32C-067 (32) 2 CONZ ST BP-2003-0775
GIS#: COMMONWEALTH OF MASSACHUSETTS
Msp:B :32C-067 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0775
Project# JS-2003-1276
Est.Cost: $2100.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH KENNEDY 055440
Lot Size(sq.ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning:NB Applicant: JOSEPH KENNEDY
AT: 2 CONZ ST
Applicant Address: Phone: Insurance:
38 HARKNESS AVE Workers Compensation
EAST LONGMEADOWMA01028 ISSUED ON:3/21/03 0:00:00
TO PERFORM THE FOLLOWING WORK 6 SQUARE ROOF REPLACEMENT
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 Occupancy Signature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 3/21/03 0:00:00 13627 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
I
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of'Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit n_ -
212 Main Street Sewer/Septic Availability_
Room 100 Water/Well Availability __
Northampton, MA 01060 Two Sets of Structural Plans_
phone 413-587-1240 Fax 413-587.1272 Plot/Sitians
. 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
(')a 0/ -P�., 0o cl. 0 /a S Map Lot Unit
�a '
C ✓l
Zone Overlay District
�
Elm St. District CB District_
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Rec r > 11
gtP rS Qtc k, J g t Aess
k� r [c / -
iIIat . lo-e•
Name(Print Current Mailing Address:
4/3. _ sas— ins
' Signature Telephone
r
2.2 Authorized Agent: f1 I
tHavk h b s-s. N ,--e F c4 s . 1. ..J
Name(Print) Current Mailing Address:
.....4.4.4___
A ,,,,o
Sigp ure 2 Ds - 1 ?5'.S-'
Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 7 0 c,P (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) 1- - I c' Check Number 13 „,a7 yi 5C°
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.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 Existing Ground Signs Additions ❑ Roofing 0
0 ❑
Exterior Alterations Demolition❑ New Signs [ ] Changetof Use [ ] Other [ ]
C3'�(nQ n b Accessory Building [ ] Repairs [ ]
f _
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 ❑ A-2 ❑ A-3 0 1A ❑
A-4 ❑ A-5 0 1 B 0
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C 0
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 0 1-2 ❑ 1.3 ❑ 3B 0 _
M Mercantile 0 4 ❑
R Residential ❑ R-1 0 R-2 ❑ R-3 ❑ 5A 0
S Storage ❑ S-1 0 S-2 ❑ 5B I ❑
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
_.. ' ? ,
2nd 4� ° s °
•1st ,; ' .i;..;.
3rd
2"d , i
4tn �
3rd ,If t A 2
� l
4th f�i
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
Versionl.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:
Public ❑ 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:
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
r
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
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
49.3 General Contractor
CJAcv l)S 4C C✓.. f k.,C `t-( C'°'► Not Applicable ❑
Company Name:,
T�-e )eV t'o ?
Responsible In Char a of Construction / n
1 - -
Addr ss
4 Q„..„...A.,
sic r,s,
Sign t re Telephone
Versionl.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 ❑
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, l , a, r erW� , as Owner of the subject property
ere: authorize �0P12• ` .��-VlY1�
to act on
$ y b:half, in all a el A ive to work authorized by this building perm application.
� (r . 6 21 6
•gna ure of Owny A ate
. • IAA / Q.(-CS V\ , as Owner/Authorized Agent
hereby decl.ajl that the atemenk and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
S gned und the pai ,s and penalties of perjury.
14
Pr'nt Nam
Ad, # I I
of Owns/Agent • Date
(SECTION 12 - CONSTRUCTION SERV S
0.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder : OS e pC Int/vet)/ O sc
License Number
O r�c IA S S
)Idr7s_ Expiration Date
er
nature 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 ❑ No 0
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•q DEPARTMENT OF BUILDITNG INSPECTIONS 111
212 Main Street • Mttnici¢Sal Building \tit
Northampton, Mass. 01060 `'��
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I-,
(li cevseeipermi ttee)
with a principal place of business/residence at:
•
(phone#)
(street/city/stair/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ram an employer providing the following coin nsation coverage for my
employees workhn on this job:
W0e0.?6'40 6.7g3
(Insurance Company) olicy 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:
i
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
r (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
: (Name of Contactor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
• (attach additioml sheet ifo <.ry to inehi&information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do pninrrn.o.r construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be
employ under the worker's comp-*K*tion Act(GL152,sa 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's.Compensation Act
I understand that a copy of this statement may be forwarded to the Depertmcat of Industrial Amideat>'Ofrioe of Irssurusce for the
coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
oomistiag of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against tt
For dRzartnrr�al uac m7y
4 �,--( �_0 Permit Number
� c
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Map# Lot#
- titre.of T i.,.-.,,,,,,to..—:,-t.-n Date