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31B-267 (2) Versionl.7 Commercial Building Permit May 15, 2000 J SECTION 10 STRUCTURAL PEER REVIEW (780. CMR 1 • 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 1, (...?"3.-e/ . —e/ . ... _ C. �.__ _,4-%, _ as Owner of the subject property hereby authorize.' _- _..... ...... .,q..– ....... . .._..._ act on my behalf, in all matters relative to work authorized by this building permit application. _ 1______ Signature of Owner ;.i Date --- ,/ - I, _ m.4 1 I? . l4� I ' . / - ______ _ , as Owner/A horize• gen ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge a elief. Signed under the pains andsenalties of perju W ,EirA _ it _..____ _ _. ._.. __..,. Print Name --- . /Ai (7 ) Signature of 0lA n Dat SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable El _ __ Name of License Holder ........,_ , 4.� r G 1.Gli � . . ...____ .. -.... . ...�..�.....- ... . _.. _._. ._._.- License Number w_ _ C eCal Hsieh v / 6 o7� ! d . .y / Address Expiration Date ! — Y: -,...1 -,M... ' Signature Telephone gte.......r 1 -i I I /.. J 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 CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: S7 —57 The debris will be transported by: D. l,,), Cam[' L. ,c The debris will be received at: FA j2( yc_ f C- compsaR Signature of ennit Applicant Date r is Building Permit Number: Versionl.7 Commercial Building Permit May 15, 2000 4 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 EISLOSED SPACE) 9.1 Registered Architect: F Not Applicable ❑ . ti p D o v 49 1. Sq 44 Name (Registrant): _. _. , - Registration Number I1Co PLEAS AN 5 NoI2�N -tot,/ _ g 3) I�. ____ __. Address _ _..._.__._....__.,.__..,._ 1 " /� /1 / r y O 6 41 Expiration Date Signature �/ Telephone 9.2 Registered Professional Engineer(s): J PIKE S MITN P 1 S 7t2ub-rvr2PiL Name Area of Responsibility 8 G O A c C 5 ( ..__._. _._ t: PEES-Fir-443 .__ MA .r i 1 4'3- 4.36 Address Registration Number 413 6(05 4 to►_� . Signature Telephone Expiration Date m Name Area of Responsibility Address _ egistration Number _ R ...M. Signature Telephone Expiration Date i Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date ...... --^- , r __.._... _ Name Area of Responsibility I Address _ Registration Number Signature Telephone Expiration Date 9.3 General Contractor _____ t Applicable ❑ Company Name: 4 _ _. Responsible In Charge of Construction Address C Signature ) ' Telephone 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 . _ {._ ._.�.__.._...__. Frontage o... _. .(Qa _. . _. _ Setbacks Front 14' Side L , 2e 7 : R ` i L: ..i R: : . Rear T Building Height t. l Bldg. Square Footage % "' " : Open Space Footage % -- Lot area minus bldg & paved parking) # of Parking Spaces i Fill: (volume & Location) — A. Has a Spec'al Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: ' IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW YES 0 _ IF YES: enter Book !! Page and /or Document # _..._____._ _ . B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES . 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 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 Q . "?_( ......' IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exca ion, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .,.,, Version 1.7 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 • 0 Demolition W(Repairs 0 Additions 0 Accessoi Building 0 1 - Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other 0 Brief Description Enter a brief description here. 104_,e_ ba ,84c.,4.. , Of Proposed Work: if - AJ ', C-4/ 4 ) 4 - coA•Lee& 54 :- -' ..._ SECTION 5- USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable)_,,, CONSTRUCTION TYPE A Assembly A-1 0 A-2A p A-3 0 1A I 0 0 A-4 0 A-5 0 1B 1 0 B Business 0 2A 0 E Educational 0 2B - r 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 _ __ _ 3A 0 1 Institutional 0 1-1 0 1-2 0 1-3 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 LP' .._ , U Utility 0 Specify: M Mixed Use 0 , Specify: S Special Use 0 Specify: 1 , . — COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE .. Existing Use Group: 7TAT: " 4 - ', — ____.: 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 1131/ _ _........___ _ __ 3 3 , 4 - ......,........ .'. fff'ff...*--...-■.........f.fff-ffff'ffff h Total Area (sf) 205 ----- —7 Total Proposed New Construction (sf) Total Height (ft) '7 1 Total Height ft . . 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zpne Information: 7.3 Sewage Disposal System: Public 0 Private o Zone Outside Flood ZonelD Municipal 0 On site disposal system El Version1.7 Commercial Buildin. Permit May 15, 2000 Deartme't1 oriT , �eGe City of Northampton 9 ' < .. uilding Department , ; � � �J 212 Main Street Se des a Ig � �, gal ova os Room 100 rlai i z c3� orthampton M 01060 T °`' : N one 413 - 587 -1240 Fax 413- 587 -1272 Js lo is $ � � ' APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THEJ IsF OR "i7CC:I IPAUCY OF. OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO :AmILREGEsivED SECTION 1 SITE INFORMATION kI 5 5 i0 � 1.1 Property Address: This s Ic io gip omp eted by office iJ ( C �" ,i� / IMF DEPT. OF BUILDING U4RcTIONS _ Unit � C NORTHAMPTQN, MA 01060 C `J ; Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _ ,_1 ) ^fie SA, L Lt~ . _ 6 S $ $i.. .._ PO ` � Name (Print) Current Mailing Address: Signature Telephone 2.2 Authorized Anent: Name (Punt) Current Maili Address: _, . 1 Yf i X577, _ ` fir _ ___ _._ Signature ►� Telephone `— y, -7 �Y�© SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building I (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) ________ . 3. Plumbing i Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Only Building Permit Number Date Issued ... Signature: . /75— it ing A of Buildings Date 57 CENTER ST BP- 2012 -0479 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 267 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit # BP- 2012 -0479 Project # JS- 2012 - 000490 Est. Cost: Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J C PRATT BUILDERS 061401 Lot Size(sq. ft.): 6011.28 Owner: CENTER STREET LLC Zoning: CB(100)/ Applicant: J C PRATT BUILDERS AT: 57 CENTER ST Applicant Address: Phone: Insurance: 43 MONTGOMERY RD (413) 568 -4246 0 S O UTHAM PTO N MA01073 ISSUED ON:11/16/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH BACK SECTION & SLAB 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 11/16/2011 0:00:00 $200.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner