Loading...
17C-214 (18) ¢1ll/J-f P", Rio � 0yti C!%if of �\To fljallt}lfoil g ~ E (11 fir c S DEPARTMENT OP BUILDING INSPEC1-101JS Hia 212 Main Strcct ' Municipal Buddint, Northampton, ?Hass. 01060 V,'OR.ICEWS COi\U ENSATION INSU_ ANCF AF'F11MV_T (IJC scIl cJ(Y_iT131ttCc> \Vlt11 a PI-mcipa1 pal"at-- ofbusiuess/residenc, at /f /y� �/ / y 11.1 (StTc--t/citf/natcIzip) do hereby certify, under the pains sad pen'-hies of perjury, x_112! ( ) I gun an employe: providing the rollow11w wolkcf's colnotns_::Jon (or Iny errlployccs wol_�ang on uhis job ---- (ljis)]_ ^C:� L.ot cI-Ev) -- -- (PcAic NLL' ,]bcij ( ) I am a sole propnetor, general contractor or horleovY-ner (tacit one) and L e hired the consactors listed below who Ilave the foLlovrine •,vorkc�s coy��Der va orl uo'ucles� (Namc 0. Con,,..!Clo:) (Na Inc of Coutrzc,cr) --- Oi s-,lr-ancc ComDau""/Potic-" Numcsr) (—Ex-o,_m.;!o n Date) (Name of Cownclor) (Insuranc Comp2-o)-/Police N;urbJ) (Expirrioo Datc) (Nafflc of C0rt11c-,G0 (In uran Comr 17}�/I olio Nu17��t) (L��;u�tion Datc) to�:>:_'wl-uifo(L-�i_i oc:f.•.3-tzvz:i;F to.11 ,� I a1� a sole proprietor and have no one woi kdj)g for ❑1e- ( ) I am a hone owner performing all the wor k myself. 1401-E:plc Lr cw-act+,,. Jc bcaro„�_n Ibo cmplay pc:o to dD t�jZj ^ of acx 2�o(c U,-;Larr uni'u in„iu:cb tb> lronrXn,vcr r�d�of oa the �uy!r zi- „,-rt�-rL.r'tbc-�..n c.-c r:x C�:Dv ccc.d_cd w[i ­_Vlayc}ua Lx„ai d;c�_ ticct Act(GL152_-1(5)} zWGp _ocn try fcr c Lr ,_a pzrnu I c-,&mcc Lbc 1<g.1 0--*'-of cn cz�Ploy� undo-r do Wc,k_o (Cow al-ipa Ai_ 1 underrtnnd t-e>copy of(b-z�m.y b-foc-w.ird.od to tbo of Icw viol At &__Jy Of -of I,-�fo(dx oovm&c vrrifictioo aid th-1 w taurc-%-C�uridc scctioa 25 A of MGL 152 m foal to tba i.^q>-2ioa of t---i-t'n,l pcn-.Lka .. oomittis of a floc of up to S 1,300 00 e N- of up to otx year c.�d o,il p�.,t;ia in t`.x f(,,of o Stop W o(k Order end o rim o(S 100.00.da y t ea n x ar_ P crini t N tun bcr 00("t—Az ----- 2� G Imol^ Sifnaturc of LIccj)_-c&PccIm1tcc -- 3Ce f ` Version 1.7 Commercial Building Permit May 15,2000 SEC7ION;10-STRUCTURAL PEER REVIEW(7'$0 CMR 110:11) dependent Structural Engineering Structural Peer Review Required Yes......❑ No.....16 SECTION!11-OWNER AUTHORIZATION -7013E COMPLETED WHEN OWNERS°''AGENT OR CONTRACTORAPPLIESr FOR BUILDING PERMIT 'Dili Ace)(61,410k as Owner of the subject property her 'by auth --� tK GZ`f'�G�''Y to act on ml I matter i rk authorized by this building permit application. Signature of Owner Date .�� I ^�� Lt,�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 Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : --^��/C� ���L��x 05--Z " ,A,� License Number Address , Expiration D to Signature Telephone SEC71C1N,1S:WORKERS',COMPEN"SATICN INSURANCE AFFIDAVIT(M.+G.L. c.152,§ SC(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....... No...... ❑ f ` Version 1.7 Commercial Building Permit May 15,2000 S IQ 1, 9 PROFES,SI0WAL QESIGU AND'CONSTRtICTION'SERVICES -FOR,BUILDINGS AND STRUCTURES SUBJECT TO C NS"t JC' ON G 3NTRCL PtJR I1ANT�t(�7 3t> CNII�R 116{CONTAINING M S IE THAN. S;�1C} C. , OF'ENDLfi3 l l Ph"t Registered Architect: Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number nature 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 -- �4�'Z St ' Not Applicable ❑ Company Name: Responsible In Charge of Construction Tb. HL11Y77 67-04 dress Signature Telephone ` Version 1.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L. c. 40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: blic ❑ Private ❑ Zone: Outside Flood Zone Municipal X On site disposal system ❑ 8. NORTHAMPTON ZONING 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 DON'T KNOW X YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES _ NO IF YES, describe size, type and location: fi'm% of 'm-s-7,urmcr D. Areithere any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: Version 1.7 Commercial Building Permit May 15,2000 CE S' TI N'�4»CONStRtlCfIC?N-SERVIS FOR PROJECTS LESS THAN 35,000 IC"FEET Off' CLOSED SPACE Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] °�� �!�'6°I�,l� �i � ��►S��db .� C.°9^d'�" �ECc.�.� i�'z3Frn�'� fN �'i��ts'�`.�' 4� SECTION;5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 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 ❑ 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: 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): SECTI01 5 Bi 1 RING HEIGHT AND AREA, BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION �� s old ,N w Floor Area per Floor(sf) 1St /s k' ' AN f F 2nd f 1st Ni ' v rd AS- 2nd 3 � 4 th 3rd �F 4 th H Y� :/ 1p' SY ylf / E Total Area (sf) Total Proposed New Construction (sf) ' i xw y 2 ............................ /. _ 1 a Total Height(ft) �' w Total Height ft ------------------- oj,. Versionl.7 Commercial Building Permit May 15,2000 x, ity�of rthampton Z.�3 B '� partment 0 ain Street Room 100 orthampton, MA 01060 r one 413-587-1240 Fax 413-587-1272 s- 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 INFORMATI ON This se i tt t beorh}l�ke` , I 1.1 Property Address: , Sxcc Nlap Lot clay Digtri' 3 RoREIgCr' �l .. elm SECTi,'. N.2-PROPERTY OWNERSHIP/AUTHO,RIZED:AGENT 2.1 Owner of Record: 7 Nam (Print Current Mailing Address: Sig ature Telephone 2.2 Authorized Agent: 441, 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. &d0d#rg Fc6 Cl� (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6" 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 +4+ 5) Check Number T:his.Section Fur Official Use Only B uild.ing:;PermitNumber: Date Issued: Signature: Building Qommissiopep°/1nsppctor l3uitdings Date 99 MAIN ST BP-2001-0089 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-214 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_roofing BUILDING PERMIT Permit# BP-2001-0089 Project# JS-2001-0140 Est.Cost:$3600.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor: License: Use Group: Jack Walton Construction 052591 Lot Size(sq.ft.): 18 120.96 Owner: ALEXANDER MAURICE&PAULINE F Zoning:GB Applicant: Jack Walton Construction AT. 99 MAIN ST Applicant Address: Phone: Insurance: 130 County Road (413) 667-3358 HUNTINGTONMA01050-9727 ISSUED ON.7125100 0:00:00 TO PERFORM THE FOLLOWING WORK.-COVER EXISTING ROLLED ROOFING W/RUBBER ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/25/00 0:00:00 1843 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo