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24D-258 (2) • f •.v A h � fi t- of Northampton 4 w t� +mote ,32c3aaci nccita' sue• �!' DEPARTMENT OP BUILDING INSPECTIONS • eN 212 Main Street • Municipal Buildin6 Northampton, Mass. 01060 r ' WORKER'S CO v{PENSA'1tON INSUIRA ±CE AF EDA\'IT /wd1-A C_JJ C t - - - - - -- (lictms Jpermittec) tll -e- N -�7 f>al-- p-l-ac ° ^�- -- -_.'i-ae- -ss/r -4-s Id Ci3F�— 1: 1- '0 ∎ac.1 3�2- LE d.64- ltie,& .07/>F°✓ 0 /a Z& (phone:') 1 //3 ' SZ S - 3 Z (sn c IJci ty /stalcra p ) do hereby certify, under the pains and penalties of perjury, that (1.„)-1 am an employer providing the following'ti'orkcrs compensation coverage for my employees wording on this job: riv/i.:./ < v x,: eA/ /-+"i/ (ric: vc •f 7 f rya -. / c/3//10 (Laru_r Company) (Polio: Number) (r :'piraon Date) ( ) I - am a sole proprietor, general contractor or homeowner (ccie one) and have hired the contractors listed below who have the following worker's.compe,nsadon policies: (Name of Contractor) (In Branco Coinoan }'ri'oLic; ?N'um =cr) (i_z =)i uon Datc) (Name of Contractor) -- (lnsu - ancc Company/Policy Nu.rilc•r) (kpir iion Date) • (Name of Conrractor) (Insuranc:- Company/Policy Number) (Expirrion Date) (Name of Contractor) (Losurano Company/Policy Number) - (Expiration Dice) (..Each chcd ifnoxs-try to a,cu& intocooc, pertaining to all ooczr - oo: ) ( ) I am a sole proprietor and have no one worl,3ng for me. ( ) I am.a home owner performing all the work myself. NOTE: pie be awato thi .t :Jc bemeowven who ploy pc-scos tow - ; -r rrpair u -ork au . d••cn_;, of not mocv t an t!- _vain is which the botnoowacr rtn.i•o, cc cc the grottoes zppurtco:rn them ao one Eoetily coca:dun.1 to be employes uod - the wxa cr' pc tea Act (GLI5b-s51(5)). r.pplinoon by a bomeou-cc for c lice _ co- permit roc) cvidmcc the Icga1 n3.y< of an cc:*loyoc undo tlio Wecic.or', Cocop000.tioa Act_ I understand that a copy or lhi, mtemcaa may bo fora.urded to tbo pe ,, oa of 1.,.4.veriJ Aecideot'f O[Soo of Ira*nooa for the covcmsc vcrif c=tioa and th i Lilt= to Loa= ) ovcrasc tncdcr suction 25A of MOL 152 can Iad to the i-m, nsitica of criminal prnsllio 000si of a frn< of up to S1_503.00 arxi/oc impriwcccocut of up to ooc ycar rand d J pmahia in tx form of a Stop Work Ordcr and frb of5l00.00 t day tp,iaa coc For dcparurc =•t u.c only Pcrmlt l` umber Lot ° SigaLure of L Date + Version1.7 Commercial Building Permit May 15, 2000 r.. SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.1 t Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION, II - OWNERAUTHORIZATION. - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR `:BUILDING`PERI MIT " /Y YC�C ', as Owner of the subject property hereby authorize ,�(> /U L lJ A 4%t''-0 -- "C_ 0 to act o behaf, in all matters relative to worls..authorized by this building permit application. Signatur of Owner f 1 Date I, +00,Z >,4L /J � � jygsc vC c3 , 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 pains and f penalties of perjury. /Y r: � � ��/ �,/+� Print Name POLI - 5 1 3C — GA C = Signature of Owner /Agent Date -SECTION 12.- CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : I �� L a� .$C c�G r > 7 P4 License Number I 0 ©A 3 Z t= h v,tJ �Yv �i� tom- ale -a- 67/ l> z>f ; r >/i y/ Address Expiration Date Suture Telephone 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 No 0 r i ' • Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION- SERVICES -FOR BUILDINGS AND STRUG RESSUBJECT `tO CONSTRUCTION CONTROL PURSUANT TO-780 CMR;116 (CONTAINING MORE THAN_ 35,OOQ. 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 i Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I I E Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I I • Signature Telephone Expiration Date Name Area of Responsibility 1 � I Address Registration Number I Signature Telephone Expiration Date 9.3 General Contractor T , �3u[ ( . 4 ) � Not Applicable ❑ Company Name: /,) c? Responsible In Charge of Construction I _ r j A2 � G'E' 3x4 4- /yd._ Address Xa...5 - 2-5 3 �`, Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 1.. ° a 3 t4 O. S - O. ,. Existing Proposed Required by Zoning This column to be filled in by Building Department i Lot Size € I Frontage , : Setbacks Front i i i ; }: i Side L: R : E L:7 R"-1 i I. r : Rear I < - Building i i t 1 j Bldg. Square Footage I i% I o Open Space Footage % ; (Lot area minus bldg & paved = _ j { ' i parking) # of Parking Spaces 1 : Fill: ' I , i (volume & Location) A. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO e- 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 Paged i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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 0 NO a IF YES, describe size, type and location: j ` D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q IF YES, describe size, type and location: 1 I f 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. r , 4 Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SER1710ES�FOR:gPR THAN 35,0 CUBICEEET'OE ENCLOSED SPAGg' Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. / Z � '� /Z (..,.,0 ,U� 4 v /1!� j Of Proposed Work: 1 A aNYdfiuG - ...5-7,76.--/- - • ;'SECTION 5 - USE GROUP AND CONSTRUCTION TYPE " USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ CI -- A-4 ❑ A -5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ( ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential CI R-1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ 5-1 ❑ S -2 ❑ 5B L ❑ U Utility ," ❑ Specify: 1 M Mixed Use 0 Specify: S Special Use 0 Specify: j 1 i COMPLETE THIS. SECTION (F EXISTING BUILDING UNDERGO1? RENOVATCONSr ,A[7DiTIO1 S: AND /OR CHANGE IN USE Existing Use Group: I Proposed Use Group: r Existing Hazard Index 780 CMR 34): ` 's Proposed Hazard Index 780 CMR 34): i SECTION "6 BUILDING:HEIGHT ANDLAREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ' �`` Floor Area per Floor (sf) ._ - . — 1 st i ,,, 1s, i 2nd »ma R �' 3 3rd ' �„ w `«' ^ "' a: t.T_i- ,; .ma y ^ Total Area (sf) Total Proposed New Construction (sf) 57i "° T , � , t `"� , i _ =,' -- 3. ,,,:. x,,.023 :` Total Height (ft) i t Total Height ft 1 i 4 t , I : •:',,. - __... ., . — ter ' .: 7. Water Supply (M.G.L c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone I ! Outside Flood Zone❑ Municipal ❑ On site disposal system r a , t Version1.7 Commercial Buildin• Permit Ma 15, 2000 w '� s r City of Northampton 9 � � r Building Department 3 , _ - r ^Q10 212 Main Street - r4 Room' 100 N c s ,.�7 -te. Ni�irtharipton, MA 01060 9 ' " - `Q`-� phone 413-5,57 Fax 413 - 587 -1272 iQ 2 �� : " � O c �- '0 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 ;ti - 11 Property Address: his section to- - become` ed by office. .._ M /3 / - /. 3 C Lejsc -vA. r'' .j T �t of Un ? i e O er[a . EI St "D fri __ . CB Distri _ __ � � �' SECTION .2, PROPERTY O /AUTHORIZED -AGEN 2.1 Owner of Record: h'L /2 t .�i-4 ye g. --5:-.4-'6.1- - ; Name (Print) "n . Current Mailing Address: 1 1/ Signature A _.I� . A Telephone 2.2 Authorized Accent: �� 1 ) /.)./ i ) ._ ,v�S c t � � ( "j4" 13'4'.e 3 caZ L . : c..,..,t / iy ,2 e,, r" 0Z,` c.- Name (Print) Current Mailing Address: i `'il3 Se_S_ 3e 74. / Signature , �' -� / - yam -- '- If' Lz�,, Telephone -- SECTION-.3. -- AT ESTIMED :CONSTRUC COSTS Item Estimated Cost (Dollars) to be Officiai;Use -Only, completed by permit applicant 1. Building I � # (a) Building'Permit Fee r °J � , 4, ° 2. Electrical I . i (by Estimated Total Cost of i I - "Construction fr'orri (6) 3. Plumbing ; Building P ermi t : Fee 4. Mechanical (HVAC) 1, 5. Fire Protection I 6. Total = (1 +2+ 3 + 4 + 5) � � ai;, C .: =Check Number 46 O / ; 3 7 � .= % .', ._This- SecfionFor.Of iiciiat Use Onlyr Building=Permi!t Date Issued r Signature Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0718 APPLICANT /CONTACT PERSON PROSPECT BUILDERS INC ADDRESS /PHONE P 0 BOX 302 EAST LONGMEADOW (800) 486 -4976 PROPERTY LOCATION 133 CRESCENT ST MAP 24D PARCEL 258 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / #37,2 Fee Paid Typeof Construction: REPAIR WA'1 'R DAMAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 017699 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 Signature of Buildin Official Date 7 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. 133 CRESCENT ST BP- 2010 -0718 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block; 24D - 258 i 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 -0718 Project # JS- 2010- 001068 Est. Cost: $62000.00 Fee: $372.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PROSPECT BUILDERS INC 017699 Lot Size(sq. ft.): 12632.40 Owner: MAYER HERBERT JR Zoning: URB(100)/ Applicant: PROSPECT BUILDERS INC AT: 133 CRESCENT ST Applicant Address: Phone: Insurance: P 0 BOX 302 (800) 486 -4976 Workers Compensation EAST LONGMEADOWMA01028 ISSUED ON:2/9/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAIR WATER DAMAGE 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 2/9/2010 0:00:00 $372.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo