17C-259 ,
Versionl.7 Commercial Building Permit May 15, 2000
,
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) "
p
Independent Structural Engineering Structural Peer Review Required • Yes 0 ` No 6
SECTION 11 - OWNER TO T
- AUTHORIZATION !BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR AUTHORIZATION BE BUILDING TED PERMIT
I, _—v Lt __ ... _ , as Owner of the subject property
hereby authorize I . _..__-1 t<m L_ v `c
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 at 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_ofierjr ,_ .._ . .. .._ _. . _ ...m_ ,- ... ._.,,
Print Name _ _______ _
/„.....%-----21----7-------- trerFaf of Owner/Agent r /Agent Date
1
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder .. t . ' :27:.,1"....4...._........___...... . . -'� h 0 5 7`
License Number
;..
Expiration Date
__ u_3_ IxG�
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 build' permit.
Signed Affidavit Attached Yes No
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): -- , ----- •- ---- -- -
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 Ristration Number
Signature Telephone Expiration Date
_ __—
Name _,, . _-- __ Area of Responsibility
__. _ _. _
Address Registration Number
-
Signature Telephone Expiration Date
Name Area of Responsibility
Address .._. Registration Number __ _.. ,. ._._.____.._.
I
Signature Telephone Expiration Date
9.3 General Contractor
L.t _ , L � ._ _ _ _ _ "_ _ Not Applicable ❑
Company N e:
Responsible Charge of Construction _
Address_ _
Signat - �� "� Telephone
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Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning .
This column tOre filled in by
Building Department
Lot Size __,_ - ' L ._ ------ _
Frontage
Setbacks Front ,
Side L. ,_... R:- L:: , , R__ .:
Rear __._,. l
Building Height r__ T
Bldg. Square Footage ... % _'__
Open Space Footage % (Lot area minus bldg &paved
parking) �__._._....
---J
# of Parking Spaces •- ---'
Fill: ._W._ °__. � �y�...�.,..__..�..
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 t Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:.
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 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 Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 t
CUBIC FEET OF ENCLOSED SPACE " -.,
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ ditions ❑ Accessory Building ❑ (
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofin Change of Use 0 Other ❑
Brief Description 'Enter a brief description here. z
Of Proposed Work:
L _J-€0-4 , - o -c_ i /
SECTION 5 - USE GROUP AND CONSTRUCTION TYP.
USE GROUP (Check as applicable) I CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 El I 1A I ❑
A-4 ❑ A -5 ❑ 1 1B ❑
B Business 0
1 2A ❑
r
E Educational ❑
❑ 2B -
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H - High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ I 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ I 5A ❑
S Storage ❑ Si - ❑ S -2 ❑ I 5B ❑
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
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
4
1 i
1st .._,,..(
2nd_. _ _.....__,_._. _... 2 nd
3ro _w..__ —__ - . _ ..... —,
4' _ 4 � .._._ __ ____ _ _ __
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft) _.._...__. _H ...,.._.._..w,_.
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public El Private ❑ Zone _,_ _ __ M , Outside Flood Zone❑ Municipal ❑ On site disposal system
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Version1.7 Commercial Building Permit May 15, 2000
';„,... 200 ;: ... ; 44:;.44,1% : ; : ; , ; . , .i. ,y, -.,r;• ;z:,:: -'-or ..v,..%.4,w7
RECEIVEDuildin Department
OG1 ,,,, , "':-.S 7 ' ,› :,:le '; ' ,,• ', '''; ,'• ':''''t:=•I#,tf;'Ariri•tM.tttkrMV•Vt•fq
12 Main Street
- 7 2OR ' ,, :‘, ,,,,,,,I,,,,,
',' - star vt: .
Room 100 4-. - yz. - -..„:::z4,r,;;;iii,i;,, , ii!,i;i;,,;:;',':% - ,,;;;VAt
ort ampton, MA 01060 ,,,T'tL
a II • I - ' - ;7-1240 Fax 413-587-1272 AiiCit.i.,iiilAitii--;:;-.5,24.1figll',ZW;r:)SiziegKZ',Z
, ,.• . OF : MING INSPECTIONS
NORTHAMPTON, MA 01060 ' i7ti ' lu'''''` 4 6 )44'4441 t' !ff#0
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:
: Map Lot Unit
( g No c_11..). AA A_ % „,, 3 4 il-ce- •.-+ ; -
Zone Overlay District
FLt•A .A,,,, c, , / 44 -
_ : -
.-- ----- --% — --- --- - ---, Elm st pistrict CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
' r)/ 6 NO tthi FA/L."3 ik . /1440t. , A
Name (Print) C A) Lt, c E:-.. Current Mailing Address:
___............_ __________. .....,_____ , „.......... ......_ , ,
Signature _2YfYle9(.451Nd GP -4-4 : -< : - . 1?-. . Telephone
2.2 Authorized Agent:
--- Tyvt. --- ; ---- -- , --
I --- ........._
Name ( rint) Current Mailing Addreas:
Signaturr _ Telephone •/) 3 ri"j :', iieD ----- — --
SECTION - - 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
, ...... ......._______,
.... ,
1. Building ,..--2-1.-,,.._,
6 7" - : (a) Building Permit Fee
1 • ' ,
, ;„,,„,,,.....„.„.....„...___„..........„.._ .
2. Electrical . ' (b) Estimated Total Cost of
= Construction from (6)
............
3. Plumbing - 1 Building Permit Fee
4. Mechanical (HVAC)
_ .,.. .... _ ..... „, .... ., _ „_
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) , C. -,
T 1 4. V Check Number 4 0,.55 —
This Section For Official Use Only
Building Permit Number Date
.. Issued
Signature:
Building Commissioner/Inspector of Buildings Date
.1w •
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68 NORTH MAIN ST BP- 2012 -0359
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 259 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0359
Project # JS- 2012- 000582
Est. Cost: $5900.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIMOTHY J LUCE 100515
Lot Size(sq. ft.): 15333.12 Owner: LUCE GORDON R & KATHLEEN
Zoning: URB(100)/ Applicant: TIMOTHY J LUCE
AT: 68 NORTH MAIN ST
Applicant Address: Phone: Insurance:
P O BOX 14 (413) 387 -9800
LEEDSMA01053 ISSUED ON:10/12/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP,PLY & SHINGLE ROOF
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 10/12/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner