32A-155 (5) 12 MAIN ST BP-2007-0711
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 155 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
categotyL
BUILDING PERMIT
Permit# BP-2007-0711
Project# JS-2007-001076
Est. Cost: $20000.00
Fee: $75.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Robert Reckman 009498
Lot Sizcq. ft.): 914.76 Owner: MASTERS TOM
Zoning: CB Applicant: Robert Reckrnan
Al: -i2 ivikir,i
Phone: Insurance:
Applicant Address: (413) 584-1224 Workers
36 Service Center - Unit 2
Compensation
NORTHAMPTONMA01060 ISSUED ON:1/16/2007 0:00:00
TO PERFORM THE FOLLOWING IF WALGE 1ST FLS.INSTA R NEW BEAMHEAT,INSTALL IN CELLARN AL
FIRE ALARM SYS, REMOVE BATHROOM, PATCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET BuildingInspector
Insp.ctor of Plumbing Inspector of Wiring D.P.W. p
Underground: Service: Meter:
Aiglb7 �t'i Footings:
Rough: Rough: F 7
e; 7 vim^1 House# Foundation:
f;: ,i 1,f — Driveway Final:
Final: Final: , -, a.- -� 6K V�7 a 7`4
,, Rough Frame:
`4/,( Fireplace/Chimney:
Gas: Fire Department
Insulation:
Rough: Oil
Smoke -r
Final: a 3—/ .3•07. -Q�
Final: � S/0� ��I�� F��
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occuranc Si nature:
FeeType: D. a aid: Amount:
Building 1/16/2007 0:00:00 $75.0012055
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
A ')/
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File#BP-2007-0711
APPLICANT/CONTACT PERSON Robert Recicman
ADDRESS/PHONE 36 Service Center-Unit 2 NORTHAMPTON (413)584-1224
PROPERTY LOCATION 12 MAN ST
MAP 32A PARCEL 155 001 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 XX('
Typeof Construction: CHANGE 1ST FLR HEA ,INSTALL CENTRAL FIRE ALARM SYS,REMOVE
BATHROOM,PATCH WALLS,INSTALL NEW BEAM IN CELLAR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 009498
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFWIATION 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
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.
Version1.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterNVeil Availability
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
1.1 Property Address: This section to be completed by office
IA *In stheef Map Lot Unit
/rlar*twrnptan. 114 0106°
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Reek lvhihng> (►a-Y2v 4ea//y Test Si *aerg tree t Nar//ai v fn
Name(Print) Current Mailing Address:
413 584 3500
Signature / d a v git/v Telephone
2.2 Authorized Agent: f/ /
Bob IQecklrr.j .3 4, .4c-vloe &ter Narthnmpizn
Name(Print) Current Mailing Address:
4/3 56/1 ma�l
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
1700
2. Electrical (b)Estimated Total Cost of
2 Sd J Construction from(6)
3. Plumbing Building Permit Fee
Z�oJ
4. Mechanical(HVAC)
5. Fire Protection JvJa _
6. Total=(1 +2+3+4+5) 2 D r oO D Check Number /&Q7
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations m Existing Wall Signs ❑ Demolition❑ Repairs 71 Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other El
Brief Description Enter a brief description here. 1741431 healing in lsry00ndnstall new fenlral Vahan fire c1.<hrm
Stem timnve ,daffirxm, Ile denalld al0411s, consolidate ele2k rt,
,eal, Install new !ka
Of Proposed Work: in l I
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 El 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 El 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 El R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 El S-2 El 5B ❑
U Utility ❑ Specify:
M 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):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st 1st
2nd 2nd
3rd 3rd
4th
4th
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone El Municipal El On site disposal system
• Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
/�( n{, ems` Building Department
Lot Size No e�q G TU Fod-pr,n t or �S�
Frontage `J/
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 Q DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: Mare wienhhcQhO�
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
IF YES, describe size, type and location:
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 Q NO G
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 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):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature 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
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Obi) Rea kman Not Applicable ❑
Company Name:
bob Reeky aii
Responsible In Charge of Construction
31.e S vwee, Cfr. korikenptui
Address
alit//ail
Signature Telephone
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Be'1 w,//17,g , as Owner of the subject property
hereby authorize d 10iinan to
act on my behalf, i all matters relati e to ork a orized by this building permit application.
Signature of Owner Date
I, r bb 41eekVYY.2,d1 , 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.
�+JCI L�
Print Name
J/ 9 (D4
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: /Q Not Applicable
ebbed- ❑
Name of License Holder: d. /(tM n'an Ot'L`/�7 8
License Number
di' &r14C Infer Akrth 2mp/ n /I/vg
Address Expiration Date
-13 ,5-134i sJ
Signature Telephone
SECTION 13-WORKERS'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 will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0 e•ffhh0/111 Oh RI&