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38C-026 y , Version! .7 Commercial Building Permit May 15, 2000 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 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW O 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 i IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO O IF YES, describe size, type and location: E. WII 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 © NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. C. Version1.7 Commercial Building Permit May 15, 2000. SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign 0 New Signs ❑ Roofing Change of Use ❑ Other ❑ Brief Description E rater r a brief description here. Po rhv"`-5 04" ; 1(11'1 I I - , - C ` - Of Proposed Work: R fr , a , va 5 � 5 14, ; n S 11,,,(1,2,4w- 5 d 1 o L - U �'1 ,, y SECTION 5 - USE GROUP AND CONSTRUCTION TYPE I USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly CI A - 1 ❑ A -2 ❑ A-3 ❑ 1A 1 ❑ A-4 ❑ A-6 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 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 I BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 * 1e 2nd 2'"c 3id 3 4th 4°i 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 ZoneD Municipal 0 On site disposal system[] RECEIVED - versionl.7 Commercial Buikline Permit May 15, 2000 Department use only I NOV — ZOU C y of Northampton Status of Permit a r w B ilding Department Curb Cut/Driveway Permit t .ORTM BUILDING INSPECTIONS ON, MA 0110 0 12 Street Room 100 SeweriSepbc`Availabilit 1NaterNVell AYafilaBility' Northampton, MA 01060 Two Sets ofSlxuctiiraf 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 I 1.1 Property Address: This section to be completed by office 33 Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: IL-) a. n t L vv P0 L� S r1 fk-� s cs,-1 . r Name (Print) Current Mating Address: y� Signature Telephone l 3 2.2 Authorized Anent Name (Print) I ( w..., 11^A1 J • ` y Current Mailing Address: ?) I 1 1.,.5 424 Giv `; Signature "'" Telephone .7 Y oa SECTION 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 7—' " (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) X - 1 04 ' Check Number l ` co 15 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date 335 SOUTH ST - BP- 2012 -0441 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38C - 026 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 -0441 Project # JS- 2012- 000713 Est. Cost: $4700.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TIMOTHY J LUCE 100515 Lot Size(sq. ft.): 7492.32 Owner: POLACHEK DANIEL W & TRACEY G Zoning: URB(100)/ Applicant: TIMOTHY J LUCE AT: 335 SOUTH ST Applicant Address: Phone: Insurance: P 0 BOX 14 (413) 387 -9800 LEEDSMA01053 ISSUED ON:11/2/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE PORTIONS OF 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 11/2/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner