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23A-075 (7) ?O R E (riff of �'Toif jaliipjoll A � E �icsaarlyntclta' _ 4 .. DEPnRTMEIJT OP BUILOrNG INSPECTION'S _ 212 Main Strcct " Municipal Building Northampton, Mass. 01060 `N'ORICER'S CO'NMENSATION bNSUIZANC`F AIM)A1,,Tf' ' n�a (Ij 0=-<--X-JPCTMI acc) x,;04 L o V/"o (su-�l/city/slai.cra p)' do hereby certify, under the pz.ins and penalties of perjury, h.? O I am an employer providing the followine \�,orkcr's comoensn�o, cove age for lny eruployecs wor�Jng on Jus job` Conn n.-) (Pclic; N-u--Zrx--r) -- {r:pirlior,Dau) O I am a sole proprietor, general contractor or homeowner(ci:cie one) and have hired the coouactors fisted below vqho have the follo%vi�g worker's compenszhon policies: ('Llamc Oi CO"Tnaor) (InR!rancc ColrlpanyiPo6ci NIum-1Cr) - (Name of Cooa-amor) -- (tasura.nec Comoazv/Po!.im Nuocrr) (Expiration Date) (Name of Coaa7acio;) G-rsuanc: Compare}'/Polio' Nlunb i) (Exairrioo Datc) (blame of Contractor) (Insuran(-- Company/Pobcy Number) (Eapimiioa Date)- (ease:Ai;:oca1.5x iraocezaO•to iacud=ia1ortat--ioo pcYLya]ns to.11 (� I am a sole proprietor and have no one wor4dng for me. ( ) I am,a home owner performing all the work- myself. NOTE:plea be eorNc ti,,-�j,,jo bcmco.tivers W-oo cc=ploy pc7La to Ss ccrszcu,,o cr rcpair w•oric co a dN•clL^;:or o,w moct thn Line Imils is weft the borwa -oc r r-=4.a oc the pv c.s zpputtearl tba-ao e-T wt 11y a ca dyad 10 be �tploycs uoCe ttx.•�ir is c=pc oa Act(GLl 52--1(5)1 appbcatioa by-botncna-oa rer:li -oc permit rr_y e%idcooe Lbr Icg ct�-xc of en erployec under d3o Wocto(c Comp..aGi a A+;(- I uvZc-% d ds4 a Copy of thi.mlemooz m..y bo for-Hnrded to tbo Depanmevr or Ioausrid Amdcwy Onioo of Srzwoa+for dta cov-x6c vaZeUOa>_-1d a"U=to—'Mwmr c=ddcr section 2 S A of M01,112 tact Iad to Lb--impwaiov of eimi-I P-b` - ooasiv-ing of a rrae of up to S 1X00.00 a—vor impri30an3c=orup to anc yor ead a%il pcmtjo in dIc focm of a Slap wort Ord end a rrm of S100.00 a d--y apj=me For dcq'�ux only Permit Number Amp:;—_ .J Lot Signat n �`---f— . um of L;croscrlpcnnittcc U3te .-- Versionl.7 Commercial Building Permit May 15,2000 J.. SECTION 1.0-.STRUG'fC1RALFPEER REVIEW(780 CINR 17011 Inde endent Structural _: __ _ --• p I Engineering Structural Peer Review Required Yes No 4 SECTION•11 -:OWNER At}THORIZATION TO BE-COMPLETED OWNERS"AGENT OR CONTRACTORAPPLIES-,FOR;BUILDING'PERMIT t F 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. i E Signature of Owner Date j 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 perjures Print Name Signature of Owner/Agent Date SECTION 12,-CONSTRUCTION SERVICES: 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �yP✓�,e y . wk�,v 15 ao G 3 9 License Number O ll�o.>,�c2c v4 Address Expiration Date Signatur Telephone SECTION 13'-WORKERS'COMPENSATION.INSURANCE AFFIDAVI` 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 r Versionl.7 Commercial Building Permit May 15,2000 SECTION .9-PROFESSIONAL.DESIGN AND CONSTRIJI&d I SERYIGES EQR BUlLb.INGS AND STRUGTURESSU63ECT'CO _ w e CONSTRUCTION CONTROL_PURSUANT TO,780-CMR­11,;(-&.{Ct)NTAINING MORE THAFF 35;OOa C:F.OE[°NCL SE"PACE) 9.1 Registered tA,rrcchiiteect: '7� I`'�j `' C11,41�Ir/YNC/l V, YY/7�T�T�� # Not Applicable 0 Name(Registtr+ant): / T Registration Number , Address Expiration Date . Signature Telephone 9.2 Registered Pro essional Engineer(s): Name Area of Responsibility i Address Registration Number Signature Telephone Expiration Date I i � I Name Area of Responsibility E Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone (Expiration Date f t f Name Area of Responsibility i Address Registration Number i i Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable 0 Company Name: R. I Responsible In Charge of Construction r 1 ! , Address I Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 © job,1Z�'Y Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i i , Frontage 2 , . Setbacks Front F—TI-1 ( { Side L:_.,Z_ R:s L:= R:= i Rear Bldg.Square Footage �12 '7 Q� % Open Space Footagey� % 6p!(Lot area minus bldg&paved L 1'hF �` I arldn ) .4 + r #of Parking Spaces -� Fill: t i /V Qt�tt i volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued: 1 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 jr DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: j 3 O i"x 3G" r4cN�0 S/DL oP i3��c Oi.�G` - D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: j 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 NO r IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 i SECTION 4 COiiISTRUCT llobu SERV/ICE&-�FOP.�,PRO.IEC,TS'`CESSTHAN 35�OOQ CUBICFEETOF ENCLOSED SPACE Interior Alterations [!f Existing Wall Signs ❑ Demolition LI Repairs❑ Additions eAccessory Building❑ Exterior Alteration ( Existing Ground Sign❑ New Signs❑ Roofing 1W Change of Use❑ Other❑ Brief Description Ent r a tine descri tion here. c o 1.rMVC rA(RW H.C. R> K? PF1 O 3 FIR, s 9F /NS',�'�ct NEW Roa �+/EW tPo)fc y $41M Y. AleW WINAO as Of Proposed Work- t .r_ SECTION'S USE GROUP ANQ_CONSTRUCTION`TYPE- , USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A71 ❑ A-2 ❑ A-3 ❑ 1A ❑ El A-4 ❑ A-5 El 1 B ❑ B Business ._.Y 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 CM Q M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use 0 Specify:s i S Special Use El Specify: COMPLETE THIS;SECTION tF,EXISTING BUILDING UNDE> GOING REN9--V T[©tVS ADD�TIOIt1S:ANDIOR CHANGE-IN USE � . . (/�f'/���r ! Proposed Use Grou U �y -r Existing Use Group. po P� Existing Hazard Index 780 CMR 34): — — Proposed Hazard Index 780 CMR 34): SECTIbw.* BUILbING--k1EIG1 'F AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION °Ii t 0.yr a Floor Area per Floor(sf) /1 St 1 st A1 . 0/9 T 2nd .; . 2nd / /7� L! rd rd 3 Ott' Total Area(sf) ,�-�Q Total Proposed New Construction(sf) Total Height(ft) f Total Height ft 7.Water S pply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage 9isposal System: Public [ Private E] Zone' I Outside Flood Zone Municipal [ff On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 i.. City of Northampton Building Department 212 Main Street Room'100 Northampton, MA 01060 phone 413,-587-1240 Fax 413-587-1272 W APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE Cj O LiO F,!6R lbiiill ISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY-DWELLING - rSECTION SITE iNFORMATiON _ R RY _ 5 2C ----"-ProPertyAddfesV 0% tt�s sec rontabe compre#ec�i� o c� OR Al. �7 i. ) M•`i L D E C J /'I j on�,,, QtrertaDt nctx j ,�" .• ------- .L'S�v SECTION 2. eROPERTY`01NNERSHIPlAUTFIORIZED AGENT 2.1 Owner of Record: fie/j eR-rjp Name(Print) �,, Current Mailing Address: �113 -LOL e213 Signature ' Telephone 2.2 Authorized Agent: 1 Name(Print) Current Mailing Address: Signature Telephone --SEC--nOf-3--ESTIMATED:CONSTRUG.TION COSTS__ Item Estimated Cost(Dollars)to be OfficiaCUst3,rJ1 . completed by ermit applicant 1. Building a)B iilding-[ a it Fee g 1/04 Qtoto. 2. Electrical Esfimated'Total Cost of 4 Construction A I Build'ing.perm�t Fee 3. Plumbing � t✓� �d � 4. Mechanical(HVAC) r o ! • i i ; 5. Fire Protection I 6. TotaC=0 +2+3+4+5) �� QQ -Check Nijmber This Section ForOffictal't7se Oni Buttd►ng Permlt�[�um"ber; - - - _ , Qafe.�" Issued' r Signature: Building.CommissionerAnsli, r of Buildings Date File#BP-2005-1091 APPLICANT/CONTACT PERSON BARRY R COHEN Q ADDRESS/PHONE 40 O'DONNELL DRIVE FLORENCE 3 U 3 PROPERTY LOCATION 40 MAIN ST MAP 23A PARCEL 075 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT NEW HC RAMP,DEMO 3RD FLR SHAFT&INSTALL NEW ROOF NEW PORCH ENTRY& 1ST FLR NEW WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 005639 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF,QJC'IATION 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 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 mmission Q� S' OQS Signature of Buildmg 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. • r 40 MAIN ST BP-2005-1091 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-075 CITY OF NORTHAMPTON Lot:-001 Permit: Buildina Category BUILDING PERMIT Permit# BP-2005-1091 Project# 35-2005-1481 Est.Cost: $111000.00 Fee: $525.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: 3B Contractor: License: Use Group: B BARRY R COHEN 005639 Lot Size(sq. ft.): 74052.00 Owner: GOUGEON ROBERT Zoning: GB Applicant: BARRY R COHEN AT. 40 MAIN ST Applicant Address: Phone: Insurance: 40 O'DONNELL DRIVE (413) 303-9092 O FLORENCEMA01062-3525 ISSUED ON.5119105 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT NEW HC RAMP, DEMO 3RD FLR SHAFT & INSTALL NEW ROOF, NEW PORCH ENTRY & 1ST FLR NEW WINDOWS 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• Date Paid: Amount: Building 5/19/05 0:00:00 $525.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo