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32A-162 (2) Version L7 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 as Owner of the subject property 1>1b _._. hereby authorize _ y Z"V L� to act on my be If ma ters l ative to work authorized by this building permit application. Signature of Caw er q Hate 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 th ains and penalties o, f pen iw(� _........� Print Name Signature of 2 er,'Agent Date SECTION 12-CONSTRUCTIA SERVICES 10.1 Licensed Construction Supervisor: Not Applicable )I Name of License Holder: ' k� ht lyfil ' m _ License Number olle ---- Expiration Elate Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)j 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 Ver,,ion].7 Commercial Building Permit Nhy 15, 2+:00 r— 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) i 9.1 Registered Architect. Not Applicable Q Name(RegistranO Reg siration Number Adc:ess Expirat.on Date i Signature 9.2 Registered Professional Engineers): ti 1�s �,� e L i st?C.i ctn ' Name Area of Responsibility Add s5' - - Registrat,on Number signature Telephone Expiration ate Name �_..._9_�._ \ �`�Y�k-��� �. C._• Area of ResponCsibility ��`t Address Registration Number - 336 � a� l Telephone I Expiratior, ate I Area of Responsibili'y — i Address Registration Number — SignatureM _ -- _-- Telephone �— Expiration Date Name Area of Responsibility Address _ Registration Number �— Signature :elephane Expiration Date 9.3 General Contractor ...._..... Not App icabie ioirpany Nacre; Responsible in Carre of Construction. Addrsss Signature __.._......._...Telephone 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) _ . �J� Registration Number Address Avg, 7016 '►— yr�' ',a6 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name � Area of Responsibility Address Registration Number Signature Telephone Expiration Data Name Area of Responsibility�� Address Registration Number Signature - Telephone Expiration Date I Name Area of Responsibility i Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name. Responsible In Charge of Construction Address Signature Telephone 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 ED SPACE) 9.1 Registered Architect: Not Applicable 0 Registration Number Exp€rations bate Signature Telephone 9.2 Registered Professional Engineers}. Name ' ' - ' 46t pns�ly l A ass /t-t— R istration Number +y8 iatU E7ir3lratiCN1Ltate �„ Area ssf Re sponsibility Address I?eglistretion Number Signature _ Telephone Expiration Date Name Area of Responsibility Registration Number Signature _ Telephone Expiration gate Name _ Area of Responsibility Address Registration Number 5igriaWre Telephone Expiration Crate 9.3 General Contmetor _ Not Applicable 0 Company Name: Responsible In Charge of Construction Address S gnature _ Telephone Versionl.7 Commercial Building Permit May 15,?tint) S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size S"°G, s3? G�c 5-'?3 Frontage 2co .F�- 2Go ��- Setbacks Front .� Side 1..: 3° R: IUC> L:3 o R: Rear 3 Z 3 Z- Building Height Bldg.square Footage 2S Z % Z Open Space Footage ",ii (Lot area ininus bidg&paved parking) #of Parking Spaces l4 l O Fill: 6 volume&Location} A. Has a Special.Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW ( YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'/KNOW Or YES IF YES: enter Book Page and/or Document## B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES 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 KX NO IF YES, describe size, type and location: /V' x Z0, &A S f-Xq f�c" i e 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: NEW S 00 f h,-- 25 514 tack t 4 N./ 1 4+ 1 e lo+ A'i SOAK O Q E. Will the construction activity disturb(clearing,grading,exca4ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versioni.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 3amolition Repairs❑ Additions Accessory Building[] Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rooting❑ Change of Use Other Brief Description Enter a brief description here, Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 Z A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ is ❑ B Business ❑ 2A ❑ E Educational ❑ 2B F Factory ❑ F-1 ❑ F-2 ❑ 2C H High Hazard ❑ 3A I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 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 I I Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: R') Proposed Use Group: Ar I Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34)• SECTION 6 BUILDING HEIGHT AND AREA I BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) st z 2 nd 5—y 2" 0/(v 3fd 3rd 4 Total Area(sf) Z- 5—/ Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water;upply(M.G.L.c.40, 54) 7.1 Flood Zone information: 7.3 Sewage Disposal System: Public 0 Zone Outside Flood Zone g Municipal [j On site disposal systemC3 N Private I Versionl,l Commercial Building Permit May 15,2000 f" >. Department use only City of Northampton Status of Permit: AUG 2 a �Q�S Building Department Curb CutfDriveway Permit j Li ' 212 Main Street Sewer/Septic Availability _ Room 100 WaterAVeli Availability Elect ic. F,u e actions Nurtr ,I <,:: , c a Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/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 This section to be completed by office 1.1 Property Address: 3 ?H'J"�o f 57 Map3' Lot /6 Unit Matte-�yt !��'►� !v (5110 0 d Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: N 1_A t_ ,4� �VAM 1 V`U c,T Name(Print) `�'� L� Curren Mailing Address: o Signature Telephone 2.2 Authorized A t: Name(Pri V,1 L � w�N — Current Mailing Address: Signature ._�._ Telephone i SECTION 3-ESTIMAT CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted b ermit a ,;cant 1. Building i -� ` - `'"` (a)Building Permit Fee 2. Electrical i (b)Estimated Total Cost of Construction from 6 3. Plumbing - Building Permit Fee 4. Mechanical(HVAC) c� 5. Fire Protection ' ' ` 6. Total=(1 +2+3+4+5) - - 1 t- Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: - '�� �. - Building Commissionerllnspector of Build!ngs Date File#BP-2016-0240 APPLICANT/CONTACT PERSON D A SULLIVAN&SONS INC ADDRESS/PHONE 82 NORTH ST NORTHAMPTON01060(413)584-0310 PROPERTY LOCATION 33 HAWLEY ST MAP 32A PARCEL 162 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INTERIOR DEMOLITION New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building,Plans Included: Owner/Statement or License 53667 3 sets of Plans/Plot Plan THE FO LOWING 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 Commission Permit DPW Storm Water Management Demolition Delay X= /Z,4J 612slit 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. 33 HAWLEY ST BP-2016-0240 GfS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 162 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2016-0240 Project# JS-2016-000284 Est. Cost: Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: D A SULLIVAN & SONS INC 53667 Lot Size(sd ft.): 20211.84 Owner: Northampton Community Arts Trust Zoning: CB Applicant. D A SULLIVAN & SONS INC AT: 33 HAWLEY ST Applicant Address: Phone: Insurance: 82 NORTH ST (413) 584-0310 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:812612015 0:00:00 TO PERFORM THE FOLLOWING WORK.INTERIOR DEMOLITION 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 Occupant Signature: FeeType: Date Paid: Amount: Building 8/26/2015 0:00:00 $200.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner