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Permit App - Concession Stand"6, r\i& lww/ The Commonwealth of Massachusetts Office of Public Safety and Inspections Massachusetts State Building Code (780 CMR) lding Permit Application for any Building other than a one- or Two-Family Dwelling is Section For Official Use Onlv) Building Permit Number:Building Official: SECTION 1: LOCATION City /Town Name of Building (if applicable) Block # and/or Lot # SECTION 2: PROPOSED WORK No. and Street Assessors Map # Edition of MA State Cocle Existir-rg Building D lf New Construction check here E or check all that apply in the two rows below Alteration tr ange ofOccupanry D it Appendix 2) I Specify:Char.rge of Use tr Are building plans and/o Is an Independent Stru y{Description of P construction docurnents being suppliecl as part of this pennit application? Yes }( No D alEngineerirlgffr[u",u*rgguire{,f_ C l_ \ _ 1 Yes D No)( THIS SECTION IF E)(ISTING BUILDING UNDERGOING RENOVATION ADDITION, OR CHANGE IN USE OR OCCUPANCY "n {'"gj1y:9ttglqgjlgj1 4 93!91 " .'f c losect_ (See 780 CMR 34) tr Use Croup(s): SECIION 4: BUILD AND AREA SECTION 3; COMPL Check here if an Existi Existing Use Group(s): ) & Area Per Floor (sq. ft.) sEcrloryLV.s_t_cf@Lcles-\jl p1!! _tr Nishtclub tr A-3 D A-4 D A-5 tr I B: Business E No. of Floors/Stories (i Total Area (sq. ft.) and T A: Assemblv A-1 tr A U.!reb.!43sd __ Jl-1 n H--2tr H-3 n __lt{_tr____U l8 Y:!!":g$:]. I __ _,_ _lR: Residential &E__!2D__l_9!__!t4 a;.-- - ;U: utilig tr_Llpg:gt tr'"!_l'Ilp$:1q9'.1'b" ujl"y, _ SECTION 5: CONSTRUCTION TYPE (Check as applica tr I-3tr I-4tr Factorv F-1 tr I: Institutional I-1 fl I- S: Storage S-1 tr S- VAtr VBtrIAtr IBtr IIA tr IIB tr IIIA tr IIIB tr ION 7: SITE INFO TION (refer to 780 CMR 10!.3 for details on each A trenclr-rrfll not be reou.il€cl E or trenclr it is enclosed E hirport approaclr area? YesE orNoE Debris Removal: L,icensed Disposal Site tr or speciiv:runicipal E on site system D Hazards to Air ljavir Is Structurepplicable nsent to Build e YesE No E ATE OF OCCUPANCY Edition of Code: Does the building contai Design Occupant loor and Assemblv s SECTION 9: PROPERTy OWNER AUTHORIZAION rcl Acldress Name 0 oPe Owner 7ip lt: IlA rytpSrcn _413l. ft_^l' I z fr Telephorre No. (business) Teleplrone No. (cell)If applicable, the property ow hereby authorizes: Strbet Adclress owner's behali in all matters relative to work authorizecl R e-mail address MA ztp this build nllt a lication Date TION 10: CONSTRUCTION CONTROL (please fill our epp"rrdi* 1han 35,000 cu. ft of enclosetl space antl/or not untler Corrstruction Cor.rtr.ol then ctreck he.ff A-199,p!9vlle sqn$uelon-eqlrclfu (see s91!,o492$llt9 J9!tg)eClgtlr]lq{_*_:_\ :i:-'. :-:- -.-t:.:l_:::i:la.::l:.1:*____*_ __lU" f"LlqrytrClljS4 qo"qq-G!9lrofessional coordinating document submittals No.e-mail adclress Regish'ation r City/'fown State Expiration Date thi9**otio nG -L-*bosS.,ec- -fr#{AufhH-;t cq!',H*'pJ - flu *)$;.."0'' ozP"'oo'" o6 z-7 -l Citv/Town State Zip %oL1sa. o+sz lsyrcoeu@Shneil, ewr-__ _ lgl_"$pr:e No. (e!L _ e-mail acld-ressi-wgstsgggENry nsll rance Affidav it flornll"n t toN tNsUtANSt] (tvt.c.r. c. 152. g 25C(!)L___ florn the MA Deparhner-rt of lndustrial Accidents must be comrrletert-intt - Failure to plovicle this affidavit will lesult irr the clenial of tlre-issuance of thc buitclirrg pemrrt.g4-{{r4gyrt-'-g9-'"r-S9g-ytqr-!l','glllse!'g{ _ ___ __!_"!X..N-"_..q,_..-.._SECTION 12: CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor and Materials)I'otal Corrstructiorr Cost (fronr ltem 6) : $s-7ibOo --Building Pernrit Fee = Iotal Construction Cost x _ (lnsert here appropriate nrurricipal factor) -, $ $ $-^ Note: Minimunr fee.- $_ --__ (contact municipalit_v) ON 13: SIGNATURE OF BUILDING PERMIT APPLICANT b)' "tt"tt "t ,t", tl*-t-"*;,,,G"";lt*; p;.Jr.y th"i"rr "f ir."l"f-.r*-ti. .-rt"i i"-a --t-nir" t1 Professional Name (Regish'ant) Street Address 10.2 Genera-l Contractor IJS-Un:ve Conrpiyrv Namq^ Nanre of Person Resoonsible Street Address 25.7:Pa& .lclqrlrn', " llg_&seltess SECTION 1 A Wolkers' Compensation subnrittecl with this applicat _.I rrlrgr-l*- _ 2. Electrical 3. Plumbing , N4..-h";l;;i-livn-i 5, Me_c-ha1!g! (Q!!eg 6. -fotal Cost B" ;rlt"-lg ;r-ry r*"* b.l"-J application is h'ue and accurate and sign namc Municipal Inspector to fill out is section upon application approval: CITY OF'NORTHAMPTON SE]'tsACK PLAN MAP:___ _ LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONTSETBACK FRONTAGIi Name of Hauler: Signature of Applicant Date: lZ'Ol-Urc In accordance of the Number City of Northampton Massachusett,s DEPARTMENT OF BUILDING I,NSPECTIONS2I2 Majn Street . Municipaf BuildingNorthampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT OR ALL DEMOLITION AND RENOVATION PROJECTS) ovisions of MGL c 4O, SS4, a condition of Building permit is that all debris resulting from this work shall be disposed of in a properly licensed was disposal facility, as defined by MGL c 1.j.L, S 1504. The debris will be di sed orin: EV D is Posa-t Location of Facilitv:o7r5 | The debris will be tra ported by: 4ufl' Initial Ccnstrnction CcntroX Document T* t'e sutr::ritt*d r.';ilh tlte tru:.lding rr€r''dt ,rpplicatr.olr b"". a Regisiered Sesign Fr,ofessio*al f,i.rr ruork per fire nu:fll Erfifjo* *f ffte .&f*ssrrcllu.setfs Sfnte Eriflding Cr:rde" iSS C.e.f& Sectioff IS7 EI r beth as aprplicable: Ner+. cunEtruction Ccnstructioa i IIA Regrs'tra liunrher:Expkati*rr date a rry.lsterer{ riesigil profes_rlrrrlrll. atrd I tra.r;e r'., sed the Eleparaii*n af all drsigr s, c *nrpu ta ti,*rrs and sp're c ificatirt rs c once rrtirr g: Architer Project Title: Froperty Adfuess: Projectr Cnreck {r-} *rle Project destription: preparert r:r ri{l'ectl',. sqr *.t tlw Struciural Ele.clrir:al &{echanical Other:Fire Frur{ect on ior the a-be';e na*"led r *mg-ru t& tri6i*s and sprec olect *nr-1 fltat ts thefest L1f ill1' krrcrr'[66U*. in{srtxatisn, and belief ru.cts pians, Clr,[Rl, and accepteri ,:i e :.:i gtee I slreall per$*nr arrtl periodic lrasr:r to: ications meet the ag able ;rrc.,'i*ions ef tl-re l,'{assachusetbl SieFe Euilding Code, ql$r-'r ginee*i.trtg nracticU LTI cr the PTFFDEed pr$ect. I ,un"desstend erttl agree tirat I (or ler-.. t}'ee necessan'p sronal selr.jc*s aud b,e pr:ese*t ,:'n ti:Le construrtion gite on a regtrlar Rer,.ier;t', fr,-r c,l to::nrartce thir cod.r arrd the design cr-rncept, shopr dralr.inga, samples and other strbn*"ittaLs b-,,: Perforur the d Be prerent at in accordanre rtith the requirenrents urf the ru-nstructrr-.* doct-nrents. tererl riesign professionals in I,9* Cl,.{R Chapter 1i, aE applicakrle propdate iu the :rtage of cnngtruction t'-r ber--onre generall',: familiar',';'ith tl-r* Flt'Lrgfe:rs and qu ti'lt'l isrk and to determitrE if the '.tork ir being perforrned in a rna*ner csr,']sisteni r.;'ith $re elrrFro onsbtection documents ar'ld. this cod.e \*thing rn this d*cu t relie-;e-e the coniracturr cf itr res;'roruitrilitr. regardirrg tlr.e;rro.,'isior-r,s of J$* Cl'"lR i0l l 1 l: Qlrtf ginr, i'Cing *fJicia1, I'-rhall subtnit fi*trd;Jprogres repcrts iree ite.*r -1. j tcgetl:e*r rr.ittrr pertinent f:rtable ts the l.uilding afi'icial. li,'trrk" n :r,3ea11 s,tibr*it t,-r thg 6u*ting officiai a 'Final Conste.uclien Coxrtrol Docuueni' r:91:l a "rr.et" or se$l: t,'ihen required [::", f L1l]'1"!ner1t!, ur a ln Llpon cnrnp Enter iii ihe ele,:trol"t'i{ signature P'nro*e numfrer: Suilding Off icial l{arzrer Feruni't ]fs":D*tel )totp 1, Indi**i: tiiJt an'rl' c.I'.c'::r'.. pr,:r:d* r ce;cn1:tia :u:er:i,3ri :J 1_{J 1_1,} ig Suii'fi*g 0,fgrrr:l lfse Sulq. I *jeet de:l,$r x).r:r-', ronrp',-rLrtfun: ans. s:-e"rjirrah*i'u :]re: ',-cu r:r'*p*ei c,l ,j.xectli' suFenj-cad. t ctl.rel i.: nltl aut Co che the do< lonstruction Docume hecklist below is a co re checklist and prov ocuments. This appr Appendix 1 ts are required for structures that must comply with 780 cMR 107. The rpilation of the documents that may be required. The applicant shall fill out le the contact information of the registered professionals responsible for the rdix is to be submitted with the building permit application. Checklist for Construction f)ocumentsx Mark "x" where applicable No,Item Submitted Incomplete Not 1 Architectural 2 Foundation \ 3 Structural T 4 Fire Suppression C tr Fire Alarm hlav lquire repeaters) o HVAC 7 Electrical 8 Plun.rbins (includ local comections)( 9 Gas (Natural, Pro arre, Medical or other)x 10 Surveved Site PIa (Utilities, Wetland, etc.)( 1 Suecifications ) 2 Structural Peer Rt lew 3 Structural fests &brspections Prograu'r A Fire Protection Ni rative Report 5 Existiue Buildius iurvey/ Investigation x o Energv Conserva on Reuort -'.-x- 7 Alchitectural Acc ss Review (521 CMR) d Workers Compen ation Insurance o Hazardous Mater I Mi-tiga tiqn Documentatiou )\ 20 Other (Specify)ETC-x--__VOther (Specifv)rls I_ 22 Otl-rer (Soecifv)-6nffi-?) leas of Design or Corrstruction I rst not bc conmreneeti urrtil tlris lholity having jrrrisrlictior.r. which plans are rlot conplete at the time of applicatiorr submittal must be iclentified herein. Work so iclentified plication has been amenrlecl antl the proposecl construction riocument amentlment has been applove cl by thc Itegistered Professional Contact Information R"g"tr"tr.l Nmrb"t Discipline ExpirationDateCity/Town Nane (Registrant) Street Address e-mail address Registration Number Discipline Expiration DateSt"t" Z:*Citv/Town Name (Regishant) Street Address r"r"-pnon" Nr "-t*"u .,ic|**R"gtrtt^f.. N"-b"t Discipline ExpirationDateCiW/Town State '' 7it Name (Regishant) / Street Adclress / lease follow this link for trol forms to be used bv Registered Desien Professionals. PROCEI) MUL City of Northampton Massachusetts DEPARTMENT OE BUILDTNG INSPECTIONS 212 Main Street o Municipaf Building Northampton, MA 01060 RE I.'OR OB'I'AINING A BUILDING PERMIT FOR COMMERCIAT, & I-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS {- t. Nft -2.MA- r.{ -a.{n5. / -6.Nft -7. tvA - 8. NA -9.pA - ro. tt{ 'tt. sJ k- tz. Building agent. Application signed by legal owner and filled out by owner or authorized One set plans and specification of proposed work (digital and hard copy). Site Plan ith location ofproposed structure(s) and setbacks. c Debris Affidavit filled out and signed by applicant. Worker's ompensation Insurance Affidavit filled out and signed by applicant. must supply a copy CSL and proof of Liability Insurance. Energy C Note any nservation Compliance Certifi cate (if applicable). onservation and/or Special Permit requirements (if applicable). Driveway t (if applicable). Proof of ater and Sewer entry fees paid (if applicable). 'I'rench it (if applicable). Initid C ction Control Documents filled out and signed by the Registered Design Profess I in rcsponsible charge.