32A-122 67 KING ST BP-2002-0068
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 122 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0068
Project# JS-2001-1565
Est.Cost: $29000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Robert Reckman
Lot Size(sq.ft.): 28880.28 Owner: NORTHAMPTON CO-OPERATIVE BANK
Zoning: CB Applicant: Robert Reckman
AT: 67 KING ST
Applicant Address: Phone: Insurance:
36 Service Center- Unit 2 (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:7/20/01 0:00:00
TO PERFORM THE FOLLOWING WORK:NEW PLANTER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/20/01 0:00:00 9699 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0068
APPLICANT/CONTACT PERSON Robert Reckman
ADDRESS/PHONE 36 Service Center-Unit 2 (413)584-1224
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
Typeof Construction: NEW PLANTER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 ' on
Signature o uilding Officia 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. r
Version1.7 Commercial Building Permit May 15,2000
(.^ try lJ U E Department use only
! ei'iy f Northampton Status of Permit:
Btu Id Department Curb Cut/Driveway Permit
1 8 2001 76
' Main Street Sewer/Septic Availability
Room 100 Water/Well Availability___
^Fa°1F Btllli)INGINSPE�6�8 am')ton, MA 01060 Two Sets of Structural Plans
phorf6 4M-58Z: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 Property Address: This section to be completed by office
61 Hint? &free f Map_ Lot Unit
prtionvtnni Zone Overlay District
Elm St. District__ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
I,/ r nlp�vn (-41xnhvi Etnk 67 idizy sf'e t
ame(Print) Current Mailing Ad ress:
584.4614
Signature Telephone
2.2 Authorized Agent:
�vb /Peckrrb, . 4 Lirv,ce &n/ t
Name(Print) Current Mailing Address:
p
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building Lt)U (a) Building Permit Fee
2. Electrical /,D00 (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) Ye G'lro Check Number
This Section For Official Use Only
3uilding Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r Versionl.7 Commercial Building Permit May 15,2000
I 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
Exterior Alterations Demolition❑ New Signs [y]^ Change of Use [ ] Other [ ]
0 Accessory Building[ ] Repairs [ ]
BfkwDesce-Tp—Trams: 4 ,'?'-r91 - -'q i s/g ri
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 ; 0 A-2 0 A-3 0 1A I 0
A-4 0 A-5 0 1 B 0
B Business 0 2A ❑
E Educational 0 2B I ❑
F Factory 0 F-1 0 F-2 0 2C - 0
H High Hazard ❑ 3A 0
I Institutional 0 I-1 ❑ 1-2 ❑ 1-3 0 3B 0 _
M Mercantile 0 4 0
R Residential ❑ R-1 ❑ R-2 0 R-3 0 5A ❑
S Storage ❑ S-1 0 S-2 0 5B I 0
•
U Utility 0 Specify:
II 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) 15t
1st NO onef :::
tiro Aio Ank inq
2"d
4th
3rd
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
1
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:
olic 0 Private 0 Zone: Outside Flood Zone ❑ 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 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
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)
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
;nature 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
idress
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
' CTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11)
...dependent 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
/// i>1P/e/j17 , as Owner of the subject property
hereby authori e ,(:C►11 iehrryl to act on
my behalf, in I atters relative to work authorized by this building permit application.
Signature of Owner Date
b iSeekma+) , 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.
D 0 � � �cLCRin✓\,J
Print Name
gnature of Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : ifiher1 e �(i/� /� 4M
License Number
J'viee r Atarlibiniivo !oNbs.
Address Expiration Date
Signature Telephone
SECTION 13 -WORKERS' 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 0 No 0 - c t \C-
•
ti �x I n Narti antpton
R66
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DEPARTMENT OF BUILDING INSPECTIONS
• 212 Main Street a Municipal Building 'o
Northampton, Mass. 01060 .�r'�
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I,
(licensee/permittee)
with a principal place of business/residence at:
• (phonell)
(a ti cet/city/sta tthip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providingthe followingworker's compensation coverage for my
{ P
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
•f
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
4,
(Name of Contractor) (Insurance Company/PoLicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowner,who employ persons to do maiotrnarx-r,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or ea the grounds appurtenant thereto are not generally ooasidersd to be
employers under the worker's oernpros*tica Act(GL152,ss 1(5)),application by a homeowner fora license or permit may evidence the
legal status of an employer under the Waimea Compensation Ad
-
I understand that a copy of thin atatcmem may be forwarded to the Department of Industrial Accidents'Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A(I MO.,152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprison of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against tee..
For departmental uses only
Permit Number
Map# _Lot#
Signature of Licensee/Permittee Late
• � CITY OF NORTHAMPTON
i..,
t. ''",ie 212 MAIN STREET-MUNICIPAL BUILDING
La �:',,.,, NORTHAMPTON,MASSACHUSETTS 01060
-BUILDING PERMIT FEES
DEMOLITION S10.00-ACCESSORY STRUCTURE
$35.00-PRINCIPAL BUILDING
* NEW CONSTRUCTION,
$.40 per square foot for the 1"floor
$.20" "2"d floor
$.10" " '/2 floors,attic,basement,garage
INTERIOR STRUCTURAL ALTERATIONS IN ALL USE GROUPS:
S5.00 Per Thousand dollars of estimated cost or fraction
thereof, with a minimum fee of Fifty Dollars(S50).
WOODBURNING STOVES -$25.00
* NEW ACCESSORY STRUCTURES , one hundred twenty(120)square feet and over.
$.10 per square foot with a minimum fcc of Twenty-five
Dollars (S25.00)
* NEW ACCESSORY STRUCTURES, under one hundred and twenty(120) square feet:
$25.00 per inspection
* SWIMMING POOLS $25.00 FOR ABOVE GROUND
$50.00 FOR INGROUND
* SIGNS AND AWNINGS $30.00
* Decks $50.00
REPLACEMENT WINDOWS $25.00
SIDING AND ROOFING-residential
per structure $25.00
Tents $25.00
* ZONING REQUEST FORMS $10.00
* Home Office/Occupation Registration
REPLACEMENT OF LOST
BUILDING PERMIT $25.00
CERTIFICATES OF ANNUAL INSPECTION $75.00 MINIMUM
PERMITS REQUIRING ONLY ONE(1)INSPECTION WILL BE A MINIMUM OF$25.00 ALL
OTHERS WILL HAVE A$50.00 MINIMUM.PERMIT FEES SHALL BE MADE OUT TO THE CITY
OF NORTHAMPTON AND SUBMITTED WITH THE COMPLETED PERMIT APPLICATION TO
THE OFFICE OF THE BUILDING INSPECTOR. WORK STARTED WITHOUT PERMIT SUBJECT
TO DOUBLE NORMAL FEE.
CHECK OR MONEY ORDER ONLY PAYABLE TO THE CITY OF NORTHAMPTON
*Filing Deadline is Wednesdays by Noon
DEPARTMENT OF BUILDING INSPECTIONS
413-587-1240 Fax 413-587-1272