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35-270 (2) McCutcheon Construction Full Service General Contractors 87 Chestnut Street Florence,MA 01060 (413)584-3352 `be CAVEJ) '5y > [C)7 C(C u\ r"\ PRO ■ McCutcheon Construction Full Service General Contractors 87 Chestnut Street � �� (.- Florence,MA 01060 (413)584-3352 14 i F-V 1Y i � -ro Apo 16 ' F (riff Of �'TortIJU111PIa11 _ r — R � E �tns><rlr4incrita' u DEPARTMENT OP BUILDC?NtC INSPECTIONS 212 Main Strect ' Municipal Dodding Northampton, 1fass. 01060 «'O RICE IZ'S C 0 i\[P E NSA77ON G'lSURACE A17FMANrIj- (lrccusxJperm�ttcc) 7 7 R �- C ��� �,... (phone!) (strz~t/c�tylstaic'z�P) do hereby cerify, under Lhc pa_ifls and penalties of penury, hat ( ) I am an employer providing the following �i,orkcr's coinocriszzion covem,c for Iny emplovecs worlong on VLins job: (Iasur---O= Comn::cy) (Pclic:Ntinabccr) (r:'pirraor, Dom) O I am a sole proprietor, general contractor or homeowner (ci:c;e one) and hzve hired the coo;actors listed below who hzve the folloVVU' S works cot nens2don po!icies: (N+amcc of Co_^.'naor) (Ifisu mncc Coirinari)-Pi 1111c) - (Name of Comraaor) -- Gnslranc Comoaa`1Po!ie; Ntim cr) (Ex-Dimilon Date) (Name of Contractor) emsuranc; CompanyfPoUq- N.isbzr) (Expirrioo Datc) J I (Name of Contractor) (Insurance Company/Policy Num&�r) - (Expiration Da1r). (an�.c�_b.-tl�oczl:�ifnxcs.ry to c>GU�inform,aoo p rta:�to.v oc�-_cv:-�) p I am a sole prop netor and have no one worldDg for me. ' ( } I am,a home owner performing all the work myself. NOTE:ply sc be nMr,the: +1ji}e 6emoo avcr�..•bo csaploy per ow to r.i.-m,= car,:c,c=renu work ca t d"mo=o'of not moot tlLa t'..r-v-.uni'u is u3irb the bornoou ac raic"or oo the P-OU04.zppuricn_r1 them r.2 ooc qtly o c=d.•rod to be aisployczunccthe..ait{;--P- ..,•c.Act GLIk-=1 S ( )1 zpplinDOO by n 6omcoaaa fv:licy_or perrort r>^y c+•idcm the IcIa1 rte..,,Or e-rployx under du Wot{;.o(r Compom.tion 1�,_ I u-&—ad d-a copy ortbi.—,—may be f-r-arded to Lb.poputmeni 0tL.ortrsz+r--for tb- covrrr se vQif c=L oa mad th_t L-il=•c to seouc bovcM;,Uln'd=wetion-15A of 1,10L 152 ew lad to the i=vosaioa of aimic-A prn116a ooasiitmg of■&x or UP to SI}00.00. Nor �o(up to roc year e.od aril pcaahin in[be rocm of n Stop Wart order nod a 4DID),.010 of For dcp.rt— ,I—Drily Permit NumbcT Lot cdPcrmittcc e J Version 1.7 Commercial Building Permit May 15,2000 SECTION 1Q 5'�'(2UCTURAL PEER RENIEIN(78DCMR�19011� Independent Structural Engineering Structural Peer Review Required Yes No SECTION 11=-OWNER-AUTHORIZATION? 'TO`BE=COMPLETED"WHEN' OWNERS:AGENT OR CONTRACTOR APPLIES FOR BUILDING PERM IT e i as Owner of the subject property hereby authorize` ' to act on my behalf,in all matte ti to work authorized by this building permit application. Signature of Owner <✓` r Date 1, t 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. Si ned under th ains nd enalties of Dedurv. i { Print Name i i Signature of OwnerlAg Date SECTION 12.-CO : TRUCTION;SER\/ICES 10.1 Licensed Construction Spoervisor. Not Applicable ❑ i Name of License Holder: License Number I Address Expiration Date Signature Telephone SECTION 13-WORKERS'GONIP.ENSATION INSURANCE'AI=.FIDAVIT;(M.G.L.c:1,52,,§;25Cf Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the is uance of the building permit. Signed Affidavit Attached Yes No 0 r f R , Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-P.ROFESSIOIVAL DESIGN AND CONTRUC lON SEftYJCES FQRBUII.DINfiSND STRUCTURES 5U63EGT0: CONSTRUCTION CONSf20 PURSO1 T T-Q-T;0 CMR 116;(GO1th7AlINING_MORE T M-,35 000 C,F OF ENCLUSED SP CF) 9.1 Registered Architect Not Applicable ❑ I Name(Registrant): Registration Number i Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility F 4 i Address Registration Number ----- Signature Telephone Expiration Date � t Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility 1 Address Registration Number Signature Telephone Expiration Date f I � Name Area of Responsibility 3 Address Registration Number s � 1 Signature Telephone Expiration Date 9.3 General Contractor G 0 i I Not Applicable❑ Company Name: I I Responsible In Charge of Construction ' r Address Signature Telephone I 1 Versionl.7 Commercial Building Permit May 15,2000 Existing Proposed _Required by Zoning This column to be filled in by Building Department Lot Size i F dt Frontage i E^ Setbacks Front L21 Side L:� R: L:= Rear i '-I-ir-' ButTdmg He—ighff Bldg.Square Footage � % au-l Open Space Footage �� % (Lot area minus bldg&paved t&M31 ! 3 j i parking) —�T #of Parking Spaces LM --F� Fill: volume&Location) i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q 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 a 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 IF YES, describe size,Cype and location: ; p D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,evation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 ` NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SEETION4=COiMS ftlfC>LIONr SERIOCES OR'PROJECTSWMEOSS`THAN CUB1,C FEET fl)=EIsIC MSEMS1' CGE= a Interior Alterations ❑ Existing Wall Signs ❑ Demolitioh❑ Repairs❑ Additions ❑ Accessory Building❑ p Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ R ofing❑ Change of Use❑ Other❑ Brief Description ;Enter a brief description here. L ; Of Proposed Work:HI-0— .a It,, N CS? SECTION 5USE G1tOURA1�D CrQNStUGTIONFTE 77-7, S4C USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A 71 ❑ A-2 ❑ A-3 ❑ lA ❑ — — A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ r 2A ❑ E Educational ❑ 213 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ 1 S-2 ❑ 5B ❑ U Utility ❑ Specify. M Mixed Use Specify, i S Special Use � Specify: COMPIFFETEHS-SECTION-[F EXISTING BUILDING REN64 DIOR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): .zECTI0w6s-, UILUING EIGI�T ANQAE2EA< BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION �r fir, Spegg,' p fi f Floor Area-per Floor(sf) 1 sc l ( 1st nd i i 2"d 2 C-c 3rd °' 3r° I 4"' + ' 4� Total Area(so 1 �^� s Total Proposed New Construction(sD a Total Height(ft) Total Height ft f 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone — ' Outside Flood Zoneg Municipal ❑ On site disposal system ry VA Version 1.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room,100 Northampton, MA 01060 phone 41387-1240 Fax 413-587-1272 L `APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ,SEG'LlON= SITE�NEORMATIOtaI' _ m Ill,-WO-1 1-Prpedy-Ad Lr$$ ` t"'�`' .c i •. N_-`", .- ,:z-f. .,'s..43'ik ? t:.r x N " �•-wt S � tF •.. -Tg�Y vsx u�sa•w.�°h z�M�`5.5 a�#�Ss k,. .�a'�' �....Eu SECTION 2 PROPERTY aWNERSHIPFAUTHORIZED AGETIT ' re 2.1 Owner of Record: Name(Print) Current Mailing Address: _ Telephone hone P 2.2 Authorized 4w—t- 4 Name(Print) Current Mailing Address: i 5 �F,- 7�<—?,— j Signature Telephone SECTTION 3--.ESTINfATED.CONS1(i IO COSTS, Item Estimated-Cost(Dollars_)to be O ctartlse 0my completed by ermit applicant 1. Building (a Building Permit Fee r —r r 2. Electrical (b'�Estirtia'ted Total Cost`of' i r 'Consfructioii from 6 r 3. Plumbing -- Bwldmg,Permit Fee T. p 4. Mechanical(HVAC) } ` 5. Fire Protection p 6. Total=(1 +2+3+4+5) ' Check•Number This.Sec6on ForD trial l7se dni Btii dmg.Permit urnT�er; safe Signature; Building,Commissior erllnspecfor of'Buildings' DatE File#BP-2005-0963 APPLICANT/CONTACT PERSON Paul McCutcheon ADDRESS/PHONE 77 FOREST GLEN RD FLORENCE (413)584-3352 PROPERTY LOCATION 27 WEST FARMS RD MAP 35 PARCEL 270 001 ZONE NB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid ,6 Typeof Construction: CONSTRUCT 2ND FLR KITCHEN/BATH&SMALL ENTRY DECK New Construction Non Structural interior renovations Addition to Existing - Accessory Structure Building Plans Included• Owner/Statement or License 062544 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF96MATION 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 Pemnvt 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. 27 WEST FARMS RD BP-2005-0963 CIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-270 CITY OF NORTHAMPTON Lot: -001 Permit: BuildinQ Category: BUILDING PERMIT Permit# BP-2005-0963 Project# IS-2005-1336 Est.Cost: $6805.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Paul McCutcheon 062544 Lot Size(sq.ft.): 29359.44 Owner: MCCUTCHEON PAUL C&MARCHELE Zoning:NB Applicant: Paul McCutcheon AT: 27 WEST FARMS RD Applicant Address: Phone: Insurance: 77 FOREST GLEN RD (413) ,;52A-111;-) FLORENCEMA01062 ISSUED ON.4127105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2ND FLR KITCHEN/BATH & SMALL ENTRY DECK 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 Occupant Signature: FeeType• Date Paid: Amount: Building 4/27/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo s low 27 WEST FARMS RD OP-M-0963 #. COMMONWEALTIH OF MASSACHUSETTS 1MW jL6&35-270 CITY OF NORTHAMPTON kQt Al -Qgtwm, BUILDING PERMIT BP- 0 wifA#._ .1S-2005-1336 FA QQ9;$6805.00 Fee:550.00 PERMISSION IS HEREBY GRANTED TO Coast,Class: Contractor: License: Paul McCutcheon 062544 ►t Sizetsa ft) 29359.44 Owner- MCCUTCHEON PAUL C&MARCHELE zonina:'NB Applicant: Paul McCutcheon AT. 27 WEST FARMS RD A;Wica�nt Address: Phone: Insurance: 77 FORLff GLEN RD (413) 584-3352 FLORENCEMA01062 ISSUED ON:4127105 0:00:00 To PURFO"THE FOLLOWING WORK-.CONSTRUCT 2ND FLR KITCHEN/BATH &SMALL ENTRY DECK ST,T 5 CARD SO IT IS VISIBLE FROM THE STREET inspector of Plu ping Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough; Y / l Foundation: 0 � Driveway Final: Itivai: , Final: FA D 60 Rough Frame:� q` Gas; Fire Department Fireplace/Chimney: Roughi Oil: Insulation: �/f aaaS' -bZ$,' Smoke: Final: Flual. 01-< 0310�o4 Cop;t THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL TION Si nature: Fee v©e� Date Paid: Amount: Building 4/27/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo