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Charista Construction July 11th 2013
2 Conz St Northampton Ma. Unit 2-6 the white building
We are applying for a permit to install white double four inch exposure vinyl siding over
the white masonite four inch exposure siding. There is vinyl siding on the other three
sides of the building. We also would like to install double glazed picture windows at the
front first floor a total of 5 units. I have enclosed pictures of the building and the products
I would like to use.
Thank You
Joseph Kennedy
Charista Construction
East Longmeadow Ma.
413-525-1735
The Commonwealth of Massachusetts
Department of Industrial Accidents .'
l �y.� , .
cl,. 4�,.--.;. - Office of Investigations t. ,
600 Washington Street
. =-4,__. Boston,MA 02111
-4 www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): CI,A, S `\ d LA CAi'tJ e k cI.c,(-�
Address:3 V JLA."-e cc 11/4--,_,-0
City/State/Zip: ct S Lc c,,?. k� °0 ?Phone#: `I t S . S - I )S
L-
Are yo an employer?Check the appropriate box: Type of project(required):
1. 1 1 am a employer with Lt 4. El I am a general contractor and I
L.� have hired the sub-contractors 6. El New construction
employees(full and/or part-time).* Remodeling
_2.,0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑
These sub-contractors have
ship and have no employees 8. Demolition
working for me in any capacity. employees and have workers' 9 0 Building addition
[No workers'comp.insurance comp.insurance.$
required.]
5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work
officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no e'`
q ] 13.0 Other to NbU C.4
employees. [No workers'
. comp.insurance required.] V lk-ky( S''`� `'�j
*Any applicant that checks box#1 trust also fill out the section below showing their workers'compensation policy information. /
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. kc Insurance Company Name "(,
` C °I-c� 4-c`e C ) V ifo
Policy#or Self-ins.Lic.#: v �C) 0 ��
v 7 Expiration Date: 6' - ill
Job Site Address:
C- LA--2- - o f-LCUe City/State/Zip: N_c 6(OK 0
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the p ins , i ,e hies of perjury that the information provided above is true and correct
Signature: . 1 '
4
Date:
Phone#: fr-k-'4---- si? "...' t)c — 1---7 ?-5. )
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: - Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 N
SECTION 11 -OWNER AUTHORIZATION-TO I3E COMPL.ETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-CZ
I
I, ..r. L..e.k.L.1..._........ ....-122.7:7:2../29._n__..._ __ ____ _ .....:,as Owner of the subject property
hereby authorize I_ ..71---0, ---e_.....e(,.._... 6...v,v,-4,`()
act on my behalf,in all matters relative t work authorized by this building permit application.
Signature of Owner Date
-1---- —--- — --- * : ,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 thepains and enalties of perjury.
Fri Name ---\s---- ------- — .------------
Alp
)1k..A...k IPA .._
Signa(fIr of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: , ,Not Applicable 0
' 1 IQ
1i
License Number
, r.. t----f -- — --
V T' ,:ct\r 5'4— cic.2-i) Sl__:?(U V(IC - 43 .0 Or(
......._ .. _
'dress Expiration Date
S_ Lit )?7 6"
---
Si
Si., Mr Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.aL.c.152,§25C(61)
.
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 lie building permit.
Signed Affidavit Attached Yes e No 0
110
Version1.7 Commercial Building Permit May 15,2000
J
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 EIVLOSED SPACE)
9.1 Registered Architect:
Not Applicable 0
Name(Registrant): I --------
Registration Number
Address ■ I ...._.. ___..._.___.,
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
I
, r
Name Area of Responsibility
Address Registration Number
i f
Signature Telephone Expiration Date
l
Name Area of Responsibility
Address Rr.22 istration Number
l
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
s _ Registration Number _,
Addres
i
Signature Telephone Expiration Date
9.3 General Contractor
fN'<S _.c •Srt C c v�..
._ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
f—j"/ Ilklik all .__ _____
Sig re Telephone
Version1.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON..ZONING .
Existing Proposed Required by Zoning ,
This column tore filled in by
Building Department
Lot Size I } _
Frontage w w .._ _.._;._
Setbacks Front 1
Side L:1 1 R:L I L:1 ! R:!: . I
�-__, 1
Rear ----
Building Height �- ...
Bldg. Square Footage °--e 1----_' % 1----1 s I M
Open Space Footage
(Lot area minus bldg&paved 1 1 i 1 s t, , —°—
parking)
#of Parking Spaces
Fill: 1 L�
i ;y i
(volume&Location) - -- `-
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
- NO DONT KNOW . YES 0
AF. YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT 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 41? DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued t
C. Do any signs exist on the property? YES ► NO Q
IF YES, describe size, type and location: 3><,s- p,,,, (�:, �r `�.,, S .__...
1� f� ( Cj
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excav tion, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
- 4
Version1.7 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❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Car r`-%
Brief Description =Enter a brief description here. v�c - U c V �y� r v t�'� `u,, 0 w r
Of Proposed Work:1 V k•.Y( S ti(\ Q 4L c re �. S c tc c"r _
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑-
E Educational ❑ 2B r ❑
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 ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
s Storage ❑ 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: _ f Proposed Use Group: l ____ __.._. �� _._..._w,
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)
t
-_____-- ___.- 1St 1,
________
2nd _ _______ __._ _ 2nd `
3rd ._—.....__ _. 3rd
4m __---. _—._
€ 4tn I
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft _.,. ___ ,_-a
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
Versionl.7 Commercial Buildin:Permit May 15,2000
City of Northampton _� -
t Building Department ' 1 ;
212 Main Street -e ,t.,4:,-,
JUL / Room 100 Fa m
l =4 2O rthampton, MA 01060
QEpr of pho e 4 3-587-1240 Fax 413-587-1272 ,a r ! - -_ ,.' 1
�Rr1fAMP ON SPCTl(� -0 . .,., ... *4'51 .,tee
APPLICATION TO • : i CT,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:
C c c.1 Z C �,- o r cLu�n l e�4, Map Lot Unit
U w 1}S r —6 ._ V,t,T j :Zone Overlay District
(r I
(J . l\�.fin 1
---_'
Etm St-District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
. G. ,cn"c L� 7' kt�c s 6 l_. ocoad'
Name(- Current Mailing Address:__ . ____ .____ _
Signature / £���( �.rAi v• Telephone
2.2 Authorized Agent: ' A
,s L Q ���. � R t �ck-eC... EA_ ,--
atop,
Name(Print) Current Mailing Address: _
Signature t I Telephone
SECTION 3 STIMATED TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building rt , O / 00 U 1 (a)Building Permit Fee
2. Electrical .___ (b).Estimated Total Cost of
Construction from(6)
3. Plumbing U `-Q > Building Permit Fee
i i
4. Mechanical(HVAC) ,,, ` ___
5. Fire Protection ___..___,__., ,_______._____.
6. Total=(1 +2+3+4+5) Ni. i O, 0. 06 Check Number 5 it y� $ (P 0
This Section For Official Use Only
Building Permit Number Date
. Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0082
APPLICANT/CONTACT PERSON JOSEPH KENNEDY C
ADDRESS/PHONE 38 HARKNESS AVE EAST LONGMEADOW (413) 525-1735 Q
PROPERTY LOCATION 2 CONZ ST-UNITS 2-6 WHITE BLDG-MAPLEWOOD SHOPS
MAP 32C PARCEL 067 001 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 � / _ 0-664 6��
Fee Paid (P (� /r
Typeof Construction: INSTALL REPLACEMENT WINDOWS&FRONT 1ST FLR SIDING V"
New Construction 9-411/.
Non Structural interior renovations
Addition to Existing P
Accessory Structure f
�
Building Plans Included: d i u
Owner/Statement or License 055440
3 sets of Plans/Plot Plan
THE FOLL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN O ION 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
D- olition Delay
Signature(7-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.
2 CONZ ST-MAPLE AVE UNIT 26,32&92-MAPLEWOOD SHOPS BP-2014-0083
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-067 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2014-0083
Project# JS-2014-000167
Est. Cost: $15000.00
Fee: $90.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH KENNEDY 055440
Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning: CB(100)/ Applicant: JOSEPH KENNEDY
AT: 2 CONZ ST - MAPLE AVE UNIT 26,32 & 92 - MAPLEWOOD
SHOPS
Applicant Address: Phone: Insurance:
38 HARKNESS AVE (413) 525-1735 O Workers
Compensation
EAST LONGMEADOWMA01028 ISSUED ON:7/26/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR PORCH
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 7/26/2013 0:00:00 $90.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner