24B-073 (5) Versionl.7 Commercial Building Permit May 15, 2000
i
S�CTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No ® J
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Ct (LO )A C_, (iAC.t I Cif ( t "' , as Owner of the subject property
0
hereby authorize r �L (ir (.. c j fl ( /�-� Pf tv to
at on my behalf, in all matters relative to work authorized by this building permit application.
Signature oY4 Date
I I/
I, , f C.Or & : n/1.0 die. , 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. .
06ll rn 0 Li:'fn t4 /f .
Print Name ti 9,t((-11,;,
Signature of Own /Agent Date
S 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : i)C, -kCtm Ok i`f's ne VII (32_ --- /C(C1 V
License Number
( l t > r l r1 S % fi r' t-h il C r c� L i(� )a t 1�3
Address - Expiration Da e
Signature / Tel phone
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 b ilding permit.
Signed Affidavit Attached Yes
5i.i
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.i Registered Architect:
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
Sighature Telephone Expiration Date
Name Area of Responsibility
•
Address Registration Number
Signature Telephone Expiration Date
Narjie Area of Responsibility
•
Address Registration Number
Signature Telephone Expiration Date
9.3' General Contractor
(, it'b (tL‘01110, I I IC ICtic Not Applicable ❑
Company Name:
• ' 61LY/AnNik
Responsible In Charge of Construction
R V, C Vi � �. YV a 1 •
Address
d-)4 Ll6--;3/1:-.YE)
Signature Telephone
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be tilled 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 Q DONT KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
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 Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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Version 1.7 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 0 Repairs 18-- Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here. )
Of Proposed Work: - ' U 1C e>4S r MI / I l o (S-� 6' ICI 1 -(�(: lh 2d , l'�4..L.,s.f 1 at- eti an K,!
1 ( --.. e 'cyvA i i t !A Al ) kix) 1 / .: c k - rY't " -(( ict '(' ,L j, )'--k 1` 6
SECTION 5 - USE GROU AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 0 A -3 ❑ 1A I ❑
A-4 ❑ A -5 ❑ 1 B
I
❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F-2 0 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1 -2 ❑ 1 -3 0 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage 0 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)
152 1 st
2nd 2nd
3rd 1
3 rd
4 th
4
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 ❑ On site disposal system 0
R E CE.i V _._
IL Versio Commercial Building Permit May 15, 2000
.. 2012 Department use only
City of Northampton S tatus of Permit
` O THAMP O INSPECTIONS 212 Main Street Sewer/Septic Availability
Building Department Curb Cut/Driveway Permit
NORTHAMPTON, MA 07060 p
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
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
1.1 Property Address: This section to be completed by office
L-1 bar fe4 S , fee} Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: •
Name (Print) StCJt - iend.Q.rsoh Current Mailing Address: 1 Gerrtan Delve.,
EG.S4 Longmeadow, AAA-
Signature _SeQ. COflnicCiC;Ir Telephone 14,1'&.- at 0-- 2(.0
22 Authorized Agent:
\ 1 c, Name (Print) fl) C1,(liY1 �0 t V1 ` k Current Mailing Address: I U C � C ^ \ O\ L ( J ( -
Signature , + ( Telephone 0 1 ; 5
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1.. Building (a) Building Permit Fee
� � /
2 Electrical (b) of
Construction from (6)
3! Plumbing Building Permit Fee
4: Mechanical (HVAC)
f
5. Fire Protection
61 Total = (1 +2 + 3+ 4 + 5) ( i t 000 r 00 Check Number 42 - 0 7 4.g 6
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /inspector of Buildings Date
File # BP- 2013 -0369
APPLICANT /CONTACT PERSON ADAM QUENNEVILLE
ADDRESS/PHONE 160 OLD LYMAN RD SOUTH HADLEY (413) 536 -5955 0
PROPERTY LOCATION 72 - 74BARRETT ST
MAP 24B PARCEL 073 029 ZONE URA/URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out p_6( ) j� 7 �
Fee Paid cJ
Typeof Construction: STRIP & SHINGLE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 070626
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOXVIATION 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
C l /
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.
72 - 74BARRETT ST BP- 2013 -0369
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B - 073 CITY OF NORTHAMPTON
Lot: -029 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2013 -0369
Project # JS- 2013- 000596
Est. Cost: $39000.00
Fee: $234.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ADAM QUENNEVILLE 070626
Lot Size(sq. ft.): Owner: Classic Management
Zoning: URA/URC Applicant: ADAM QUENNEVILLE
AT: 72 - 74BARRETT ST
Applicant Address: Phone: Insurance:
160 OLD LYMAN RD (413) 536 -5955 () Workers
Compensation
SOUTH HADLEYMA01075 ISSUED ON:10/9/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 10/9/2012 0:00:00 $234.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner