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17C-245 w. a Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- ,STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, AmGY 17ar /A _ .,q., , as Owner of the subject property hereby authorize ill)/ o/ _ . `to act on my behalf, in al tters rela ' Y work authorized by this building permit application Vi Signature of Owner Date I, / s �.._, //4 _..__. , 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 per uDt �._._. .�... M ...._ _F.. _ .... �. ... Print Name -- 4 0/ 00 0, Signatur: • ♦wn-Agent b ate SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction �� Supervisor: ,►y� Not Applicable El Name of License Holder : ,...!g17E5., _. 0411 /�`' ' _ ._ CS ..w.._ t7��y - License Number S S / ) 1 f 4 ' s r z 7 T r &►/! Address Date Signatur 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 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: _ ...._ ...._.m___ 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 Registration 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 17 y� +te 11;� ! /�al - x Not Applicable ❑ Company Name: Responsible In Charge of Construction Ork.'s rna r Address S�3y6s3 '... Signature Telephone • Version1.7 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 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 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 (3) 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 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 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. & f Ai/ ,3'i C J' „ ) , kec,, p/c h s n, /E ficf 't _ Of Proposed Work:: A� ZNO p 'luc. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B . r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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 ❑ 5B I ❑ 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: 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 st 1 st , 2nd 2” d _ . 3rd 3rd ._ . _. ___.._,._____. _.___. _. _..�M...._ , 4 m 4 th . 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 Zorie,lnformation: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zoneo Municipal El On site disposal system Versionl.7 Commercial Building Permit May 15, 2000 * De ment use and ti City of Northampton Statu �e p - gig 6 ' ,I, Building Department 9 P �rt��Ck�E�1��w�y Pern�� �� i �� - 212 Main Street SewerISepfi A a ilabttO,, , LO�� Roo 100 INMOr lell Avatiabitity ; � P\\( 2 Northampton Fax , MA 01060 413- 587 - T wa;. S "e s at St rtie t r atPfans ..� ,:. phone 41?11272 . Plot/Site Ptans ,S Other Specif t . N TO CONSTRUCT, REPAIR, RENOVATE, OF, RENOVATE CHANGE THE USE OR OCCUPANCY OF ,.,..,; APPLICATION 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 4,65 /� N. M�91 AJ Map 6 Lot Unit 1 ' Zone Overlay District Fro 4'4"/ f e 1 /11,q .: -,- - - _._ _ --- EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) 31 Oc n"1 C S 6 ii t " ""x Current Mailing Address: Signature Telephone 2.2 Authorized Age . Name (Print) joci »lc J to i 1 '< Current Mailing Address Signature . ' I Telephone pry „. _ .__ ...w. SECTION 3 - ESTI Ii CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant C .. 1. Building \.,/' `%� __. (a) Permit Fee CS 2. Electrical 9 — -- -µµ'µ w (b) Estimated Total Cost of c Construction from (6) _. ......_ .. ... ... .. .. .... 3. Plumbing /0 0 ✓� ° Building Permit Fee 4. Mechanical (HVAC) _.._ ..__,.._.. .. „..,...- ...__ ,, ,. _-_ . Ss 5. Fire Protection �'" "'�'" ' - " " "�' 6. Total = (1 +2+3+4 + 5) , 1 Check / Number 'y 7/ 45 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date . • File # BP- 2010 -1078 APPLICANT /CONTACT PERSON JIM MAILLOUX ADDRESS/PHONE 55 MAIN ST - 2ND FLR FLORENCE (413) 563 -4654 O PROPERTY LOCATION 85 NORTH MAIN ST MAP 17C PARCEL 245 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out t�y y.,�,� Fee Paid / / / f ctc Typeof Construction: DEMO 2ND FLR REAR APT BATHROOM EXCEPT CEILING & UPDATE ELEC /PLBG New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 081694 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 1/ 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 61i/i Signa e of Building Official Date g g 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. BP- 2010 -1078 GIS #: COMMONWEALTH OF MASSACHUSETTS {;. s 1v- 45 :41 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2010 -1078 Project # JS- 2010- 001582 Est. Cost: $1750.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JIM MAILLOUX 081694 Lot Size(sq. ft.): 15681.60 Owner: MAILLOUX JAMES Zoning: URB(100)/ Applicant: JIM MAILLOUX AT: 85 NORTH MAIN ST Applicant Address: Phone: Insurance: 55 MAIN ST - 2ND FLR (413) 563 -4654 0 Workers Compensation FLORENCEMA01062 ISSUED ON: 6/1/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMO 2ND FLR REAR APT BATHROOM EXCEPT CEILING & UPDATE ELEC /PLBG 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 6/1/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo