11C-059 x . CE ST - LEEDS SCHO BP- 2010 -1115
GIS #: COMMONWEALTH OF MASSACHUSETTS
£` t apBloc it; 1C - 059 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -1115
Project # JS- 2010- 001637
Est. Cost: $1500.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CITY OF NORTHAMPTON CENTRAL SERVICES 054510
Lot Size(sq. ft.): 217800.00 Owner: NORTHAMPTON CITY OF
Zoning_URA(100) Applicant: CITY OF NORTHAMPTON CENTRAL SERVICES
AT. FLORENCE ST - LEEDS SCHOOL
Applicant Address: Phone: Insurance:
Memorial Hall (413) 587 -1260 0
NORTHAMPTON MAO 1060 ISSUED ON :611012010 0:00 :00
TO PERFORM THE FOLLOWING WORK.- PRINCIPAL'S OFFICE TO TWO
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 6/10/2010 0:00:00 $0.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
File # BP- 2010 -1115
APPLICANT /CONTACT PERSON CITY OF NORTHAMPTON CENTRAL SERVICES
ADDRESS /PHONE Memorial Hall NORTHAMPTON (413) 587 -1260 ()
PROPERTY LOCATION FLORENCE ST - LEEDS SCHOOL
MAP 11 C PARCEL 059 001 ZONE URA(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tyueof Construction:_ RENO PRINCIPAL'S OFFICE TO TWO
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 054510
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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 Commission Permit DPW Storm Water Management
Demolition Delay
4-1-� 1p
Signa a 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.
Version 1.7 Commercial Building PermitMa_y li, 2000
Department use only
City of Northampton Status'ofPermit:
Building Department Curb
212 Main Street Sewer /Septic Availability
Room 100 Vlfaterl Ij Availability
Northampton, MA 01060 Two Sets 'of Structural Plans
phone 413 - 587 =1240 Fa.-413-587-1272 PlloUSite,Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN_A.ONErQR TWO FAMILY DWELLING
- I!
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address iO4 . �?, .._20140..
Map Lot Unit
;Zone Overlay District
J
_.. __ ._. _..,...._ _........... _.. ...... -, Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record
i ..
Name ( �nt Cu rrent Mail Addfess
Signature Telephone
2.2 Authoriz d A t:
Name (Print) Current Mailing Address
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COS'S
Item Estimated Cost (Dollars) to be Official Use Only
comp leted by ermit applicant
1. Building 00 (a) Building Permit Fee
2. Eiectrica! _. (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) `j j� Check Number
This Section For Official Use Onl
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings 1 Date
Version 1.7 Commercial Buildinz Permit May I 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOS S PACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions Accessory Building ❑
Exterior Alteration ED Existing Ground Sign [] New Signs ❑ Roofing El Change Use ❑ Other ❑
Brief Description Enter a brief description here. CA k`M4cT n LUTON, V)Au- UYK'�
Of Proposed Work G� i�L1�J eye„ ,OR W�L - -� 1
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly 1:1 A -1 ❑ A -2 ❑ A -3 ❑ 1A [I
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H Hi h Hazard ❑ 3A ❑
I Institutional ❑ 1- 1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S -2 ❑ 58 ❑
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
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor (sf)
1 St
2 n
2 ntl
are 3 rcl
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 ❑ Private ❑ Zone Outside Flood Zone❑ l Municipal ❑ On site disposal system[]
Version 1-7 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).
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Reglstration 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
AM, Not Applicable ❑
._.
Company N e:
Res onsible In Charge of Construction
Addr
Sig to Telephone
Version 1.7 Commercial Building Permit May 1 -i.. 2000
S. NORTHAMPTON ZOI\ING
Existing Proposed Required by Zoning
This coJumn to be filled in by
Building Department
Lot Size
r
Frontage _...
Setbacks Front
Side L: __ R _.._....__. L . _.,.._ R: __. _._...,.
Rear _...;
Building Height _.._ _._..
Bldg. Square Footage
Open Space Footage ° ( Lot area minus bldg & paved --
# of Parkin S aces _ -- - - - - --
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding eve een issued for /on the site?
NO Q DONT KNOW 0 YES C)
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES
IF YES: enter Book Page, and /or Document #
S. Does the site contain a brook, body of water or wetlands? NO 0 D T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Co ission?
Needs to be obtained 0 Obtained O , Date Issued:
C. Do any signs exist on the property? YES Q NO a
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 N 0
IF YES, describe size, type and location:
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 O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit i`1ay 15, 2 000
SECTION 14- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No Q
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize _..... _. to
act an 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,, _..__. .. .....
PrintName _ ......... .......__ ._....__,_ _._,. _.
Signature of Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor Not Applicable ❑
Name of LicenseHolder l'✓ \`'�"'�^� - -° ____. ..__
License Number
ress Expiration Date
1 bl
ig r Telephone
� CTI 13' -W RK S' COMPENSATION INSURANCE AFFIDAVIT (M.G.L, c. 152, § 23C(6))
Work s 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
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