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32A-122 (9) 67 KING ST BP-2004-1125 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 122 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-2004-1125 Project# JS-2004-1683 Est. Cost: $35000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Peter Radke 047846 Lot Size(sq. ft.): 28880.28 Owner: NORTHAMPTON CO-OPERATIVE BANK Zoning: CB Applicant: Peter Radke I,1'. 7 KING ST I--. 6/ KiNG S i Applicant Address: Phone: Insurance: 12 Federal Street (413) 529-0656 EASTHAM PTON MA01027 ISSUED ON:5/12/04 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:©K G - V V-O y.1 ,! THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA 1 OF ANY OF ITS RULES AND REGULATI --7:_--44.4"....01!" .-$:'= ONS. -G �/ Certificate of Occupanc 7'—e-- L' Signature: mature: FeeType: Receipt No: Date Paid: Check No: Amount: Building °u 5/12/04 0:00:00 1700 _$0.00 /7b,- 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2004-1125 �,,� APPLICANT/CONTACT PERSON Peter Radke GE W 3-335-33 7/ ADDRESS/PHONE 12 Federal Street EASTHAMPTON (413)529-0656 PROPERTY LOCATION 67 KING ST MAP 32A PARCEL 122 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid r 7 L/// '' Typeof Construction: INSTALL REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 047846 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 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 Stre ommission - '‘'Ill-- 6P------- , .i/d904/ 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. Versionl.7 Commercial Building Permit May 15, 2000 -> Department use only City of Northampton Status of Permit:. Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availabili ty 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„QCcU 4N OF, OR DEMOLISH ANY BUILDING OTHER THAN AON b ir$ imq-LoiG SECTION 1-SITE INFORMATION MAY 1 1 2004 1.1 Property Address: be completed by office C I ,`This section to h (i i�l�l �a �7Cil�� �(`) C: 1. C Map ./p�,/7 Lot s` 0 Unit /' rl� i. l 7 ,(!�6- 5-j Zone Overlay District _ Pie/?T 17,9,- 7 U rti / 12/ Elm St.District : CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner f Record: V/tt/61 -f 73.)/kr cil 6,- '` .e, ;. / Name(Print) 1 Current Mailing Address: f/ `1,/rf,,, • ,.- - '15 T ��7V Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature 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 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) �`� '' 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) Check Number 0/775 This Section For Official Use Only Building Permit Number: ,OS"-1107c— 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 Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0 0 0 Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] [ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: ��� �c1(k_,Yl a-‘. �-�' [ll'. t�;t,0 S �(�(� �nG-rN- SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly I A-1 ❑ A-2 0 A-3 0 1A I 0 A-4 ❑ A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A 0 I Institutional 0 I-1 0 I-2 0 I-3 0 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage 0 S-1 0 S-2 0 5B 0 U Utility 0 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) 1st 2 1st nd 2nd 3rd 3rd — 4th 4th Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) s Total Height ft 4 Versionl.7 Commercial Building Permit May 15,2000 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 Flood Zone 0 Municipal 0 On site disposal system 0 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 1/ YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW ,1' YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO 17 DONT KNOW 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: {7(k.\ 4V 5160 cCi cf\t' or7d o /of, D. Are t re any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: 1 Version1.7 Commercial Building Permit May 15,2000 SECTION •9; PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO •CONSTRUCTION TO'780 CMR 116(CONTAINING MORE THAN:35 000C F. OF ENCLOSED'SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone 4 � Version1.7 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 0 SECTION 11 - OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 11- I, ib C44 *lf , as Owner of the subject property hereby authorize to act on my behal in all matters relative to work authorized by this building permit application. ro r Signatu o Owner Date h 9- w I, 1(10,0041‹.. ' !,- 40(i Z'/a4- , as Owner/Authorized Agent hereby declare that the statementskand 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 ZeiVietatote,, Signature of Owner/Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : ) 0V9 Ff476 License Number � �� Address Expiratio ate eQ' /14/9/1'7,37-1,1L-) , 1W19 . 0/0 V Signature Telephone ^ ��� 3171 SECTION 13 -W RKERS'-COMPENSATION INSURANCE 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 CI No 0 f e 4;1E: (rite of Northampton 1 _- � E � cssncSlntcttn'`At • rit ���- DEPARTMENT OP BUILDING INSPECTIONS • 212 Main Street Municipal Building Northampton, Mass. 01060 WOR1G R'S COMPENSATION s/SU-RANCE AID"I ll)AV17.' I, -- (Ii ccusccipermi ttcc) with a principal place of-business/residence at: ,S AkJ? 7 N , /17,7 (phone-') 0/0 a (sa-=/city/szas.ciz i p) do hereby certify, under the pains and penalties of-perjury, that ( ) I am an employer providing the following worker's compensation coverage nor my employees worng on this job: ([as r n Comr_-ny) (Policy Number) - (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (ccie one) and have hired the coat-ran-tors Listed below who have the following worker's compensation policies: • (Name of Contractor) (In.urancc Coinoanyt?oUc Numb ) (r?:T,)trdt 0 Date) (Name of Cone-actor) arts-dr'a.ncc Compaany/PoLicv Number) (Ekpiration Date) • (Name of Contractor) (Lasat-anec Company/Poticy Numbs) (Expiration Date) • • (Name of Contractor) (Lnsurancc Comcacry/Poticy Numbs) (Expiration Date). ( ocai dcG if cidudc inforo a oo pertaining to all ooc-oco-) (&1Kani a sole proprietor and have no one worl;ang for me. ( ) I am.a home owner performing all the work myself. NOTE pl=sc be twain thy:wa]e boa>eo avcra..tio caploy pc-total to do t-., •m c —coo c rcpair worn ea a da tU;of CD(mots the n tsee Inks is u',rieb the bornooawer rcido or oa the grounds zppuutcasr_+the o a_-r oat -zly ccco-:dcrni ran tic tatployes the wai:..uar rota-<-,;on Act(GLi52.s31(5)),npplrttnoo by•bomaooroG for a Irc�_oc pcsmn tr y evrdmoc the legal at a,i of an aee loy.c uadac tlao Woricoet Cocapamniioa Act. I m4 rta.ad tha>copy of this mteaacn2 may be for o.nic4 to tbo Dopartmcc4 of lam• rial rtceadcate Chloe or I+zau`000 for Lb. oovc c vcrirelioo 0u1d that-E:iltae to tmrre laverase tinder soaioa 25A of MOL 152 era load to the of criminal pcnalti s co eoe in of a rioc°flop to S 1.300.00 andror mat of up to oa ycv and esvil paaatia,o dx.form of a Stop Wont-;order sad■ (Ira o(S 100.00 a thy apical me For dcy.rtac.=-�u.c only • Nurnbcr �✓�l[��_ 1vL7p LOt n Si tun:of Li crmjUcc U3te . .._. •l ..0401',-0404 ., L ' ) t C E V E \ .. , \-) ch ,j 141 A`( 1 1 2004 '!l.,,.% DU-A;AAp,-',P1ON,11,,i! 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