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32A-083 (6)
File @ BP-2016-0864 kjariAgAj eot APPLICANT/CONTACT PERSON JAMES FLANNERY a �p ADDRESS/PHONE 56 CHESTNUT PLAIN RD WHATELYO1093 (508)294-4052 PROPERTY LOCATION 46 GRAVES AVE MAP 32A PARCEL 083 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid / //�,�yy�� Building Permit Filled out 1 "' - f` a) Fee Paid Typeof Construction; STRIP&SHINGLE ROOF&REPLACE SIDING New Construction Non Structural interior renovations Addition to Exictin° Accessory Structure Building Plans Included: ( vner/Statement or License 103061 3 sets of Plans/ Plot Plan THE FOLLOWING 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 ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Elnclosed, 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 Penni' from Elm Street Commission Permit DPW Storm Water Management D g/.-/<;;; I—c(f Signatm'e of Buil ng OtKciai 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_ranted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning& Development for more information. Versionl.7 Commercial Building Permit May 15,2000 Department use only it of Northampton Status of Permit: B (ding Department Curb Cut/Driveway Permit I JAN _ 5 12 Main Street Sewer/Septic Availability S Room 100 Waterman Availability 'No hampton, MA 01080 Two Sets of Structural Plans phdtte-13 587-1240 Fax 413-587-1272 Plot/Site Plans 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 1.1 proDertv Address: This section to be completed by office 9 Lo' 60 [.4yrt/t_5 AIC • Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Pont) Current Mailing Address: 2n 0(4) cca+c•a 41,4lArtf m o/Syt Signature 1f/ 11 4 Telephone L119 - 3tdl•L{Zt42 2.2 Authorized Mont: , Name(Print) 714--MES J - Ajett Current Meiling Address: 5j UI tS'-nj 1 Pl44n eel t ,AA�el , MN- otog3 Signature u Telephone Safi —+`'�r ' 4` 4O3 2 SECTION 3- wawa. CONSTRU COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ,eta , 00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(S) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection S. Total=(1 +2+3+4+5) f 000 . DC Check Number /%6�Z This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/inspector of Buildings Date V ersionl.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 0 Demolition 0 Repairs Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 RoofnChange of Use❑ Other AS, f�(l�/6 Brief Description a brid ef description here. Of Proposed Work: aWtNfll— Of aiper(IdL .�Ql a POs9 INTRi4_ d b1J IScep4 few»ufriL or mitt,'. 510 At.q !Qtr4Nww urw .3101 Liar SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 0 1A I 0 A-4 0 A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B I 0 F Factory 0 F-1 0 E2 0 2C 0 H High Hazard 0 3A 0 I Institutional 0 I-1 0 1-2 0 1-3 0 38 0 M Mercantile 0 4 0 R Residential AEI R-1 0 R-2 0 R4 AK 5A 0 S Storage 0 S1 0 S2 0 5B 0 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: 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) & 1° 2nd 2m 3"13,e 4th 4� Total Area(sf) Total Proposed New Construction(sf) 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 0 Private 0 Zone Outside Rood Zone❑ Municipal 0 On site disposal system Version!.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERSAGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT I _' I, PC1E7 R , , � p mry ,as Owner of the subject property hereby authorize it 1 r YJ to act on my �/��fNiinntall m: ers relative • work autho ed by this building permit application. Signature of er ,I , Da1 Ilte I, seg* 4't .Q ,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. Sig under the pains and penalties of perjury. Its r Print ams I— Signature , • er/Agent, / Date SECTION 12-CONST•UCTION ERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ NOM of License Hold*:J/M1tS J- F«n/!! t/ -7.913 1- JJ, License Number 5o 0 ilcsnuor PLM-7-4) /ed eNhotsitey, Mt ace?3 Va,4'7'Atltlress / ✓ Expiration Date lb.a��%ISa . 5Uf M4 4U Se Lure ' Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,$250(8)) 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 b • ing permit. Signed Affidavit Attached Yes No 0 The Commonwealth of Massachusetts - Department of Industrial Accidents --.3: —: Office of Investigations 10". I. i,�,'y; 600 Washington Street ~' .4tiit ',2i Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): TtrnlES 5. Cottl-STacc 7.LLnnl Address:,5/r eiffSTAxir PLfrJN iP>, City/State/Zip:,/,01-17FTEL,/, /I 01693 Phone #: ,50("i-94 –-fOSZ Are you an employer?Check the appropriate box: ,/ 4. ❑ I am a general contractor and I Type of project(required): I.IJ lam a employer with z employees(full and/or part-time).' have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, 5 Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.• 9. Building❑ addition required.] 5. ❑ We are a corporation and its 10.5 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.5 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12 G Roof repairs insurance required.] ' c. 152,§1(4),and we have no employees. [No workers' 13.5 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 employes If the sub-contractors have employees,they must provide their workers comp-policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LI6eery Mum/FL. .flist/Z9UCE 'Ir Policy#or Self-ins. Lig.#: yvCS-p3�1�S -3t2Lp(b/ -0515 Expiration Date: 1O////(e aatt Job Site Address: -50 61/1/6s Ave City/State/Zip: /UOYd'fkSrf11/7f01 /1if O/o lid0 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 ofa 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 5250,00 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 certify un ayy-Me p�a�in and penalties of perjury that the information provided abo//ppei true and correct Signature: Date: l/�f�l(O Phone#: 50f -219 -117CZ Official use only. Do not write in this area,to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: