31B-271 Version 1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Enaineenng Structural Peer Review Required Yes 0 No O
SECTION 11 - OWNER AUTHORIZATION - TO BE. COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i , as Owner of the subject property
hereby authorize ___ to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
_ , 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 penalties perjury, n „
Print Name
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION. SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder Wrre
License Number
Ad. ss Expiration Date
►, 5 . :123__..__
Sign :t' -' Telephone
SEC ON 13.-WO - RS" . cOMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(S))
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 0
•
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Versioni. Commercial Building Peit May 15. 2000
8. NORTHAMPTON ' |
| /
Existing Proposed Recuired by Zoning
This column to be filled in by
Building Department
_ _-
Lot Size •
Frontage ____ __ _ ___
Setbacks Front ---- ---- '-
___
____ ____ __
Side ��____��_ _ ��� ��� � __-
Rear ___ ___ __
Building Heigh _--- ---- ----
_^ _
•
Bldg. Square Footage '---- _--- 96 �---- _---, ---_
Open
_
- (Lot area minus bldg & paved �~ �
p=x�
�m
2) . _ _
# of Parking Spaces ` -- ---- ----�
—` |
Fill:
^m fun & Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
0 DONT �� YES 0
NO L~/ KNOW \~/ �_�
r --- - ----�
IF YES, date issued: l '
IF YES: Was the permit recorded at the Registry of Deeds?
NO �� DONT YES
\~/
r -------- '---'-
IF YES: enter Book Page and/or Document #
��
G. Does the site contain a brook, body ofvvaterorwetlands? NO �,/ �� DONT KNOW \ YES k_� ��
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs be
Obtained
i
Obtane y Date Issued:
-'----------�
\~� , �
/~�
[. Do any signs exist on the property? \_/
y7 YES / NO
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. Wi||the construction activity disturb (deahng grading, excavation, or filling) over 1 acre oriyit part ofa common plan
that will disturb over 1 acre? YES 0 NO �~\
\�� \_/
IF YES, then a Northam n Storm Water Management Permit from the DPW is required.
`
• Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CUR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable .0
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
110 ► i 11. 12..E
Si, v_ Teiephone .
. .
Version1.7 Commercial Building Permit May 15_ 2000 ---e,
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs E Additions Accessory Building E
Exterior Alteration El Existing Ground Sign 0 New Signs 0 Roofing 0 Change o Use El Other 0
„ . ,.. .......„_...„,_......„„......._„„...„.....„..„., _ ... ...._.„,.,.... ..,
• Brief Description Enter a brief description here. bi (1_, le- 'IL 4- -% a 4 Now -.- - it., a , ., II i
Of Proposed Work: ' -
" - .._...._,
SECTION 5- USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 E A-3 0 I 1A El
E
A-4 0 A-5 El 18 13
B Business 0 I 2A I 0
E Educational E 2B
E
F Factory 0 F-1 0 F-2 0 2C 0
■
H High Hazard 0 _ .
3A 0
_ .
1 Institutional _ 0. _ „I El _ _ . 172 0 1-3 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S-1 0 S-2 0
i 5B 0
U Utility
CLI Specify:
M Mixed Use 0 Specify:
S Special Use
0 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
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
- _
Floor Area per Floor (sf)
1 si
i st
2nd
rd
3
„____ ________ .___ th
4 5
• ,„ _
- Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft) ______„_ ____ _ ,„.. ,„
Total Height ft
I
_ .. .
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private E Zone , Outside Flood Zone:3 Municipal 0 On site disposal systemIET
., T ..,
_ ..„
. .
.„--,--,.--
. -
- ---si
Verslonl 7 Commercial Building. Permit May If. 2000
, • - ^ Department use only
City of Northampton Status of Permit:
. _
Building Department curb - Otit/Driveyvay-Perrnit -
. . 212 Main Street Sewer/Septic Availability
- _ . --- .
'Room 100 WaterA/Vell Availability
-, - J Northaripton, MA 01060 Two Sets of Structural Plans
IA phone 413-5871,240 Fax 413-587-1272
Plot/Site Plaits
-
Other Specify
---- - .
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
This section to be completed by office
1.1 Property Address:
1•0(1=CkkAtkrn (1 ‘ - 1 t. . Map Lot Unit
i t, C_,'Ef Zone Overlay District
. . _
— -- Elrn St. District Da District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
_,_„....„ __ _
l -- itlt W i .k iilk l ' l1°— (14U " 2 - A____ - _i l t. A ,V. _) A_W__, i toti‘k
Name (Prin ) Current Mailing Addr ss:
53i i'l,SS
Signature illi ki. Telephone
2.2 Authorinent:
,„„ „_ 1111,-. -, ---
Name (Print) Current Mailing Address:,
Signature Teleohone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
comoleted by permit applicant
1. Building - if \ A (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 v
6. Total = (1 + 2 + 3 + 4 + 5) 1 t D ' I Check Number 1
This Section For Official Use Only
Building Permit Number Date
Issued
E,
Signature:
I
Building Commissionerilnspector of Buildings : Date , . _ 1
_
File # BP- 2010 -0144
APPLICANT /CONTACT PERSON CITY OF NORTHAMPTON CENTRAL SERVICES
ADDRESS/PHONE Memorial Hall NORTHAMPTON
PROPERTY LOCATION 29 CENTER ST
MAP 31B PARCEL 271 001 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
Fee Paid
Typeof Construction: ENCLOSE DUCTWORK
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 FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
8 e ,2.Q®
Signature of : uilding 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.
rx �� BP- 2010 -0144
GIS #: COMMONWEALTH OF MASSACHUSETTS
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 -0144
Project # JS- 2010 - 000174
Est. Cost: $100.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CITY OF NORTHAMPTON CENTRAL SERVICES 054510
Lot Size(sq. ft.): 15420.24 Owner: NORTHAMPTON CITY OF POLICE DEPARTMENT
Zoning: CB(100)/ Applicant: CITY OF NORTHAMPTON CENTRAL SERVICES
AT: 29 CENTER ST
Applicant Address: Phone: Insurance:
Memorial Hall
NORTHAMPTONMA01060 ISSUED ON:8/10/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: ENCLOSE DUCTWORK
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 8/10/2009 0:00:00 $0.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo