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18D-004 (46) ___ __ sm....P-4 •-■..- -. .. ... . .... .. ....... .... - ... ' 11 / . , t oli l Or . " 1 r 04 gi • - 4f i 9' c..4.\ • S ' l • • :0 ` ■ Et fitrirrrna "4TPTIng . % .... . 1 • . 42 • 0 ..,%-,:,, "'..! 'IK'°'\.\ *%. 40 0 It , T i Siz " .. nw 4 • od tt *fiuTPrin: I \ \ 1,■/ ,,: 4•:,.. ..4., \ , / .1v ;t '.. k / •k. 0 . st, et.....,...._ \ , o \ ' h? T, l 1 :. ■IN C N. v. i. ‘ ,t %.7 At A4 AT I ir / gi 4 4 4 / ; 1 4 a 41 4 1 4 A A k " 1 ": / 5 t • : i ‘o , ‘ \ lkit ■ L '11 N . ueid .eliS 014 OVA r ■ liSita opyraUfia kJ 4 Pi' 4 ; ■•= 0.110........... 011.111.°11111.°) .r...■....—..m.-. ----.0,r,----.-....,.— Td WdIT:80 :700 CZ '1:::17 : 'ON Xtd : xa � ^ � � ` ' f . � ' ~ � ------------------�------------ ---~- -- - -- '-` '-�- - -- ----' '�-------�---------- - --- � ' . � ` .� ' . . � . * ^ ` | ` � • '- - � ! '. � _ 4 ` ~ . ` ' � 4 � ^ ' ` ii2400(- 1 - (as-O c 4,'5 94 -4 1 4 4K4 �i Cfralie , 2-'03 kl - t 311 ---i otA, R,;F; --.7-----,0,,' T ,... ,.....,..,....... ,..... e_de.,,,„ 1(0-4m- , .... f4. grA-1 iz S 7f51 4 t m, 1: „__ L � .L,,., - V, F:po \ erfat .. o Rs-i L f l 11 i p©01R Go TT L __—_- Go TT e: Gkra Do P - ,.: tv A-t-c_. 'T VOO F oi p4 --r cf-fx4 Por wcL-L . , ttAJd p J, / .. • R�° e ` °tip (f ii12 of llcr�;tljailtpton 0 ' �— gS E ��c�antEJnztlla' _ _ C DEPARj OP BUILDING INSPECTIONS • — 212 Main Street ' Municipal Building Northampton, Mass. 01060 r' WORKER'S Z'S COivITDNSATION NISI RANGE Al <T'D)Ax!17' ..,t ee-71---e.-e----7-c- 1, : Lot-(iril__ . ( lceuscx/permittcc) 24t h - p- 1=6 ci-p-aJ pla_.,e- afi -b-u -s -neuL -res i d en-Ge -mot :— _ (phone; =) — - (sar.„ ty /statc/a p ) do hereby certify, under the pains and penalties of perjury, that ( ) ram an employer providing the following 'orkcr's compensation coverage for my . employees worinng on this job: (InsurIo= Company) (Policy Number) (r Tin: on Dair.) - ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's co> pensadon policies: (Name of Coucmcro-) (Insurance Company /PoLlci Nunib ) (Expiraucn Date) (Name of Contractor) (Insurance Comany/Policy Nuroter) (Expu-tion Dale) . (Name of Conrraclor) (Losuranc compan Number) (Expirdou Date) I (Name of Contactor) (Insutaa Company/Policy Number) - (Ex Darr) . (much ..4dihcc_t.! 6.e. irnecazary to Cncka& inform..oc partaini.ns to all o —. ora) - . *a I am a sole proprietor and have no one worl;3-ng for me. ( ) I am - home owner performing all the work myself. NOTE: piex be aw11C tb.4 wiJC 6omcowocn wbo czaplay pezotu to do z ors.:e,1 e tcpair..-ork on a dwdli of pot tacce t t. t=tJ to wbacEt the botnoowocr rctid of oo the p- j., appt:rtca-rt tber-.n t wt c-mc-.11Y oeerd.-oi In be erployv-s nn,', ttho vn:o ce: c. --iie An (GLI $ 2ss 1(5)). o- pptiatioo try a bomeoax Ica c lice = of pert( rr_y e.-idcocc the It-5tJ rt < of as aracployor under tlro Worircla Coa$om+.lioa Ant_ I uodcrrtand dad a Dopy o(thi, mr.®coa clay be for-..nrded to tbo Dcportmocat of )n '.rriJ AsodcaU' 0-Moo of lranr•000 for t.h. covm.h -c Ycirtiioo a-nd t .t Lib-7c to scout:'cover.t c trader section 25A of MOL 152 ctn Ied to the impco2ioo of cirniasl pcoaltint oncoming of a arc of tap to 51_100.00 .nd/or iraprisooroczat of up to con year rand civil pc: mania inth form or. Stop Wort Otde and ' fim o(S 100.00 a day again t_ For dcputm� s1 u'° only pomit Number t up:% —_ Lot K S ipaatun of Li<xnscefPenniuce Date . ...- - - - Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (700 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No ( 10 SECTION 11- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPUES FOR BUILDING PERMIT I. wi !... 4 1 fr9 in 1 as Owner of the subject property hereby authorize — to act on my behalf, in all matters relative to work authorized by this budding pennit application. /1!,(24k4r 0, Signoras of Owner Date 1, i /0,426 „ /120k 1 . 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 beief. SkIRMLNOWIIMRI&LKidof12Orturlf, _. L_. : Print Name frt 6 ill 9• 0 9 0(1.---ic i _... __. Signature of OvaredArnt Date SECTION 12 - CONSTRUCTION SERVICES I 12,1112marsmnazukawder: Not Applicable 0 BIMISITIMMMaiteklei : LUX - -----._._._....o.c2 . .. . . .. ! cs oricaerts license Number L . A ..JUI.ISOk.X.Atill f._ ‘ Cotraik. wil\-. 'v340 1 _ L_ J0057 • i to Expiration Date ek, __ C -.) 1 • Telephone SECTION 13 -WORICERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L C. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this appication. Failure to provide this affidavit will result in the denial of the issuance of the budding permit. Signed Affidavit Attached Yes 0 No 0 Versioal.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 I ____ ___._ _ _ la Not Applicable Registration Number Address (.._ [ I Expiration Date Signature Telephone _ 9.2 Registered Professional Engineer(s): N L _ _ 1 Name Area of Responslb8ty __ - -- _____ _ _.____.._..._____.._ __ 3 �__ Address Registration Number i _. _. i L___._-.____..__. Signature Telephone Expiration Date 1 Name Area of Responsibility Address Registration Number i.. _ .I L ___ _ _____ ________ _._.____ Signature Telephone Expiration Date I__._ Name Area of Responsibility Address Registration Number Signatue Telephone Expiration Date S i Name . Area of Responsibility ___ _ -.__ — - -- -__ __ . �_ . _- i._ _._ ___ _ Address Registration Number Signature Telephone , Expkation Date 9.3 General Contractor — __ - - — _. Not Applicable . Company Name: L .______ .____.._._-___. ____._._.__ _.___..._.. __._.__. _. __. -.___� Responsible In Charge of Construction • Address . ____._ f Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING I Existing Proposed Required by Zoning This column to be filled in by B Department Lot Size Frontage L I 1'7 iL1 Setbacks Eagg r i LP/"..fi q ak LEIE R:[111.1 Liii E 1 Boa r-- Building Wight g3-1 , _ [II] Bldg. Square Footage % Open Space Footage ..,. (Lat area minus bldg & paved i: { t pawns) # of Parking Spaces L Fill: (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW (3) YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES IF YES: enter Book Page j and/or Document # [ B. Does the site contain a brook, body of water or wetlands? NO ir„. DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Heeds to be obtained Obtained Q , Date Issued: ] C. Do any signs exist on the property? YES 17.41 NO IF YES, describe size, type and location: 1 DC AD iff eTI:50Vdr D. Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: I E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that w disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version!.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 Will Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other • i i f Brief Description 'Enter a brief description here. 0 l+ ./, u L D �► C0�c? U �5 �� 6... 3-4 i in - f o , ,, a p _ SECTION a - USE GROUP AND CONSTRUCTION TYPE I USE GROUP (Check as applicable) CONSTRUCTION TYPE A Amy ❑ A -1 ❑ A -2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 18 ❑ B Business ❑ 2A Ja E Educational ❑ 2B ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Iinstitutional ❑ I-1 ❑ I -2 ❑ 1-3 ❑ 3B ❑ M MercarrHe ❑ 4 ❑ R Residential ® R -1 ❑ R -2 ❑ R -3 [ia 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 58 0 U Utility Specify i M Mired Use ❑ Specify: [ S Special use 0 specify: r _ _._.___. _.._._._ __.__..____......_...._. _... _.... ' COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: r _ _._ Proposed Use Group. _ Existing Hazard Index 780 CMR 34): [ — _. - . 146 ------ _ .. _�. 1 Proposed Hazard Index 780 CMR 34): 1_._ _ q ______— _ _.._ __ SECTION 6 BUILDING HEIGHT AND AREA , BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 1 _ E ...___.._ __.__._._._ n __ ___ l 4 l_ __ ___..._ -._.__ _ 9 Total Total Area (80 Proposed New_ Construction (sf) . Total Haight (ft) Total Height ft i__ _ - ___ 7. Water Supply (M.G.L c. 40, § 54) 7.1 Flood. InformatIon: 7.3 Sewage Disposal System: Public ® Private ❑ Zone _.. _ __ . 1 Outside Rood Zone❑ Municipal ❑ On site disposal system❑ • Version1.7 Commercial Building Permit May 15 ' ' , - '1` ,‘, , - 4 ., ', ,''• :4 , ,' 'A4'...t- i , r ...---- ------- r P-.-T-T--.- WOW ortvor of Northampton nit4 ,--, E G g ! ding Department ai. , NoV + g 2004 , Ctnti 0$100010410 , '"' °l a% ■,. SV,,. , • Main Street ;„44, , .;';';,1,,,,:e•-,:,.%,rtt4;.,4c1•44, 1 100 6,0094416 '0. , ‘--k W iluinvel'_, ,,4,,,,.,mat,11,.,,,,,,r,N,',-, \ Li N** ton, MA 01060 1 , t :' e v IVA $0 j , Fax 413-587-1272 . ' : ,, r ' ''' Ail #., i '''' i • r " ' PiatiSiteromm4 APPUCATIO CONSTRUCT, REPAIR, CHANGE THE F USE 13 OF, OR DEMOUSH ANY BUILDING I am-nom 1 - UTE RIFORMATION I This section to be completed by office 1 . 1 PDIRIIMILAMMIII: / a to DA-010 P g- Map Lot Uni rilerenel trY) +- 0 u' i Nott- ) . I 1 Zone Overlay DISiliCt [ _ i Elm St Mstrict CB District SECTION 2- PROPERTY OWNERSHIPfAUTHORIZED AGENT 7"1 ibllES4112131:-- OL ---- ---------- ----- ---- 1 L, i arn , , n 0 e:-. K- Name (Mint) Current Mailing Address: —I • :. _ Vert/ .66/9a 6,c_/,. c7 .3› 2 9 - __1 Slahiie alkii 1.,, r -)-4,tck., Telephone 775? - 79 0 — / c LahAtatiateam Nano(Print) 171 g.- ---12-9 t.-- IC— C t Mailing Address: . --- ,r) E 1 *i4' c7 ;te____ (3 Telephone Signature 'i 3 - ESTIMATED CONSTRUCTION COSTS I Item Estimated Cost (13oNars) to be Official Use Only led by . . it : 41r000 1 Budding (a) Building Permit Fee . 2. Eledrical I (b) Estimated Total Cost of Construction from (6) 3. Plumbing : ■ Building Permit Fee --- - 4. Mechanical (H‘/AC) 1 . ---- 5. Fire Protection 6. Total = (1 +2+ 3+4+5) Check Number This Section For Official Use Only Budding Permit Number Date Issued Signature: Building Cornmissionerfinspector of Buildings Date File # BP- 2005 -0571 APPLICANT /CONTACT PERSON LARRY J ROOT ADDRESS/PHONE 374 WILSON HILL RD COLRAIN (413) 624 -9650 PROPERTY LOCATION 106 DAMON RD MAP 18D PARCEL 004 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Perm F illed out // y Fee Paid r f� Typeof Construction: CONSTRUCT 2ND FLR EGRESS TO ROOF BLDG #2 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 070493 3 sets of Plans / Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 ..........c....e .00.....er-------- 1,/ e ql7 ' 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.