23A-077 (2) a • . 7r
- 1 1 j}'- -g' -2' ,}' LEGEND:
- ' t t : _ : 3 DEMO PARTITION
1 . .......r...........�.... :.�.... SEXIST. PARTITION
.�. .......1
CLO 2 I SEXIST. DEMISING PARTITION
r' 1 OB I ••••■••NEW PARTITION
1-_0 OPEN " ®NEW PARTITION/ INSUL.
i 11061 N
_ NEW DEMISING PARTITION
- r TOILET - - EQUIP /St1PP. - ( EXISTING DOOR
11071 11041 1
[ . NEW DOOR
OUTDOOR CLOSET DUPLEX RECEPTACLE
5' - BOA +QUADRAPLEX RECEPTACLE
o 101 4 DEDICATED SIMPLEX RECEPTACLE
�, I ": W/ ISOLATED GROUND TO BE
MARKED WITH `D" & ORANGE
¢ ' PORCH A SINGLE GANG PHONE /DATA
E 4li • : BOX
' TOILET - 0 f . DOUBLE GANG PHONE /DATA
BOX
c / 11051 '-• 2' - A $ SWITCH
• _ E EXISTING
I, O L LANDLORD'S RESPONSIBILITY
L P ELECTRICAL PANEL
i FA ( OFFICE . 1 ()THERMOSTAT LOCATION
Q WATER HEATER
i
IF
oa 4 . EXR/EMER. COMBO
0E4 Pla
i ** CONTRACTOR MUST
' �� i HAVE (5) PAGES FOR
i1. , , lira _ THIS SET OF DRAWINGS.
IF YOU ARE MISSING
1._4. ANY PAGES, PLEASE
PARTITION PLAN /I►\ CONTACT DESIGNER AT
1/8 " =1'-O 1r 800- 824 -6525
w • • O S" D -Mark extension work per
Detail on sheet 4 of 5. to be
a EIp D EXISTING DOOR; INFILL WITH NEW PARTITION TO MATCH EXISTING completed on the first day of
construction. GC to install
board and conduit and
• . coordinate install of CAT5E
DEMO A c rr% G DOOR; INSTALL NEW 40 CASED OPENING. DIMENSIONS MAY lines with INC. oil photo to
VARY BASED ON WALL PITER"OR' Leasing Coordinator to confirm
work completion.
O INSTALL FIXED GLASS SIDEUGHT: 84"H X 241W; WOOD FRAMING, HEIGHT TO - - - -_ _�_
'�'C" NEW DOOR. Edward J o nes
<4 PAINT PER FINISH SCHEDULE. "(' � .
BRANCH FACILITIES
N'j'RAC QR_ S BRANCH OFFICE 16207
CO.... T SPACE AS - IS CONDITION. 55 Main St.
2. ALL ITEMS TO BE COMPLETED PER EDWARD JONES SPECIFICATIONS (SEE Northampton, MA 01062
EXHIBITS Be) UNLESS OTHERWISE NOTED. LEASE SQ. FT. 1114
3. INSTALL NEW ELECTRICAL PER PLAN UNLESS WITHIN 36" OF EXISTING ISSUES/ REVISIONS
RECEPTACLE. NO. o-E of
5. INSTALL /RELOCATE SUPPLY & RETURN GRILLES AS REQUIRED FOR -
COMPLETE & BALANCED WORKING SYSTEM. CLEAN & CHECK HVAC UNIT;
6. INSTALL /RELOCATE 2'x4' FLUORESCENT LAY-IN LIGHTS ACCORDING
TO NEW PARTITIONS; CLEAN LENSES AND REPLACE ALL
STAINED /DAMAGED CEILING TILES. DRAW BB:: BAB EXHIBIT A
7. PATCH, REPAIR, & PREP EXISTING PARTITIONS AS REQUIRED FOR 800- 824 -6525 sir
NEW FINISHES; REMOVE EXISTING WALL COVERING AS REQUIRED. 1 �.,r. ng,, � I .
`' ., The Commonwealth of Massachusetts
4 , ° a Department of Industrial Accidents
--ti F ./7 Office of Investigations
''=` 600 Washington Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): _
Address:
City /State /Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required): I
4. I a a g eneral contractor and I
1. ❑ I am a employer with 6. ❑ New construction
_ (full and/or part- time).* have hired the sub - contractors
2. MI I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
No workers' comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work
officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13. ❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations_of the DIA for insurance coverage verification.
I do hereby certi , .' , e p s and penalties of perjury that the information provided above is true and correct.
Signature: a, DLitt.
Phone #:
Official use only. .Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
•
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 Q No 0
SECTION 11 - OWNER AUTHORIZATION -.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, as Owner of the subject property
hereby authorize .. ... _. to
act on my behalf, in all matters relative to work authorized by this building permit application
Signature of Owner Date
, 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.
Print Name
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : w.a ,�__S,J.,r"'! �`. p.1
License Number
o1- „_ . ,,. `�+ L JI .,. �_L _.___. g . 4 ...... .... _ 6 i _ /, !' _. (1 / 1) 17 US
Address Expiration Date
a S9 ...._ ...
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
..R
•
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 _..x..
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 hone Ex irati
9 p Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
l.L .._.. A t V ' M C►� C5L gIE4y Not Applicable ❑
Company Name: __., ..._._... __ ..., _._......
� Construction
Responsible n Charge o
es onsi a
MC *s
Address 2- te '4 jl,o. w, ti .__. ,) i d 2 ?
4111ra_ / # 56.3. %`t ..
•
S i n.
9 p Telephone
Version 1.7 Commercial Building Permit May 15, 2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size - ..
Frontage
Setbacks Front
Side L. __...._ R:...._.r.._. L.,.. , .
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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 comt11011 pl8n
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
ANN
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 0 Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration 0 Existing Ground Sign ❑ New Signs ❑ Roofing 0 Change of Use ❑ Other ❑
Brief Description Enter a brief description here. d/ & SSA/ 60 , xt7 - 6.,c - cy en, -i ¢77s.iC i
Of Proposed Work: WA w/ 7 7/A,Z t C1Aff I" we iii it a/wn4( vFr C/vSi?r", 1 5�
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE [
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business V 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ _ S -1 ❑ 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: „_._ ___ „_z Proposed Use Group: ........ _...____
Existing Hazard Index 780 CMR 34): .....,... , .,r...„,_ 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)
1 1st
2" 2nd
3ra 3
4th 4
Total Area (sf) Total Proposed New Construction s
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❑ Municipal ❑ On site disposal system❑
/NA
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Version1.7 Commercial Buildingyermit May 15, 2000 .‘
Department,useanly
City of Northampton
status ofypirnit
puilding Department 6urb
s 212 Main Street SeWarISeptic
C;C:\ Room' 100
Northampton MA 01060 Two. Set of Structurai Plans'
Phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
Other Sped(
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER R THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
5-3-,n_oliv Map Lot Unit
Zone Overlay District
.„„„ El St Di CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
1 / 4 -f/i/ 1 71- 1-- Current mailing Address: I
C t
5 1 3
Name (Print)
V A%2
/-? .57er
Signature
„
Telephone
2.2 Authorized An_
Name (Print) Current Mailing Addressi
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
c mpleted by permit applicant
1. Building 0 75- A v A • O)
(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) Check Number
/17(1°V 01/4.0
Thls Section For Official Use Only
Building Permit Number Date
Issued
Signature
Building Commissioner/Inspector of Buildings Date
Am IR
File # BP- 2010 -0370
APPLICANT /CONTACT PERSON JIM MAILLOUX
ADDRESS /PHONE 276 SOUTHAMPTON RD WESTHAMPTON (413) 585 -1592
PROPERTY LOCATION 55 MAIN ST
MAP 23A PARCEL 077 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid M d0
Typeof Construction: RECONFIGURE 1ST FLR OFFICE SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 081694
3 sets of Plans / Plot Plan
THE FO OWING 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
/572-e.cDar
ZONING BOARD PERMIT REQUIRED UNDER: § eljz,e—y
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
7/0
Demolition Delay
/d /5zvo
Signature of Building Off cial 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.
55 MAIN ST BP- 2010 -0370
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A - 077 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2010 -0370
Project # JS -2010- 000492
Est. Cost: $2500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JIM MAILLOUX 081694
Lot Size(sq. ft.): 4138.20 Owner: MAILLOUX JAMES G
Zoning: GB(100)/ Applicant: JIM MAILLOUX
AT: 65 MAIN ST
Applicant Address: Phone: Insurance:
276 SOUTHAMPTON RD (413) 585 -1592
WESTHAMPTONMA01027 ISSUED ON :10/13/2009 0 :00 :00
TO PERFORM THE FOLLOWING WORK: RECONFIGURE 1ST FLR OFFICE SPACE
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: 9 i to ,
THIS PERMIT MAY BE REVOKED BY TH ITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGU . e ION
Certificate of Occu•anc Signature:
FeeType: Date Paid: Amount:
Building 10/13/2009 0:00:00 $55.00
212 Main Sheet, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Coirmussioner - Anthony Patillo