32C-067 (13) ,
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02/14/2012 16:55 4135252327
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CHARISTA CONSTRUCTIO PACE 02/02
RE- CONSTRUCT EGRE65 IBALCONY
2 CONZ STREET
NORTHAMPT0N, MASSACHUSETTS
214"1
3 -5/8' LAG 5/8' LAG 5LTS. 4' L.
BLTS. 5 -5/8" LAG BL,T5. 61 32' Cc. INTO BOX FRAME
1201 I BL1 G. WALL 1-11-U526-2
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ANCHOR 6'x6' COLUMNS TO 2141 r it 12' SONO TUBES 48' INTO S06
ES
GROUND. 3080 ■ x .0
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1411111-111411111-11. �.._ N0t,14 6 "xE"" -,434 2 -'S/8' LAG
MUS26 MTS. 3'
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BLDG. WALL
NOTE:
ALL WORK SHALL BE IN ACCORDANCE WITH 1150 2O09 AND
MASSACHUSETTS AMENDMENTS 180 CMR EIGHT ED1TIam.
STEEL CONNECTORS REFERENCED ARE E5Y 'SIMPSON STRONG -
TIE COMPANY INC."
LUMBER 5YP PRESERVATIVE TREATE 1 // 4 1/4"" - 2-'
ALL NAILS, SCREWS AND FASTENERS SI-R ALL k3E 1-40T D IFPEt : T
GALVANIZED.
PLANNERS
DESIGN LOADS: LL = 100 PSF '
CHAFFIN' A,SSOC1A -
T L r b PrSF ARCHITECTS -- t {' ..
tl. s 108 121 CHESTNUT STREET :
SPRINGFIELD, MA 01 103 f ;
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The Commonwealth of Massachusetts
* I . Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Mass. 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers
Applicant Information I Please Print Legibly
Name ( Business /Organization/Individual) :C OtAr S �—C C d 1.A.S4 ruc\ O R
Address: ? r C tn. S'S R t..P — E cc L d L., u pa d P w
City /State /Zip: kV- 0 C Phone#: ( "V Sa S l7 ?�
Are you an employer? Check the appropriate box: Type of project (required):
1.2I am an employer with t 'i 4. 1 am a general contractor and 1 6. _ New construction
employees (full and/or part time).* have hired the sub - contractors
7. Remodeling
2. 1 am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub - contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance. $
required] 5.1 We are a corporation and its 10. Electrical repairs or additions
3. ! 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required] t c. 152, § 1(4), and we have no 12. Roof repairs
employees. [no workers' I Lc' c �( d
comp. insurance required.] 13. Other ` O V`c P -4
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
*Contactors that check this box must attach an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If
the sub - contractors have employees, they must . rovide their workers' coml. lolic number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. I I
Insurance Company Name: 0. Pr + y cc t� CcSVoU -
Policy # or Self -ins. Lic. #: At C 0 04 -. 5? - 7 Expiration Date: 0
Job Site Address: - C d ``Z S' City/State /Zip: NortLeuttLe t O K O
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration (date).
Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine
up to $1,500.00 and /or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify une r the pains and penalties of perjury that the information provided above is true and correct.
a S 1 2
Si: nature: ... L� ��� Date:
Print Name: d "e lAtn Phone #: 1 ? � $ ) 7 ?.S
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license #:
Issuing Authority (circle one):
1.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact person: Phone #:
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 ® No
SE • N 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
t .
• T - AGENT OR CONTRA «, OR APPLIES FOR BUILDING PERMIT
I, , _ .�� , .,4.4 , as Owner of the subject property
I r
hereby authorize - -e • ,P d to
act on my behalf, in all matters relative to work authorized by this budding permit application.
1- Zs-
Signature of Owner Date
I, — N M - ICI- LA.H.,0 , 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 pal s and penalties of periury.
'- Ce LA t.k
Print Name .. k
l- �S - 1 1
Sign re of j r/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
I
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : —E° fit? e -` A 4 Ltt4r,A7 0 s sj Lj 0
License Number
t 8 -rol $ -I S 4 - Y044.a 1-v At UkA- o c O G I - 7 — 'a-1— 1
Address n Expiration Date
natu �/ Telephone
C {ll- L113- 61 -/-737
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 4C 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:
*1 0 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
C L (p i s A.- ek C v K A t 0C-ic)Irt Not Applicable ❑
Company Name:
70 e tA.tA.42 ay
Responsible In Charge of Construction
35r' Pckv arc E c 4 r i r 1,.d aw O L O J
ddress
4(?-car-
Si. ature Telephone
Versionl .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 C4 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO ire DONT KNOW 0 YES 0
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 NO
IF YES, describe size, type and location: 'goorr imauN4A ?> 6 i
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO.
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, ex .vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO CO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl .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 a
Brief Description Enter a brief description here. R -e 6v ta °, 1-; 14 y pot `L^ 'A ? 0 I
Of Proposed Work: 4 "r co 1,t44.4 f -{LA .. u..iky -6) - fir•t buel��f
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑
A-4 ❑ A -5 ❑ 1B I ❑
B Business ❑ 2A ❑
E Educational ❑ 2B 1 ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I 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 ❑
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)
1st 1st
2nd 2 nd
3rd 3m
4th 4m
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 0 On site disposal system
Version1.7 Commercial Buildin& Permit May 15, 2000
Department use only
ce City of Northampton Status of Permit
R : uilding Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
3 \A '2- 5 2 �2 Room 100 Water/Well Availability
ampton, MA 01060 Two Sets of Structural Plans
.„ r .;it -- ;7 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
A • • (CATION 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 Properly Address: This section to be completed by office
a I C o Yt 2 S' - � Q wo o a 5444'.11' Map Lot Unit
�0r4,4 Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
'�,� �.. .G'aov\ ■ . 3 Sr l k err 4- u-e P • 1, . 0 la 2 S.
Name (Pia Current Mailing Address:
t it ra -17?5"
/
Signature Telephone
2.2 Authorized Agent: 4
- To -to aY 38 1A- arkwrs E.L. o(o
Name (Print) Current Mailing Address:
kl3 - S`1f /7 ?S
Signature \ ' Telephone
SECTION 3 - ESTIMATED CONSTRUCTIO COS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building V� 7 s (a) Building Permit Fee
2. Electrical 1 1pi (b) Estimated Total Cost of
`moo _ Construction from (6)
3. Plumbing o n-e Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection N 0 1 .&-P
6. Total= (1 +2 +3 +4 +5) T7f0d Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0675
APPLICANT /CONTACT PERSON JOSEPH KENNEDY
ADDRESS /PHONE 38 HARKNESS AVE EAST LONGMEADOW (413) 525 -1735 0
PROPERTY LOCATION 2 CONZ ST
MAP 32C PARCEL 067 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out _ o2 /'���
Fee Paid Q' l� /`�
Typeof Construction: REBUILD SIDE ENTRY PORCH 4X30 CONNECTS 3 FAM TO FRONT BLDG
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 055440
3 sets of Plans / Plot Plan
THE FOL NG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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 Slreet Commission _ Permit DPW Storm Water Management
e • itioq vela
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.
2 CONZ ST BP- 2012 -0675
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 067 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 -0675
Project # JS- 2012- 001164
Est. Cost: $7500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH KENNEDY 055440
Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning: CB(100)/ Applicant: JOSEPH KENNEDY
AT: 2 CONZ ST
Applicant Address: Phone: Insurance:
38 HARKNESS AVE (413) 525 -1735 () Workers
Compensation
EAST LONGMEADOWMA01028 ISSUED ON:2/15/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD SIDE ENTRY PORCH 4X30
CONNECTS 3 FAM TO FRONT BLDG
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 2/15/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner