32C-044 (3) 76 PLEASANT ST BP-2001-0891
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:32C-044 CITY OF NORTHAMPTON
Lot:-001
Permit: Bui ding
Category:ALTERATION BUILDING PERMIT
Permit W BP-2001-0891
Project# JS-2001-0548
Est.Cost:$7000.00
Fee:$50.00 PERMI'LVION IS HEREBY GRANTED TO:
Const Class Contractor: License:
Use Group: RICHARD SHEA 013676
Lot Size(sa,ft.): 7492.32 Owner: SHEA JOAN,
7,onine:CB Applicant SHEA JOAN L
AT: 76 PLEASANT ST
Applicant Address: Phone: Insurance:
137 ELM STREET Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:5191010:00:00
TO PERFORM THE FOLLOWING WORK:REMOVING NON BEARING PARTITIONS AND
INSTALL HANDICAP BATH
POST TIDS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
{ r Footings:
/9/ORough: Rough: 6 i f r House# Foundation:
Final: 'milli Float) 4*4 V424I /i..1,.,,... /
2/ / ,.,,
Rough Framer# 7-10.07— -o iy
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: . .
Final: Smoke: Final: 6k 7-PS-a/
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT OF
ANY OF ITS RULES AND REGULATIONS/
Certifi. ;.: of 0 .•an• - -- ��, Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5(9/010:00:00 18230 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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BP-2001-0891
#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot-001
Permit: Building
Category:ALTERATION BUILDING PERMIT
Permit# BP-2001-0891
ProjectJS-2001-0548
Est Cost $7000.00
Fee:$50.00 PERMISSIONIS HEREBY GRANTED TO:
Confit.Claw_ Contractor: License:
Use Group: RICHARD SHEA 013676
Lot Slze(sa. ft.): 7492.32 Owner: SHEA JOAN L
zoning:CB Applicant: SHEA JOAN L
AT: 76 PLEASANT ST
Applicant Address: Phone: Insurance:
137 ELM STREET Workers Compensation
NORTHAMPTONMA01060 ISSUED ON:5/9/01 0.00:00
TO PERFORM THE FOLLOWING WORK:REMOVING NON BEARING PARTITIONS AND
INSTALL HANDICAP BATH
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 5t9/010:00:00 18230 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
Version 1.7 Commercial Building Permit May I5,2000
oY1110 YW NOIdW rG `+ s„°s
SNON3 SNIDNI011 s a �' _g ars
City of Northam ton
Building Depart t • a v
212 Main Str 1O 8 �f c m ..
Room 100 fa t fl
Northampton, M1 jcra �y �,
phone 413-5871240 Fa - =782i2J i ". �„ l s,.
1!AiR Tff'Y sa kg rs', ' 'h..'.....
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE 0' ryL' U Cdr �b , r I R\'E r• }r NY BUILDING
OTHER THAN A ONE OR TWO FAMIL •VT U
ar7AAY - 8 2001
SECTION 1•SITE INFORMATION gN� yyL�qq
()hiss Jj arc?by off
11 Property Address: fIL........
iL. Pte.,< nn t si-. Map Lot. Unit
'Jot f'hht.m /N Zone Overlay District
Elm St.District CS District_
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2','}Owner at Record:
.., frto 137 £im St. Nioc Ar "efl
'ame Print) Current Mailing Address:
-- a ..,.- (ha-) 584 -9(.015
Signature elephai
2 2 Authorized AeenY
c hnrd 54.-C 131 Ef m Sf. 1\lorFho.rpfO
Current Mailing Address:Natme( Cnt)
7
RP./
—citA N
i
Signet e ( Telephone
SECTION 3• ESTIMATE()CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
17
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) r) 000 Check Number
This Section For Official Use Only
4uilding Permit Number: tP_�z�r i-6/�/e/J4,fc"y�";— Date Issued:_..
Signature: ^�—Cdy ,/7%. .�=t7C/ O v: .
Building Commissioner/Inspector of Buildings Da e
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICESFOR`PROJECTSLESS THAN 35;000=:
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0
Vi 0 0
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
0 Accessory Building[ ] Repairs [ ]
WE —rax,n de,:in
Becw SCe- - -1: 4,P-rra. n e;rrhet,or teaQQs (S4nc 66S7^•C-SS 042-4/./b /Al/
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE Am.,cPtic< ACEfr" SA-'E" Fi 4e
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly I Al 0 A.2 0 A3 0 IA I 0
A.4 0 A.5 0 1B I 0
B Business ❑ 2A ❑
E Educational ❑ 2B I o
F Factory ❑ F 1 0 F•2 ❑ 2C 0
H High Hazard 0 3A 0
I Institutional 0 l•1 0 1.2 0 13 0 38 0
M Mercantile 0 4 ❑
R Residential 0 R-1 0 R 2 0 R3 0 5A 0
S Storage 0 S-1 0 S-2 0 50 0
U Utility 0 Specify:
M Mixed Use 0 Specify:
• S Special Use 0 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 ''�° Af_EIeE 'e ,i
'�s +mow 'R':.: t 3'r ?4«t :ex5�•<
Floor Area per Floor(sf) 1,+ ‘EIa a�� mkp "
le :id
a44Ctrst'LI°I.I Ls
'+V' 3� 4
2'd 3 _ x + " s aP r. 3
4th "iX ' T y 'std' x' $f �+'`
3rdt ,,,
,lir . ' ' Y• '• v �
4th fi
• ..
Total Area (sf) Total Proposed New Construction (sf) °
r ' ytta",, z>s
Total Height(ft) j 'Y a"Asa< ^ I, :
Total Height ft r d� s n 'tee�t.d,y-t� ,'
Version1.7 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:
'ublic 0 Private 0 Zone: Outside Flood Zone 0 Municipal 0 On site disposal system 0
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 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:
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 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)
1 Registered Architect:
Not Applicable 0
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
ignature 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
�,
rt- �,- 30--
Not Applicable 0
Compa y Name:
rrL--
Responsible In Char of Construction
✓ rss7 to . �/re 4404
ddress
/ �! 5-5.1 -r' i 9
lYtft/ -•
Signature / Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
ndependent Structural Engineering Structural Peer Review Required Yes 0 No ❑
SECTION 11 •OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, bc.0 51‘ an , as Owner of the subject property
hereby authorize rG/C hc.rd A Let._ to act on
my behalf, in all matters relative to work authorized by this building permit application.
airing S 150
Signature of Ownercc Date
I, :To C66T/� Uri , 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.
JOCA(i SLati
Print Name
6faIC) I
Sign re of Owner/Agent ate
SECTION 12-CONSTRUCTION SERVICES
10.1 I icensed Construction
Supervisor:
C Not Applicable ❑
Name of License Holder : F-/ Char / ..1/ 51,1/4-e cc (5 O/3Y7 .
License Number
130 Elrn Street JJar-fh n MA 91..3/0/
Address bl�b Expiratio Date
L I35`i 9-9L19
Signature Telephone
•
SECTION 13-WOR RS'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 1,
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes g' No 0
1!
e
O.Y1NHp�O —
I? „ -; ,iia °Ting offM Varflfanytalt t __*_
1.1. a a� Siassmtantta wig'`
je DEPARTMENT OF BUILDING INSPECTIONS 4 VIII:
212 Main Street a Municipal Building
Northampton, Mass. 01060 —'
•
WORIER'S•COMPENSATION INSURANCE AFFIDAVIT
1, Ri/M a[d cT16t'5,_
(lianmlpemvaee)
with a principal plafr of business/residence at:
•
1...37 ijin FSt Na ,l 14 • . a ca honest) J�cgY-'I(do I9j
( .. citylstatehip)
do hereby certify, under the pains and penalties of perjury, that:
)<) r am an employer providing the following worker's compensation coverage for my
employees working on this job:
:iii,
fir' £L'i`+ieri) Cc4Mate, L ADOdf3n? ler9. IIityl01
(Insurance C4tnpany) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Instance Company/Policy Number) (Expiration Date)
(Ntme of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
Oatoott additiml.Lod jIee®ty to mahlde information paining to an<rn i don)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing ail the work myself
NOTE:plrv.e be ante St wlrile ItOrat as who employ pen=to do s-;rata.„,.asmmeima=Pa'to/1"a.da4ioS of
rot mat than throe units in whirhtbo immeosermiles ccm the gosh apprtount4ndo Atom generally aaudered to be
appioym under We%Pockets troorooptp Art(Class 1(A),application by ahomeowu fora Pose ec pact*may cridctte dw
rept atss of an®ploy«undertha Wnkd.Comp.m.tiva Att.
1 vadcm.nd Mn a oof°fulls mrmrmt may be fawardad to the Deyurmw afmAmai.l Aniden&Offs of twists for S
wveragevai@cgim sad St failure to MOOG t mag,undor ration 15A&M3LISE Can Slid the Epmaim°faimmat pma164
Stiog of a Erie of up to Sl}OQ.00 ah
toroamatt of up mmra
oyeod melpmahim the f io ora Stop WolkOnks and a ..
Tae ofSIoo.00 a tby apical me
Fa dapamral use ootY
Permit Number
y.• CJS 0 t Map# Lot#
S.
ofLiccosee/P 'ttoc a=
Hqjhl,,5hteci cirecks are ec"stir), L;ck-( (s thr, (Jill
be removes! ,
•
64 A he ;C(1/4 pped b& hroom cell be_ added
_rth Sde •
-Qvk°' • I I + i y
L1 WARY 4:M3CE 15FFlc,¢_ OFFIEE OFFICE 13Ar/1 LIFT/ca AFFICE orP/ce
14X15 'tat i30y iris ,cFZ ( pi r —
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