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23A-079 (25)
41 MAIN ST BP-2007-0878 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-079 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0878 Project# JS-2007-001436 Est. Cost: $9000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: James Phaneuf 011632 Lot Size(sq. ft.): 7318.08 Owner: FALK SYLVIA Zoning: GB Applicant: James Phaneuf AT: 41 MAIN ST Applicant Address: --- Phone: _Jnsurancf 74 Old Stage Rd (413) 247-9993 - W HATFIELDMA01088 ISSUED ON:3/26/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE 2 INTERIOR WALLS & INF. i.::.LL 3 SINKS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.Y.W. Building Inspector Underground: Service: Meter: Footings: Rough::/ -(7(f /� Rough:S= ,L 7 House# Foundation: Driveway Final: Final: �7 _ Vj Final: 401 Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: n'1: Insulation: Final: Smoke: Final: Q'K 05/0`t(0% (;.6ctics THIS PERMIT MAY BE REVOKED BY THE CI' ' OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvpe: Date Paid: Amount: Building 3/26/2007 0:00:00 $50.001344 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2007-0878 APPLICANT/CONTACT PERSON James Phaneuf ADDRESS/PHONE 74 Old Stage Rd W HATFIELD (413)247-9993 PROPERTY LOCATION 41 MAIN ST MAP 23A PARCEL 079 001 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 13 7 74 Typeof Construction: REMOVE 2 INTERIOR WALLS&INSTALL 3 SINKS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 011632 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 fro Elm Street 'ssion L Zook 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. R ♦ ♦ Versionl.7 Commercial Building Permit May 15,2000 _ Department use only '' ' s City of Northampton status:of Permit; Building Department Curb-Cut/Driveray Permit_ 212 Main Street Sewe&Septic Availability _-.---- '' 1 Room 100 Water/Weil Availability_ . - Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 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 This section to be completed by office 1.1 Property Address: -- — • - PM`I 51 WO Lot Unit r�1 1tr r • SC. i!one Overlay District s Elm St District CB District; SECTION 2--PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 6EOlzkr fAI.K- ; siA_ksk-iSF x- ( u A ig�- . (c s$Name(Print) cc.44,047z /l/ .'55ç .. Current Mailing Address: Signature t' _ Telephone 2.2 Authorized Agent: ... JAll{iS> 731/4i i i 7e-- n,4_, Sri S W/HAT-60144. � I Name(Print) Current Mailing Address: :./►y�e-mod ge—ev-A-----/ Telephone "9! 1 3 Signature `��' SECTION 3-ESTIAYATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4 S I Lys I (a)Building Permit Fee 2. Electrical 4 . (b)Estimated Total Cost of I l U—'� Construction from(6) 3. Plumbing ', # -1 U—v-- : Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) W q, (`--('-t) Check Number / ?4iii r (,/ This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version1.7 Commercial Building Permit May 15,2000 /•• SECTION 4-CONSTRUCTION SERVICESI FORPROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE . Interior Alterations Ed,Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration ❑ Existing Ground Sign 0 New Signs❑ Roofing 0 Change of Use❑ Other 0 Brief Description Enter a brief description here. -V-614 0 iJ ' 1 fS I . LJ kt,j^S1 C U3TALL Si►- , Of Proposed Work:`,pi r4 G- Fop_ J' -. , (R-, W,IJApri,.. SECTION 5-USE GROUP AND CONSTRUCTION`T'YPE-`_ , USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ElA-2 IDIDA-3 ❑ 1A I A-4 ❑ A-5 0 1 B CI B Business I ❑ E Educational 0 2B I ❑ F Factory 0 F-1 ❑ F-2 0 2C 1 CIH High Hazard CI3A ❑ I Institutional 0 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B Er M Mercantile ❑ 4 ❑ R Residential 0 R-1 0 R-2 ❑ R-3 0 5A 0 S Storage ❑ S-1 0 S-2 0 5B [ ❑ U Utility ❑ Specify:1 cf t.,w of l isf 0 fEt cie, M Mixed Use ❑ Specify:1 3 S Special Use ❑ Specify: t COMPLETE THIS.SECTIONJF EXISTING BUILDING UNDERGOING RENOVATIONS ADDmoNs AND/OR CHANGE IN USE Existing Use Group: ! Proposed Use Group: Existing Hazard Index 780 CMR 34):' I Proposed Hazard Index 780 CMR 34): ! SECTION 6BUILDING HEIGHT=AND AREA_ BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ? :-Viz.': SE:ONY" , Floor Area per Floor(sf) '' 3 w -ii3O, , 2nd r �a. a '#K 4.,3- s' x i40.14 3rd ! 3 N u x 5ws Total Area(sf) I Total Proposed New Construction(sf) p' -'3 ` { r �Total Height(ft) , ,Z -k' r Total Height ft ! ' tt Pili60 li' 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public El Private 0 Zone. Outside Flood Zone Municipal El On site disposal system El Version1.7 Commercial Building Permit May 15,2000 8;N©R'M M OOZON1N 13 , Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i i Frontage { 1 • Setbacks Front Side L R L:l i R:i _T_ Rear I i i ButTdtng et i Bldg.Square Footage I ; % 1 il ii Open Space Footage (Lot area minus bldg&paved I i I parking) #of Parking Spaces I l Fill: ' I ' i (volume&Location) _ A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO Q DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW e YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO e5 DONT KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES er' NO 0 - IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 IF YES, describe size, type and location: i I 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 0 ' NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. • 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 El Name(Registrant): i Registration Number i i1 Address Expiration Date I Signature Telephone 9.2 Registered Professional Engineer(s): . Name Area of Responsibility Address Registration Number I i Signature Telephone Expiration Date I Name Area of Responsibility Address Registration Number i I j Signature Telephone Expiration Date ' Name Area of Responsibility Address Registration Number f Signature Telephone Expiration Date i Name Area of Responsibility 1 Address Registration Number i i i ; 1 Signature Telephone Expiration Date 9.3 General� +, Contractor ` I -PAPA J E. f- 1.b NcI�� LT L O"' Not Applicable ❑ Coomm �an/y Name:' I u� •`/ I V i '"l ��IRNbP Responsible In Charge of Construction NA) S' OP- W► d4Tt"161-q MASS. Address D-47y9,3 . Signatur Telephone Version1.7 Commercial Building Permit May 15,2000 t.. SECTION 10-STRUCTURAL PEERREVIEW:-(T80 CMR 11011. - Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION.11 OWNER AUTHORIZATION:-TO-BE COMPLETED WHEN OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING`PERNIIT Iw---4..— ,as Owner of the subject property hereby authorize v'et,I4LeS v '`a h 01f- to act on my behalf,in all matte elative to work authorized by this building permit application. ,it.n F-T-4,0,____?_,,,,,, . Signature of Owner Date I `'� rn' ] 1 1r � 1.; V 3 Yi��i 1.16 Lf f I ,as Ownerl�4uthorized j Aereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge an belief. Signed under thee ' s and penales of perju . Print Name `�44 X f Signature of Owner/Agent Date.( SECTION 12 CONSTRUCTION SER17_ICES. - 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:' v zs V i-t r'rJiik LNumber -7� btI 7 2�. L). t4/a�f tet,,v, f . DIo% 1 1 i Licens 3(/o Address 40.... 4 �� O�.�. Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION:INSURANCE"AFFIDAVIT(M G L.c.1;52-- 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 b 'Wing permit. Signed Affidavit Attached Yes No 0 r . r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street -' Boston, MA 02111 •' www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organi7ation/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. I am a general contractor and I 6. 0 New construction employees(full and/or part-time).* have hired the sub-contractors 2.E1 I am a sole proprietor or partner- listed on the attached sheet. 7. g Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.: required] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other • comp. insurance required.] *My 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 employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I an: an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date:_ Job Site Address: City/State/Zip 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 of a 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$250.00 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 under the pains and enalties of perjury that the information provided a ove is true and correct Signature: / Date: 3 74/67 r it Phone#: Z 7 c( t ? Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 'VW (1)(`'- 51 210-y Ls r ' -) _______ , _ 5-)0Q U+I 10 ? r - c P ' a4PC/ --7. , ile . 19014 Y sy,_,, ' aid ..._. -,n v-21'91-1--) , ,ri 7, „ip,,,,,,.,_,11 __, , tir ,, , . . r 1 - - -r -z1 _10. 13s'Q l--) . 63J • 1