature Building Commissioner%Inspector ofi Buildings Date 165V"GE RD 4 BP-2006-0895 GIs#: COMMONWEALTH OF MASSACHUSETTS Map Block: 17A 054 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category BUILDING PERMIT Permit# BP-2006-0895 Project# JS-2006-1374 Est.Cost: $4000.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Gunnar Jonsson 034709 Lot Size(sq.1): 22346.28 Owner: NORTHAMPTON CONGREGATION OF Zoning:URB Applicant. Gunnar Jonsson AT. 165 BRIDGE RD Applicant Address: Phone: Insurance: 47 CLAPP ST (413) 527-0585-0 EASTHAMPTONMA01027 ISSUED ON:311312006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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 3/13/2006 0:00:00 $50.002113 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo