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32A-255 (24) , . . . .. .. . . .. . . . . . .. . . . . . � ( ) . ( � - � � � :�a® « ��© � y ��} : . . '�� . � . ��. . \ : � z ��_:a. .w©, �d��: . � �Z «. ��d 3 § � . y ��>y .�����y . ���g . w. . . . �:, � .�, » 3 . ! /}��.��! < : § , � z : & : �§ � §< w :% . r , y« . .� . z . � �» � � \ ( § � «� �\@�q « «-�% z� . � : � :y > � , . �/�.���\�\ � . ( \ © � ^ . � �\� �@�/��\( � . a�«,m : ��} � ������\��. � } � �` � � ^ : . .��� �����: y g�� g � � \ � �.� �� : ¥ 4�Ntt/_If P� `f4 Crz �aaz#I� 1il�rait 9 B f�lasaactrnsctfa' DEPARTMENT OF BUILDD,(G INSPECTIONS 212 Main Street ' Municipal Building 'o Northampton, Mass. 01060 ,~ WORI{ER'S COMPENSATION INSURANCE AFFIDAVIT I Pioneer Contractors/PI Con Inc. (kic;euser/permitt.ec} ,,vith a principal place of business/residence at-. P_n_ box 1145— Northamp ten, MA 01061 _(Phone 0586-5491 (stmt/city/stalrlup) do hereby certify, under the pains and penalties of perjury, (X) I am an employer providing the follo"vuig workers compensation coverage for my employees working on this job-. _t= _ rs_���_ -nom--- 6,30/94 cz rnpan (Policy 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 pohcies: (Name of Contractor) (Insurance Compa_uy/Policy Number) (E_,T mtioa Date) (Name of Contractor) (Insurance Compauy-/PoLicy Number) (Expiration Date) (Name of ConLractor) (Insurance CompaBy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Numbcj) (Expiration Date) (attach additiooil shoat if mccnAry to include info (Xl pertaining to&U oocdlndors) ( ) 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 wbile homeowncra who,x�lay persow to do mairt�qo uuoo or repair work m a dwelling of not moon than tbroa units in which the homeowner r=des or oo the grounds appurtenant ther• ate oot gcncralty ooandcrcd to be dk cmployraa undcr the vodka's mien Act(OL152,=1(5)),application by a homeowner for a 6ccwc or Parma may evidence the legal o,w of an amployer under the Workce&Compomxlioa Act I undcr:tand that a copy of this may bo fo:wardad to tho Dcpartmcal of Iodwto d Acct Of .of Ln." oo for tha oovcrxgc vaificatioa and that Ld=to&oct=ooverago tmdcr soctioa 25A of MGL 152 can lmd to the imposition of criminal ptaaltics consisting of a fine of up to S1,500.00 and/or of up to one year and civil pcaniti a in the form of a Stop Work Ord--and a film of 5100.00 1 day tg:tinA me Fo dq—m,- s oly PCp4 NmL ot#Ma Signa of Li ermitt= Date Versionl.7 Commercial Building Permit May 15,2000 ECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) dependent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ ECTION 11-OWNER AUTHORIZATION -'TO BE COMPLETED"WHEN WNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Star northampton, Inc. as Owner of the subject property 3reby authorize Pioneer Contractors to act on y behalf, in all matters relative to work authorized by this building permit application. 6/7/04 gnature of Owner en. Mgr. Date Pioneer Contractors as UrXEX/Authorized Agent -�reby declare that the statements and information on the foregoing application are true and accurate, to the best of my aowledge and belief. gned under the pains and penalties of perjury. David Claxton pint Name 6/7/04 gnat, e of /Agent Date ,ECTION 12-CONSTRUCTION SERVICES 0.1 Licensed Construction Supervisor: Not Applicable ❑ ,ame of License Holder : David A. Claxton 017890 License Number P.O. Box 1145, Northampton, MA. 01061 1/19/06 ddress Expiration Date 586-5491 'gnat re Telephone )ECTION 13,-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c, 152, §25C(6)) Vorkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit vill result in the denial of the issuance of the building permit. >igned Affidavit Attached Yes....... No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 ECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO .ON$TRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) .1 Registered Architect: Not Applicable ❑ ame(Registrant): Registration Number :]dress Expiration Date gnature Telephone 2 Registered Professional Engineer(s): ame Area of Responsibility adress Registration Number 'gnature Telephone Expiration Date ame Area of Responsibility ]dress Registration Number gnature Telephone Expiration Date ame Area of Responsibility ddress Registration Number gnature Telephone Expiration Date jme Area of Responsibility ldress Registration Number gnature Telephone Expiration Date .3 General Contractor Pioneer Contractors Not Applicable ❑ :ompany Name: David A. Claxton esponsible In Charge of Construction P.O. Box 1145, NOrthampton, MA. 01061_ adress `i86-5491 gnature Telephone Version 1.7 Commercial Building Permit May 15,2000 Water Supply(M.G.L. c. 40, § 54) 17.1 Flood Zone Information: 7.3 Sewage Disposal System: ublic1 Private ❑ Zone: Outside Flood Zone Municipal V On site disposal system ❑ 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 S aces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW X _ 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 X 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 x 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 X IF YES, describe size, type and location:_ Version 1.7 Commercial Building Permit May 15,2000 'ECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 UBIC FEET OF ENCLOSED SPACE iterior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ xterior Alterations Demolitions New Signs [ ] Change of Use [ Other [ ] E� Accessory Building[ ] Repairs 141 TDE- .PP-T43: Replace Existir g Doors & Ballroom see photo) ,ECTION 5 USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE Assembly Io A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ Business ❑ 2A ❑ Educational ❑ 2B I ❑ Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑ Mercantile ❑ 4 ❑ Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ Utility ❑ Specify: Mixed Use ❑ Specify: Special Use ❑ Specify: COMPLETE THIS SECTION 1F EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE isting Use Group: Proposed Use Group: fisting Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): ECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEN CONSTRUCTION OFFlCEUSE ONLY oor Area per Floor(sf) 1st 2nd ,d 3rd d 4th x th otal Area (sf) Total Proposed Ne,,u Construction (sf) ............ ....................... Dtal Height(ft) Total Height ft `_ Version 1.7 Commercial Building Permit May 15,2000 �� e'��� `�� ��I1 t � ELI ��� f .• �a�� ,����� Cit of Northampton, ttu ote t lt� �Yl 8u ing Department� -- ,' Main Street: Se aer7Se a alalli �, }M, Qom 1001�+f l - _ xn+(ort ton, MA 01060 yroets, . ; �f phone 41387-1 40 Fax 413-587.1272 IPIlF rtz a ; APPLICATION TO C6NSTR6C ; , 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: 36 King Street (Hotel Northampton( Map Lot Ur Zone Overlay DstrECt bm St District CB D1stC,�ct iI SECTION 2 -'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Star Northampton, Inc. 36 king St- , Nnr hamnton, MA. 01060 flame(Print) Current Mailing Address: 413-586-5491 Signature Telephone 2.2 Authorized Agent: _ Pioneer Contractors P.O. Box 1145, Northampton, MA. 01061 'dame(Print) Current Mailing Address: 413-586-5491 Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant _ Building 3,000.00 (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 This Section.For Official Use!Onl " . Building Permit Number: Date'Issued: Signature: Building'Commissioner/Inspector of Buildings Date File#BP-2004-1250 APPLICANT/CONTACT PERSON Pioneer Contractors ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491 PROPERTY LOCATION 36 KING ST MAP 32A PARCEL 255 001 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 T_ypeof Construction: REPLACE bALLkOOM DOORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 017890 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFPRMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED LENDER:§ 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 Co ion —4Z 10 260 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. 36 KING ST BP-2004-1250 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 32A-255 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2004-1250 Project# JS-2004-1568 Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Pioneer Contractors 017890 Lot Size(sg.ft.): 72614.52 Owner: STAR NORTHAMPTON INC Zoning: CB Applicant: Pioneer Contractors AT: 36 KING ST Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAMPTONMA01061 ISSUED ON.6110104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE BALLROOM DOORS 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 6/10/04 0:00:00 9124 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Connnissioner-Anthony Patillo