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32C-260 (4) 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 r No It SECTION 11 - OWNER: AUTHORIZATION - TO BE COMPLETED. WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, LA!"-. S ._4 �! _ __. _ d . _ _. ._ _m .__ _ _ M....., as Owner of the subject property hereby .1 hor¢e ._ 1 .0 �`'� J_ :::: sr . / iv: o work aut . y this building permit application - . Owner � D to __.._.._.__._._. , as Owner /Amitf4erircd 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 un. er •, - _. -'f d enalties o lei . Print Name _ __..__.__ _ ___ t ( $ ' (,(- lb 24 t 1 _. _ -- ___._.__ --___w ___ „.W Signature of Owner /Agent ate SECTION 12 - CONSTRUCTION: SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder . l ..- `!l ` ____ ._.. C5.7119 C7 License Number . D ' 5 12•D D r4 Fi b 3 � cL4*k ol3©1 Address / Ex iration Date !-- Signature Telephone j: • i SECTION 13 - WORKERS'; COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) '` � . J 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 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 E IJsLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): -. Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name w Area of Responsibility Address Registration Number Signature Telephone Expiration Date i I • I _, Name Area of Responsibility Address Ristration Number I ; Signature Telephone Expiration Date Name Area of Responsibility Y Address Registration Number f Signature Telephone Expiration Date Name Area of Responsibility Address_ __ _ Registration Number ". Si Signature Telephone Expiration Da � "'�__ ___.... ._._._. „„ ,, 9 P P to 9.3 General Contractor _,...._..____ _” __.. Not Applicable ❑ Company Name: Responsible In Charge of Construction Address -_ 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 M�..} r a _. Frontage .. Setbacks Front Side L w I R L: R: Rear _ _. Building Height Bldg. Square Footage 4 % wyr Open Space Footage % m (Lot area minus bldg & paved _ ... parking) r I t 3 4Z # of Parking Spaces ` Fill: (volume & Location) — -- A. Has a Special Permit/Variance/Finding ever been issued for /on the site? NO 44 DONT KNOW 0 YES 0 IF. YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book Page, and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ►44 DONT KNOW Q YES Q 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 10 NO 4� 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 * # IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, exc- vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO "4 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 > �,r f CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building, Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing El Change of Use ❑ Other ❑ J Brief Description ;Enter a brief description here. -,, Of Proposed Work = nr'I , be. t •- (y 8 }�� SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ -- _ 3A I ❑ 1 Institutional ❑ 1 -1 ❑ 1-2 ❑ 1 -3 0 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: r-- 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): `. „_ _ __ i SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ,ONLY _,BUILDING s ) CMc Bt (5-) Floor Area per Floor (sf) 4 1 2nd 2 ___ ____ .__- ___. -_ _ ___..__ ! 3 3`d ... - Total Area (sf) 6d Total Proposed New Construction s ._.. 2 -_ t - Total Height (ft) 114.- y f Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewagepisposal System: Public Private ❑ Zone ____,___,, Outside Flood Zone,, Municipal On site disposal system Versionl.7 Commercial Building. Permit May 15, 2000 f a — , ,, D„,„ Olt Use on ' 4 Cit of Northampton ; t - 18 2 0 Building Department 212 Main Street pe aeilt VZZAWAr. ., Northam of vs t om �° Northampton, M A 01060 „ ® e . ' a ®i I s� i . te p � ���`� phone 413 - 587 -1240 Fax 413 - 587 -1272 r Y � 24 v ° lathe era 'Fx ,'c ° ! d r 1 fr '.1',,,,64--t4;':,,,-- 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 1.1 Property Address: This section to be completed by office 0 �Ql k.> -O ( --nn_ i _ _. ` Map Lot Unit 0 ( 06 Q Zone Overlay District a __.W..:...e..:_...__ _ ..._ —.- "' Elm St: Districti CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: . ___ _ . . _.E..5 '..H.. ow' P .� $ .J 1k; ( Pat c - Lfo(�q— h Name (Print) fCurr nt Mail Addr 1 ! / / 1 / f � ,� . ... __�_ Signature , - Telephone 2.2 Authorized Agent: Name (Print) Curr nt Mailing_Address: }_ 41496 .� _0131) ' __ _ Signature - Telephone SECTION 3 - TIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ®QC) I (a) Building Permit Fee 2. Electrical (b) Est Total Cost of cell) . 8' I Construction from (6) _._._ ___ ._ ........ ........ 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) — .*; pl t A 5. Fire Protection - .. -.. - - _ __ ..._. . .. 6. Total = (1 + 2 + 3 + 4 + 5) l Li + 5 00 • 00 Check Number Q 15 This Section. For Official Use Only Building Permit Number Date . Issued Signature: ._,1 ..--_-9 /////ii Building Commissioner /Inspector of Buildings Date • File # BP- 2012 -0503 APPLICANT /CONTACT PERSON GREGORY J BROWNE ADDRESS/PHONE 335 ADAMS RD GREENFIELD (413) 687 -1666 PROPERTY LOCATION 90 POMEROY TER MAP 32C PARCEL 260 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fe.. Paid :uildinl Permit Filled ou Fee Paid : - -- —. ✓� . r —� -- - -- - ; , v — — - — - - - -- - -- — -- - Ty_peof Construction: CONSTRUCT DET 1 CAR GARAGE New Construction Non Structural interior renovations _ Addition to Existing Accessory Structure_ Buildin . Plans Included: Owner/ Statement or License 76573 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION 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 • / ,12% /( Signature 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. 90 POMEROY TER BP- 2012 -0503 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 260 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: GARAGE BUILDING PERMIT Permit # BP- 2012 -0503 Project # JS- 2012 - 000841 Est. Cost: $15500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: GREGORY J BROWNE 76573 Lot Size(sq. ft.): 23304.60 Owner: MUERLE LINDA Zoning: URC(100)/ Applicant: GREGORY J BROWNE AT: 90 POMEROY TER Applicant Address: Phone: Insurance: 335 ADAMS RD (413) 687 -1666 GREENFIELDMA01301 ISSUED ON:11/28/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT DET 1 CAR GARAGE 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 11/28/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner