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13-073 (38) 25 COLES MEADOW RD BP-2006-0624 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -073 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0624 Project# JS-2006-0916 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Roger Clark 021310 Lot Size(sq. ft.): 492663.60 Owner: NEW ENGLAND DEACONESS ASSOCIAT Zoning. :i : ooer �a{" AT: 25 COLES MEADOW RD Applicant Address: Phone: Insurance: P O Box 34 (413) 584-1170 LEEDSMA01053 ISSUED ON:12/8/2005 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT ROOFS OVER SIDEWALK BETWEEN GARAGES & BUILDINGS 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: 6 fC `-/l�6 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF ANY OF ITS RULES AND REGULATIONS' Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 12/8/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 25 COLES MEADOW RD BP-2006-0624 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -073 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0624 Project# JS-2006-0916 Est. Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Roger Clark 021310 Lot Size(sq. ft.): 492663.60 Owner: NEW ENGLAND DEACONESS ASSOCIAT Zoning: SR Applicant: Roger Clark AT: 25 COLES MEADOW RD Applicant Address: Phone: Insurance: P O Box 34 (413) 584-1170 LEEDSMA01053 ISSUED ON:12/8/2005 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT ROOFS OVER SIDEWALK BETWEEN GARAGES & BUILDINGS 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 12/8/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2006-0624 APPLICANT/CONTACT PERSON Roger Clark ADDRESS/PHONE P 0 Box 34 LEEDS (413) 584-1170 PROPERTY LOCATION 25 COLES MEADOW RD MAP 13 PARCEL 073 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / Qom" Fee Paid ��v` Typeof Construction: CONSTRUCT ROOFS OVER SIDEWALK BETWEEN GARAGES&BUILDINGS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 021310 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 Co ' ion / *' .c. . / zoo, 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. s - - I Versionl.7 Commercial Building Permit May 15,2000 f x Department usennly.` `r▪ i1 \\tiny ofi Northampton is of;Permit: 1• U r-r-....."\wrr'_ c=" Building Department ` r,reway Permit t �1 212 Main Street Sec Availability " Room 100 Water,F1l/eti Avaiiabithty i\,\l •ti Northampton, MA 01060 TwoSets-of Structural_Plans ._ phone 413-587-1240 Fax 413-587-1272 Plot/SitePiaris .: 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_1NFORMATIONFn ----1-.I-Property-Addresc: , .this section to be completed by'office a-3- C O I eS /41G OW Id. ' Map _ Lo • U n AldfLT 19-eip. --dam 1 /)74- did' d ' m1, - . ..,.z.- .vz.:, , I!,:Zone LL ,-.Overlay=Distnt ct AElni*Ostrid In Z7BtSis ri 4 ^ ___ "qt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4/ELL' ak-L/}OD ,DEAcc.os .6 SOS- I .5- Cor!Es 4 MD dLe ref i Name(Print) ' . Current Mailing Address: r��T2t c In �S O Ko f Current cO?"a4J M7 CYd6( ' Signature (?c2 iL.l. C�=Y cl 2/ Telephone y/3 -,�-6 -.1y 0'.Z, - 2.2 Authorized Agent: C RQ6- R P. C1A4-Rk I P.O. 13OK 3 Y etfi14 c,/63'3!. Name(Print) Current Mailing Address: Signature /6 i ; Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee ',5�00. p G 2. Electrical (b)Estimated Total Cost of I Construction from(6) 3. Plumbing ; Building Permit Fee 4. Mechanical(HVAC) I • 5. Fire Protection i 6. Total=(1 +2+3+4+5) Check Number 5/0( 45- :This Section For Official Use Only Building Permit Number. .r Date Issued Signature: Building Commissioner/Inspector of Buildings Date Versionl.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 ❑ Demolition❑ Repairs❑ Additions El Accessory Building❑ Exterior Alteration B Existing Ground Sign 0 New Signs 0 Roofing❑ Change of Use❑ Other❑ Brief Description !Enter a brief description here. 1 Of Proposed Work: } / f ` ' I � i'L, ,'l S G}(.�;; 'S�O'lrt4��iik �C�I�.�c C7� cj:L��j�� '� ,,!1���r19� I SECTION 5-USE GROUPD CONSTRUCTION TYPE _ USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ ,.A1 ❑. A-2 0 A-3 0 1A1A I ElA-4 El A-5 ❑ B Business El 2A El E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 0 2C El H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 0 3B ❑ M Mercantile El 4 0 R Residential ❑ R-1 ❑ R-2 El R-3 ❑ 5A El s Storage El S-i ❑ S-2 ❑ 5B I. 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): 1 SECTION 6 BUILDING HEIGHT-AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION : '-OFFICE USE ONLY Floor Area per Floor(sf) 1st 1st ---- 2nd 2nd . 3rd 3rd { ! 4th 4th , 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 ID Private ❑ Zone, Outside Flood Zoned Municipal 0 On site disposal system❑ • 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 ' I ' ' Frontage ' j 1 ' I Setbacks Front I I 1 ; j Side L:' R:f I L:! R:L___I Rear I i___= Burldtng Height i — Bldg.Square Footage % 1 n Open Space Footage % � � ; (Lot area minus bldg&paved 1 I I L___1 I pig) #of Parking Spaces I I 1 I r Fill: ' I 1' I i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 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 I Page; I and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 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 © NO IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO IF YES, describe size, type and location: I I E. Will the construction activity disturb(clearins,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® ' NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. T Version1.7 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): iRegistration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): i I Name €€ Area of Responsibility 3 ! Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility I I 1 Address Registration Number Signature Telephone Expiration Date I Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date I I Name Area of Responsibility II Address Registration Number I i 3 I Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: f i Responsible In Charge of Construction r Address Signature Telephone Versionl.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 1,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. • Signature of Owner Date ,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 perjury. • Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction SupervisorNot Applicable ❑ Name of License Holder: Q 6 Ea 'f. C 1-4 iI K I v(2)3/.6 License Number .. 0/. 3 y L EED.f. , ,/1114 O/OS? II L//a.3JoG Address Expiration Date fel • Signature Telephone SECTION 13-WORKERS'COMPENSATIONINSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) 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 a No O T • s(ttn�-r PT r.. ,oy — � of �orili&mptoii 1 —k. 0,,s 45), • E �Zaaaac}Insctla' _ 7 ' :�'+� DEPARTMENT OP BUILDING INSPECTIONS • 212 Main Strcct Municipal Building Northampton, Mass. 01060 WORKERS COMT 'ENSATION, £NSUR&NCL AITU)AVIT - (licct>_txJ{�crmlttcc) ----- - - -- ---- -. -...--- --- plies-place of businessJresidence at: ,Lv/1d, Marl S t r tOcr c_L /1✓. (phone:=) 9/3--57YY///20 •- (s•cr=vci ty/s-iat 27 p) do hereby certify, under the pains and penalties of perjury, =hat ( ) I am an employer providing the followine \*orkcr's compensation coverage for my employees wordng on this job: (Lnsur-oc Company) (Policy Number) (E:-piraion Daic) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contactors listed below who have the following worker's compensation policies: (I-lame of Contractor) (In uranc:. Coinoairy(PoUc:; Nuulrc:) (xplrason. bate) • (Name of Contracior) -- (Lnslrancc Company/Policy Nuncrr) (Eivir.:tion Date) (Name of Coaa-detor) (Insuranec Company/Policy Nastx.r) (Expiration Date) • (Name of Contractor) (Lnsuranc Company/Policy Numb:r) - (Expiration Date) . (an>� tiocsl t-'tca ifnon-u1-to'include inform.aoo pertaining to.11 oo, -- -o a) ('‘if I am a sole proprietor and have no one worlang for me. ( ) I am.a home owner performing all the work myself. NOTE:plc- be ew-uc that 1 i3c boancosvocra.vbocm e- ploy psom t.o S.r-.fn �'.s +-asm - .i a. .•-oo repair ark cra.d.•'dLz than of Opt mart an tSoe tern, m 7 in which h Lbe b000wtacr raid=Or OO Lho Qowxl,Ippurtc a'=thn o L-c oOt COGZ�y aoo:,d7td to be caiploycs",,•"c ttx se a a-, --•lion An(GL1512.is 1(5)),applintioa&y a bomnowt fcr c Licc -or v uit may nidmc c trc • Ie¢1 rtanu of en employer wader rho WocS o?,Cocopcoossiioo-Art- I uodcotind the a copy of thie mtomnca axe y bo forv+crded to tbo Dopenrocce of I"•trial/,coded Of0oo of Irrnu+nco for the coveabc veri1iczaioa and th1 L-ilcc to tocurc leovernEc trodcr section 25A of MOL 152 CLO 168 to the i nt:tioa of eiminsl pectaliio 000sisrg of a tine of up to S 1.500.00 andror imp isoacoc-,n oCup tp ooe year e.od civil pmatia in the form of a Stop Wort Orden and a Iu o(5I00.00 a day aatia t For doperun,--scat vac only PermitNHumber Map: Lot n �_ Signature of Licanscc/Pcrrnittec U3te . .. .-- -J 12 12 10 7 _ �10 $ To% iir8.11.1p.;. \ -------- --- -- 4----- --- . rn GvG-'aO 136q N► 2x o `x V Ccrr A ,� Ka ac p 9� Zx2 Wa0� \ CoVc12.0^-)Gi [114 F.F. Y O'-Oil A.F.F. ,.__ . \ CO 42.'iq\Claes i , ---- IAir C.0 (7--'1 \ roNorn SECTION (FINISH FLOOR ELEVATION VARIES - SEE STRUCTURAL) (4) 3/16" = 1'-0" ICING /7/\\\12 �vvu�i2tr Zx2 L,vo°° Z1Z S \ y�, %‘ .. P V ieliP;. 4 ,?-09-9 8 • . EA ko01' '✓ R C'� o ,� t� 1 F.F. Oi_Oii A.F.F. EiZ) ‘-\\) Co- 37,7,101v� SECTION (FINISH FLOOR ELEVATION VCOVale ARIES - SEE STRUCTURAL) CRT ( 'Zo • �°s