23B-014 (6) .. .`
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Version1.7 Commercial Building Permit May l5.Z0(0
SECTION 10- STRUCTURAL PEER CMR 110.11)
/—\ /—\
mdepsndemS�u�un�EngineehngS�u�una|Peer Rev�wRequk \_, Required Yes No \_/
SECTION 11 - OWNER AUTHORIZATION - TOBE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES OR BUILDING PERMIT
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/` --_—____--_.-_-----'-------'-----------------_-----. Owner of the subject property
nm/eby authorize ----___-_ '_____-_-_---__
act on my behalf, in all matters relative to work authorized by this building permit application. _
Signature of Owne Date
i - -------__ as Owner/Authorized
Agent h 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 p gfperiury`_-_ __--------------------'"
_ _____ ____-_-.-_____^__'---
Print Name
--^
Signature ofnwner/Aeent _ Date
SECTION 12 - C SERVICES
10.1 Licensed Construction S nmniso Not Applicable []
�? ---'--------------
Name of License Holder
License Numbe
Ad 4i Expiration Date
Sig -t re Telephone
SEC ON 3 RS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25 C( 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 � �� �� ��ched Yes \_/ No \_/
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Versions .7 Commercial Building Permit Mav 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 0
Name (Registrant): _._. ,_Mw.u__.....___. ..__.._
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
,A t�
,_ Not Applicable 0
Company ame: .
Responsible In Charge of Construe ion
.igna e 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
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 (3 YES
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 0 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 0
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 0
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 (3 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
_ . .
Versionl.7Commercial 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 Cl Repairs ❑ Additions ❑ Accessory Building ED
Exterior Alteration Existing Ground Sign ❑ New Signs ❑ Roofing❑ Change of Use ❑ Other 0
Brief Description Enter a brief description here. CkKAP, � 'gyp
Of Proposed Work:. 4Z� � �,.rG (!L'��j') n— QPST�1°-1� 1 ACCO #4
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) j CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B 1 ` ❑
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F Factory ❑ F -1 ❑ F -2 ❑ 2C 0
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ i 5A ❑
S Storage ❑ S -1 0 S -2 0 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): u ,____ , .,. _., . ___.__ __ I 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 _. .__
2nd __ ._. .._,_._.., ____.__ _.., 2 nd ..,
_. ,,----- 4 th _ 4t
4
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
_ l
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 El On site disposal system
Version1.7 Commercial Building Permit May 15, 2000
\ City of Northampton
„ Department use only
Status Pennit,
fluilciing Department Cuib!Cut/Driveway.Permit
, -
212 Main Street Sewer/Septic Availability
Room 100 Miater/lAren Availability
..I.North*npton, MA 01 060 o Plans • • „
0 phoneA F ax 413-587-1272 :,piottqi,t0
Other .Specify .. . .... . . . ,
, . .
APPLica itiN 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
This section to be completed by office
1.1 Property Address:
I ' L tAatic Map Lot Unit
146 AkAWra 1 v■Pr Zone
Overlay District
,. CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
, „.___, „, .... _
Name (P ) • 0 , •s
)
— Current Mailing Address:
Vel. ttG ...,..
D
Signatu ili Id . Telephone
r
2.2 Aut ' orize MIR
..._ . .. — . _ .., .
Name (Print) Current Mailing Address: _,
, •
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be . Official Use Only
Completed by permit applicant
„.„...,_ ...,.._ ......_. ,. „.....,....„„
1. Building . .-156 , (a) Building Permit Fee
2. Electrical '----- ------ (b) Estimated Total Cost of
Construction from (6)
— . „
3. Plumbing Building Permit Fee
. . .
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1+2+3 +4+5) Alc0 Check Number —
This Section For Official Use Only
Building Permit Number Date
Issued
. _
Signature:
Building CommissionerAnsPector of Buildings — Date " , . .
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File # BP- 2010 -0981
APPLICANT /CONTACT PERSON CITY OF NORTHAMPTON CENTRAL SERVICES
ADDRESS /PHONE Memorial Hall NORTHAMPTON (413) 587 -1260 Q
PROPERTY LOCATION 125 LOCUST ST
MAP 23B PARCEL 014 001 ZONE SI(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid /4- -
Building Permit Filled out
Fee Paid LA."
Typeof Construction: REFRAME GARAGE DOO ENING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 054510
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Permit DPW Storm Water Management
Demolition Delay
6-151/0
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.
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125 LOCUST ST BP- 2010 -0981
GIS #: COMMONWEALTH OF MASSACHUSETTS
. o..�a it: 23B - 014 £ CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0981
Project # JS-2010-001448
Est. Cost: $0.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CITY OF NORTHAMPTON CENTRAL SERVICES 054510
Lot Size(sq. ft.): 493534.80 Owner: NORTHAMPTON CITY OF BOARD OF PUBLIC WORKS
Zoning: SI(100)/ Applicant: CITY OF NORTHAMPTON CENTRAL SERVICES
AT: 125 LOCUST ST
Applicant Address: Phone: Insurance:
Memorial Hall (413) 587 -1260 ()
NORTHAMPTONMA01060 ISSUED ON:5 /5/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:REFRAME GARAGE DOOR OPENING
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 5/5/2010 0:00:00 $0.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo