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31B-272 (2) • Massachusetts - Department of Public Safet% IN) Board of Building Regulations and Standards Construction Supervisor License License: CS 93450 Restricted to: 00 JOHN K LANDRY Y , 104N ELM ST NORTHAMPTON, MA 01060 �s --- -- Expiration: 3/29/2012 t omm6sioner Tr#: 18034 r ' /e &mr sonweald o?...l aaac%uaetla Office of Consumer Affairs & Business Regulation ,.t t ,_St QY HOME IMPREMENT CONTRACTOR 1 �� ;'j Registratioh51103 _ Irati: 12 Tr# 294118 Typei,=; tion ROUTE 9 DESIGN ..IIC JOHN LANDRY :' t "' 1! 104 NORTH ELM S1>R,.'< NORTHAMPTON, MA'i 160- Undersecretary The Commonwealth of Massachusetts Department of Industrial Accidents 3,:, i il...,_ — " Office of Investigations "n=.' a 600 Washia:gton Strut "','. Boston, MA 02111 www.mass gov/dia `Y Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumber 4p Dlica nt Infornpation / / Please Print Legibly ' Name (Business/Organization/individual): Zt� 9 p PeS� F,;1 i �d 1 h t' Address: lay . /J-J-& gA.t City/StatelZip: R -i /�� D/e 4/ Phone 51/3 -�v ' 77 &o Are you an employer? Check the appropriate box: l'ype of ect ( 1 . ❑ I am a e m p l o y e : w i t h 4. ❑ I am a general contractor and 1 p�J (required): employees (iidl and/or part - tune).• Pr�ta or Pte have hired the 6 . ❑ N constucboa 2.0' I atna sole listed on %vended sheet. 7. LRf ,modeliag ship and have no employees - These have 8. 0 Demolition working for me i any capacity.. employees and .= ve workers' y. 0 Building addition (No workers' . insurance ) • 5. We are a cosporadon and its 10.0 Elecwical repairs or additions effects bare exaciseti dies 3. ❑ I aria homeowner doing all work 11.0 Plttmhiag repairs or additions ' mysclE [No s' camp. of exeaaptios per BIGL 12.C1 Roof repairs insurance ] t c. 152, f 1(4), and are have no employees. (No makers' 13.[] Other . - ) . *Peaty npproandeoctoeia boa pttaitesla not d oadios Wow t6e+Mg their iodate oo ooitpolicy ladontsiaa. tEiemeowueesMa sabot lhitaffidavit Wimps they ore doing A look and dos bite odeideasdassos taut submits tow afrachait iadieadae such. kiaasseooes dot the* dtiw boo soot :dotal as addida al duo showiag Oa meat attic sobeea me, std same window fie not toe entities lave . ea loyaa. If the sob•eoaaadaslove aeaployoea, i1 tryst powide their wakes' cow. pefoyoungiar. • • I ins an employer that ir proeidl rg workers' earn, peaset iar teesur6atesfor cry estplevess. Below Jr dice p.Ik amid job sire iwforaeo+tloac Insurance Company Name: T 65 /w 4vf0.✓A< P Policy If of Self ins. Lie. #: CV g IM 07 Expiration Date: o8/ff67v'Zf)1 i' • Job Site Address: • CSitydStarrfZip: r Attach a copy of the workers' boa policy dedaradoo pnage the po cy masher and expiration date). Paulin bided= eavand as required ender Section 25A of MCA, a 152 mind to tie: of admiral penalties of a One up to S1,500.00 amdkr oae+ye er ingdsooment, ss well as civil pis is the tam ofa STOP WORK ORDER and a Sae of cap to 5250.00 a day apmst the violator. Be advised that a copyof this stet nmra ay be forwarded to the Office of •fthe ■ _. i . ... . ' - - I d . - ,_ hereby terse , - the 'aboard par efpaajavy drat the lefoneertoa proldat obere is true grit eatarc - Official are only. Do not smite to thk area, to be co p/eted by M et to'trat officiaL City or Town , - Peruit/Lietase a Issuing Authoa4ty (drab one): .1. Board of Bealth 2. Bedldmg Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: ,,. ,' • Phone a Y: . • 3 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 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t I, 1 �aV D - p. c-0�c. - - , as Owner of the subject property i hereby authorize Route 9 Design and Build, Inc. / John K. Landry to act on my behalf, in all rs re ' e to rk authorized by this building permit application. Signaturiof Owner C Date Route 9 Design and Build, Inc _ 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 of perjury. — _ 1John K. Landry I Print Na e . tea.. ..s?.424 { 1 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION ERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ John K Landry __ 1 1 93450 Name of License Holder : _ _ ___ _ _____ _ .......... License Number 104 N Elm Street, Northampton, MA � �� 1 103/29/2012 Address Expiration Date J K.1,401:7(. . (413) 204 -9880 Signature , 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 0 No 0 Versionl.7 Commercial Building Permit May 15, 2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size L __ ----- E_ 11. _ _ _______...i Frontage I _ 1 C_ _1 1 1 _ ._._..____". Setbacks Front 1 J L _._ L____.1 Side L: i R:l--.-i L:L___.__.] R:1 = — Rear l 1 { ` __. • Building Height 1 . C'�`? � a Bldg. Square Footage L_ l 1 J % L] L LJ Open Space Footage % (Lot area minus bldg & paved 1 I I 1 1 parking) # of Parking Spaces En = �- --�--r Fill: -- _ . .. �. (volume & Location) i__ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: L IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES 0 IF YES: enter Book 1._ ; Page I and /or Document # t B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ® YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: I ! C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: { xisting building signs and information j D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO 0 lu__ l 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 will disturb over 1 acre? YES ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Vetsionl.7 Commercial Bu Permit Ma 15, 2000 +� CE A E .0 > y ,, ,....:.,... " A j � �4 ty o Northampton B ildi g Departm 1 20 j 2 1. Main Street • _ 'oom 100 " N LDING MSPECTO ha pton, MA 01060 ° - � i �� - 58 - 1240 Fax 413 -587 -127 , r-- APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE T HE USE OR OC OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWE LLING SECTION 1 - SITE INFORMATION 1.1 Property Address: t �� � a b- „ Yed b, C e 1 ,99 — M - 9 Main Street - rm 203 p t Unit Northampton, MA 01060 � i vas k , ' x r ,, t gZVa am., j..�4 .0= ' ,.3.c+.r� �r r _ r SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED.AGENT 2. Owner of Record: ; Council of Government 99 M Street, Northampton, MA 01060 F Name (Pr nt)�� Telephone ,7--.c?- Current Mailing Address (413) 584 -1300 �_ 3 Signature „.--- s 2.2 Autho =zed Aaen : _ _ — 1 'Route 9 Des and Build Inc 1104 No rth Elm Street, No rthamp t on, MA 01060 Name (Print) C urrent Mailing Address: _ -- 1/ 1(413) 587 -3050 I Signature 1� . ���� .?. Telephone __ �__ _ _ SEC110N 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only comple by permit applicant 1. Building j $1,940.001 (a) Build ;P Fee I 2. Electrical __ ____�_ _. ------ -” $Q001 (b) Estima Total Cost of i i Constru from (6) - - 3. Plumbing ----- __._ $0.00 Building Permi Fee 4. Mechanical (HVAC) — i _ ____ _ __--- __ $0.001 # —_ ._ . 5. Fire Protection , 6. Total= (1 +2 +3 +4 +5) Check Number This Section For OnIy Building Permit Number Date Issued ciai Signature: issioner/inspector of Buildings Date Building Comm • 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 0 No O SECTION 11- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1- _ ..m.. I, , __ , as Owner of the subject property hereby authorize 1Route 9 Design and Build, Inc. / John K. Landry _ Ito act on my behalf, in all matters relative to work authorized by this building permit application. i Signature of Owner Date I Route 9 Design and Build, Inc _. _ 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 a__ins and penalties of periurv. —•,_• _ lJohn K. Land Print Na e _ ....._�..._......�. 1 . 4 -10 -24 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION ERVICES 10.1 Licensed Construction Supervisor: __ Not Applicable ❑ Name of License Holder John K Landry _ x93450 _ License Number 1 N Elm Street, Northampton, MA _ 103/29/2012 Address Expiration Date K.I...--. (413) 204 -9880 Signature ' Telephone SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, g 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 0 No Version] .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: Applicable John K. Landry Not 30257 Name (Registrant): __ John K. Landry _ Registration Number Address _� _ _ 108/31/2011 , W _..J J _ e I N � ( I ( 1 3) 204 -9880 Expiration Date Signature L,f� Telephone 9.2 Registered Professional Engineer(s): ____ _ _ _ _ _ Name Area of Responsibility Address .w.. �. _., Registration Number f Signature Telephone Expiration Date __. .,.w.,_,,.._..�,„,.,. ._,.._. _. ._______, Name Area of Responsibility Address Re istration . Signature Telephone Expiration Date Name Area of Responsibility _�,� -n_w ~^ L . Address Registration Number i_.s..._,.. .»....._.,.__.._,_J ,..__ .. ,�........,...._........,.. .,A.,,.........,_„o...�...._..l Signature Telephone Expiration Date _. ___. _. ,.__. _________ i 1 I j ..,. _.v ..__ ._..�._ , Name Area of Responsibility 3 Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ;Route 9 Design and Build, Inc. _ _ _, _ Not Applicable ❑ Company Name: `John K Landry I Responsible In Charge of Construction `104 North Elm Street, Northampton, MA 01060 I Address k413) 204 -9880 Signature Telephone , Version1.7 Commercial Building Permit May 15, 2000 r W ' 2 d 4 i ) 70 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size E I 1 i __ _ 1 Frontage L — 1 v __ .,.._ - m 1 Setbacks Front ' ront d ( tJ Side L:= R:L.-- _....J 1.1.._...J R:E1 I . , 1 L Rear { i # ! --_ I Building Height = .___. 1 1 Bldg. Square Footage L 71 "`] % I L. Open Space Footage % (Lot area minus bldg & paved 1 1 ': parking) # of Parking Spaces = ---- -- - Fill: (volume & Location) I A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and /or Document # µ B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO I© IF YES, describe size, type and location: l existing building signs and information 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 (Gearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO Q IF YES, then a Northampton 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 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: John K. Lan - I Not Applicabl CI " ' ;30257 1 Name (Registrant): - -- - i f Registration Number ; John K. Landry 9 r.._ ___..__......_...... 108/31/2011 Address J I—. LAN �� / 413) 204 -9880 i Exp iration 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 Number I ? s Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number _i i Signature Telephone Expiration Date Name Area of Responsibility i Address Registration Number la Signature Telephone Expiration Date 9.3 General Contractor ! Route 9 Design and Build, Inc. Not Applicable ❑ Company Name: 'John K. Landry ._._ 1 Responsible in Charge of Construction _ 104 North Elm Street, Northampton, MA 0106 Address (413) 204 -98801 Signature Telephone Versionl.7 Commercial Building Permit May 15, 2000 Existing Proposed Required by Zoning This column to be filled in by Building Depamnent Lot Size 1 ` _ _ 1 J Frontage } 1 1 F Setbacks Front 1 I side L:1 1 R:1 } L:.,., R:l _ .i I t _. B.= 11 LJ f 1 Building Height 11 Bldg. Square Footage =1.1%=11 ;----; i (Lot ar m e nu bldg & paved 1 t 1 I ; ( 1 1 --� Parking) # of Parkin& Spaces Fill: (volume & Location) _ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: [ IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW IP YES Q IF YES: enter Book Page and /or Document #1 B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES Q 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 O NO 0 IF YES, describe size, type and location: existing building signs and information D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO O IF YES, describe size, type and location: E. MI 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 ® NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTR SE FOR O LESS THAN 36A00 •. CUBIC FEET OF .ENCLOSED interi Alterations o Existing Wall Signs ❑Demolition ❑ Repairs ❑ A ❑Accessory Building 13 Exterior Atteratia ❑ Existing Ground Sign Q New Signs ❑ Nom 51--1 Change of Use ❑ Other ❑ Brief Description sew 10 ft ht (note existing ceiling is approximately 14 ft lit) work ar dividing work arcs "hatf height" partition Of Proposed Work: ( wood studs aad drywall) in room 203, existing room 203 (less than 300 sq t2) h as two mesas of egress sad ea ch work area will helve separate means of e gress ( use of existing means of exit). SECTION 5: - USE GROUP �GONSTR T l USE GROUP (Check as app CONSTRUCTION TYPE A Assembly CI A.4 ❑ A-2 ❑ A-3 0 1A { ❑ A-4 in A-6 ❑ 18 f ❑ 2A B Business a CI E Educational ❑ 2B f 0 F Factory ❑ F.4 ❑ F - ❑ _ 3A 2C 1 ❑ H H' Hazard ❑ i institutional ❑ 1-1 ❑ ❑ ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R - [l R-2 ❑ R-3 ❑ ❑ S Storage 0 S-1 0 S-2 ❑ 5g U Utility ❑ Specify: { M Mixed Use ❑ Spec fir Specify S Special use ❑ COMPLETE THIS IF EXJSTIN B 3 ING tliyDERGOH!!G RENOVATIONS. ADDFTS f USE Existing Use Group: [Business Proposed Use Group: Business y Existing Haza Index 780 CMR 34): .l Pro posed Hazard index 780 CMR 34): ) SECTION 6 B11lLDING FlEIGI$f° °AND AREA ° . s BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION �: °� . f Floor Area per Floor (sf) j N l+Pb 2 ntl = 1 a • nn Y q 3r i 4 � ? y �a 4th I 4e' l . .' x s y w v Y - • Total Area (sf) Total Proposed Ne Construction (sfl ` ; ` ' i P a " - "E� rc. "w ` s { X 1 Total Height (ft) y �h k � � + t � Total Height ft 1 � '1 .�T+YF 7. Water Supply (M.G.L, c. 40, § 54) 7.1 Flood Z n information: 7.3 Sewage pia posa! System: Public p Private [] Zo Outside F lood Z one❑ Municipal ❑ On s di sposa l system • • Version1.7 Commercial Buil.' , Permit 15 2000 at, of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPUCATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE DIE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR MO FANE-Y DWELLING .. • • • • SECTION 1- SITEINFONSIATION- . • :4: :: 1 11 . , • -444-1 ZEDIOLASAEISE: 11111111111.1? - _ . 199 Main Street - nn 203 Northampton, MA 01060 • • SECTION 2 41 tOPEOWNENSISIOtAtITHORtheXISEENT : • •'' ••• • : , •.• •-• , LLS/SatiestRised: 'Hama:shire Council of Government J 199 Main Street, Northampton, MA 01060 1 Name (Prilt r cured Iliallerg Address: 1(413) 584-1300 • signature Towbar* . Route 9 Design and Build, Inc j 1104 North Elm Street, Northampton, MA 01060 1 Name (Print) Current Mardi Address: 1(413) 587-3050 , signature .. LAVP Telephone = 4.. • 4 1*.i,Sik !. it, •• • . Item Estimated Ccet (Dollars) to be completed bX MIT* soplicant • ••• • 1. Building $1,9407010 • ....4 : .• 4 • 5 . ° :•!..P • • • 2. El/21 $0401 ost • - • , '`44,•.?... ,/ : 3. Plumbing : • $0.00 , ' .-• , • r rki s ' : • - • • • • ' 4. Mechanical (HVAC) SO 00 5. Fre Protection .:-‘• • . • , : • . - S. Total 28(1 + 2 + 3 + 4 + 'iis/••• • •• 4 4:" • : "1";;• • r', •••4*":. • • • • : :;:. •-._ : • • - - • • — ' 7 , • r • ,‘. . . • ' . . .77 sT .••• •'•‘ ••• • BIdk .•••• • , :-• • , • ^"•-, • s; , , , ,•• :; • • • dij 1 ' 4• ,.44K4: ."•• • • •-•••• ••• • • • GOTHIC ST ° BP- 2012 -0081 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 272 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2012 -0081 Project # JS- 2012 - 000125 Est. Cost .$194000 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN LANDRY 30257 Lot Size(sq. ft.): 15812.28 Owner: HAMPSHIRE COUNCIL OF GOVERNMENTS Zoning: CB(iQ )/ Applicant: HAMPSHIRE COUNCIL OF GOVERNMENTS AT: GOTHIC ST Applicant Address: Phone: Insurance: 99 MAIN ST • (413) 584 -1300 0 NORTHAMPTONMA01060 ISSUED ON: 7/21/2011 0:00:00 TO PERFORM THE FOLLOWING WORK :Office Partitions 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: / jU House # - Foundation: pit- r Driveway Final: Final: Final: Rough Frame: C C.° Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: S , cI It V,S THIS PERMIT MAY REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: (7 , 44- ' .4, FeeType: Date Paid: Amount: Building 7/21/2011 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck - Building Commissioner