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17C-228 • • 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 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, f V\ / PQ€610fAT or � w' J! ', as Owner of the subject property hereby authorize •0 / 1A �KtOy (Q r 7 i rcl Ito act on my behalf, in all _ t• rk - thorized by this building permit application. ilPir / a ri a , Signature of Owner Date I, i c t � , as Owner /Authorized Agent hereby declare that the statements and information orl the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perju <--- c_ k , Pt d -12.1 1 Print Name ( VIS 1 ) Signature of r/A e t Date 9 9 SECTION 12 - CONSTRUCTION SERV ES 10.1 Licensed Construction Supervis r: Not Applicable ❑ Name of License Holder : 'A© S eT' ' — — ri. G' / L icense Number 4 S Ak. t S tit-N- 4-) te L 1.6.11Y r — t- _ Address Expiratioh Dat Signature t/ Telephone SECTION 13 - WORKERS' CO PENSATION 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 Versionl .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 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 Not Applicable ❑ Company Name: Responsible In Charge of Construction S 3_ S. V&A - ( o Address Signature I I qn Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING O Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage .a 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 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 Q DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES ® NO Q 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, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 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 D Additions El Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. R4c -A-c ( *) - 00 - 14)4- ` 35 - 45 Cl) 5 °L°'" t-L116 t 5 ' Of Proposed Work: ( ILl) (Z) P► z —c� Rxr9 tNt441 -- x SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 El 1A I ❑ A -4 ❑ A -5 ❑ 1 B ❑ B Business 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 El 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 El 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 st 1 2 nd 2 3 rd 3 4 th 4th 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 Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15, 2000 RECEIVED , Department use on ly "' °,. City of Northampton Status of P ermi t , . 1e . t . aM DEC 2 8 2011 Building Department Curb Cuf/Drivewa�y Permit ` `�' 212 Main Street S�we�lSeptfcAyatlabi�ltty �� T � d � ��� i 1p�q � � �,� 4 ti Pr y . °."A w k d a i� Room 100 1Wtater/ Well Availability ; DEPT. OF BUILDING INSPE CTION Northam Two Sets of S ructU I Plans °" �' ORTHAM p PTON MA 01060 p , N hone 413 - 58 7 -1240 ton Fax MA 413 - 587 -1272 1060 P P lans Other S 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 P _._. 0 1(.1-. J- $ T Map Lot Unit FL t W(L M A 0/06 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Q� (A) - c- 3 � I At t 4- ►9l-fc , e 'er Name (Print) Current Mailing Address: '`I l 3" 5' G- 1G It- Signature I I / 9 Telephone 2.2 Auth • rized Agent: � 4 Y ' S, k -41-47-3 t 3 5 - A - ST• 5u DGt C D Name (Print) C urrent Mailing Address: Signature Telephone ,.: SECTION 3 - E MATED ON ST CTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ( 2_1 01)7., (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 0 6 (b) from (6) s 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection /___ 6. Total = (1 + 2 +3+4 + 5) I 61'1) Check Number $ lQ r This Section For Off Use Only Building Permit Number Date Issued Signature 4111e Bu'!' /Inspector of Buildings Date , 24 NORTH MAPLE ST BP- 2012 -0603 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 228 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- 2012 -0603 Project # JS- 2012- 001046 Est. Cost: $16000.00 Fee: $96.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SACKREY CONSTRUCTION 040714 Lot Size(sq. ft.): 5096.52 Owner: J W INC Zoning: GB(100)/ Applicant: SACKREY CONSTRUCTION AT: 24 NORTH MAPLE ST Applicant Address: Phone: Insurance: 83 SOUTH MAIN ST (413) 665 -9995 () Workers Compensation SUNDERLANDMA01375 ISSUED ON:12/28/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 4 REPLACEMENT WINDOWS, 2 SOLATUBES, CONSTRUCT 2 PARTIAL WALLS,REPAIR STAIRWELL 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 12/28/2011 0:00:00 $96.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner