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38B-002 j ti-l)r'7.x' "T7 ) ,n-r, ‘7 G --.l „L .Y-1 -z "41-' 7 ----tr d'.-,d as 4s' 4 a r - - 03 t-, c 1 \____________ . ------ - . . ... Northampton, MA Property Detail http : / /www.northamptonassessor.us /noho /commdetail.php ?map_no =... City of Northampton, MA: Commercial Property Record Card New Search Property Type Classification Code Reference Card 5 of 5 1 2 3 4 5 Parcel - Location - Zoning - Assessment Map -Block -Lot: 38B- 002 - 001 Zoning: Assessment: Location: 16 PAQUETTE AVE Neigborhood: 11 Land: 273,2 #Living Units: 12 Deed Book: 2330 Building: 641,4E Class: A -112 Deed Page: 050 Total: 914,7( Building Information Building Sketch Bldg #: 5 Year Built: 1900 4 # of Units: 3 $ H3 5 Quality Grade: C 16 5010 # Efficiencies: 0 24 12 16 # 1- Bedroom: 1 10 10 5 # 2- Bedroom: 0 52 50101U J 16 # 3- Bedroom: 2 1384 Covered Parking: 0 3EB Uncovered Parking: 0 28 Total Unadj RCN: 175,840 Total Unadj RCNLD: 213,440 Grade Factor: 1 6 34 # Ident Units: 1 E 6 Func /Econ Factor: 1 RNCLD: 213,440 Attached Improvements Detail Information: Type Meas -1 Meas -2 Meas -3 # Units Levels Use Ext Walls Heat AC % Good Unad RP2 70 0 1 1 B1 91 0 RP5 42 0 1 1 - 01 (11 Masnry /Frame Hot Air 0 RP5 35 0 1 1 - 02 11 Masnry /Frame Hot Air 0 RP1 1 3210 11 1 - AA 11 1Masnry /Frame !Hot Air 0 Land Data Outbuilding Info Square S Foot Type Length Yr Phys Fun q yp Utilities Descr Width Quan or Size Built Cond Util Type Feet Value no no information information 1 of 2 4/1/2011 9:11 AM • ' . The Commonwealth of Massachusetts Department of Industrial Accidents 4 : Y . Office of Investigations u - ' 600 Washing on Street 1 • -- --' Boston, MA 02111 -., www.mass.gov /dia Workers' Compensation Insurance Affidavit: Bujders/ Contractors /Electricians/Plumbers Applicant Information _ �� YYII /, Please Print Legibly _ Name ( Business /Organization/Individual)j©hq ' 1 '. 23tc'i in SO Address: [...7-S ¥ 07414' Co r-r .cr � Cit /State /Zi �' (� z ' a-- g_ Z 1 ,) y p: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 2.,E1.-I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ 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. ❑ 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 erti 0 nde, , • s a, , . , • - .. :�.� , .rjury that the information provided above is true and correct. Signa :n=- 10 , Date: 1 i t / Phone #: ` k 3 'j 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 #: . r_. r It 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 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, - ,CZt)�� ,_._. °1�I�� ... as Owner of the subject property act on my behalf, in all matters relative to work authorized by this building permit application. Or 1 ilk �� A ilk I \ Signature of 0 er Date I, r`...,�!�.�_ _._.._ _ .- ._. , as Own /Authorize) 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 ofpe , 6 .In, ._� Print Name \„ Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: ' Not Applicable ❑ ( r I (/ License Number t C Address / c: *4 1"/ re, Expiration Date (, ZZ�j Signature Telephone Z AZ3 , 20 l —. 11 SECTI►' 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affiday must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bui ng permit. Signed Affidavit Attached Yes No 0 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) 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 Telephone Signature Tele Expiration 9 p Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 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. '~_.. 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 " YES 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 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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 C NO 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 0 NO e IF YES, then a Northampton Storm Water Management Permit from the DPW is required. h 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 ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ , Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other Brief Description Enter a brief description here. Of Proposed Work: ^ ' �( l. \ v L.0 I Q-( hCT i �/ �L./J—C a `'1"-■ (..., ,, \i v-01.1 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 ❑ 2A ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 Ir R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ _ 5B J 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. _.__._...... L` 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) / i 1 st 2 d 2nd ........ -._ ......_ _ ..., _ j 3 d 3 4 m ______ 4 Total Area (sf) wV Total Proposed New Construction (s1)____,,, 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 0 Zone Outside Flood ZoneD Municipal 2 On site disposal system F l Version1.7 Commercial Building Permit May 15, 2000 '� �� enl use only RECEIVED City of Northampton St e errs Dep* artm 1 Building Department 1tiveWa Perini " � A � i4 �� gam' 2 12 Main Street `Sews Se Avrata6-tir#y , i N APR - I L.W I - - r ,r i ,,o Room 100 1�U4terlVUe Rval�lab`Ilrfj i Northampton, MA 01060 Two S � e Ts Q fSt rue tur a FPCats DEPT. OF BUILDIN ECTI , — NORTHAMPTON, MA INSP 01os�ne 413- 587 -1240 Fax 413- 587 -1272 PlattSrtetana 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 This section to be completed by office 1.1 Property Address: 11 .,...zr� , ( Map Lot Unit - -4- (-. ,r •... wry-, c)i ot., G/� I Zone Overlay District . , m w EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 5 2.1 Owner of Record . - ' 'Qs k - f is. l� hn4 O i � d X6\1 :,__ Vfi2Ji w+ uA ..._.... r a G N sr � �. x� 1� � � __.... ., 3 Name (Print) Current Mailing Address 4t3 C ass C)0 2., it � � ` � I�[t�IZJ'elephone Signatt,. 1 � I _ _ .. 2.2 Authorized Agent: - , o) - e,,,, -� l dF , .. . C V.-- � " � 1 t� �S 4 car - -- ----------- �J fi (a s t ,-,..(-_-.:41 ,-1- o 13 3 Name (Print) Current Mailing Address , --t 1 3 L^ Z.ts' , . -- 2,2. (----- L-- � Signature \----- , Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant -,_. _,- --__.. � �__ .__ (a) Building Permit Fee 1. Building 3 pn Z> O g 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 &/ Voc 0 4 S '3c1Dp, This Section For Official Use Only Building Permit Number Date Issued Signet ( /._// Building Commissioner /Inspector of Buildings Date 16 PAQUETTE AVE BP- 2011 -0788 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 002 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- 2011 -0788 Project # JS- 2011- 001302 Est. Cost: $3000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN C DICKINSON 18533 Lot Size(sq. ft.): 95962.68 Owner: WALLACE GERARD R & JEAN M C/O BARBARA HAVERSAAT Zoning: URC(100)//W I' Apjiic:;;t JOHN f', D CKINSON AT: 16 PAQUETTE AVE Applicant Address: Phone: Insurance: 154 BAPTIST CORNER RD (413) 628 -3295 ASHFIELDMA01330 ISSUED ON:4/4/2D11 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR 20' OF FOUNDATION POST THIS CARD SO IT IS VISIBLE'ROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: OK 1 1'7 -1 1 Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: ok 3 CA('` THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU A A. i.! S. • Certificate of Occupancy si ature: 1 4444.4 FeeType: Date Paid: Amount: Building 4/4/20110:00:00.. $65.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck -- Building Commissioner