32C-177 (8) To:Linda-, Northampton-BuldingDepartment From:. 09/27/00 14:28 16 Page 2 of 2
Sent by the Award Winning Cheyenne Bitware
ice+° I� ij z�, .
s t 7
SEP 2 7 2000 y
c
___:_-0_...,_. g i -9
tS3 -2 N_
4__
a
\9
--_ - P ---- 1
i
qati i
+ i
GO
1-4--;\ --.
ct
151tiAM p2,0 O 0.1—,ii s of rfIia pf rt _*°L� ,11 j ;
1 iti j
tassacilasetts ' =v -
V �y =:��
"'"'.S DEPARTMENT OP BUILDING INSPECTIONS 4 =_``=
212 Main Street • Municipal Building
Northampton, Mass. 01060 `''s:
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
1, MA1L lN.p,j i v2�
(licensee/permittee)
with a principal place of business/residence at:
boy (OL(1( Het-(01 < MAr 6(OZ-\ ( (phone#) c;°56, SC-F
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additional sheet ifneeusuy to include information pertaining to all ooalractors)
e4( )
I am a sole proprietor and have no one working for me.
I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of
not more than three units in which the homeowner resides or oa the grounds appurtenant thereto are not generally considered to be
employers ployeYs under the worker's compensation Act(GL152rs 1(5)),application by a homeowner for a license or permit may evidence the
legal status of an employer under the Worker's Compensation Act
I understand that a copy of this statement may be forwarded to the De,ertmcnt of Industrial Amide Office of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 an&or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against tae.
t1 For departmental use only
a► Permit Number
\ 9(429)Map# ,Lot#
Signature of Li. •ermittee
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
SECTION 11-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
2�L 1\S,o,.;Cl 6 g-('- , as Owner of the subject property
hereby authorize G.J2 to act on
my behalf, in 1 atters relative to work authorized by this building permit application.
Signature of Owner Date
Iv\j !A 8.t A61/ 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.
y\j\pL 1pc-C.000 —
Print Name
Signature of Owner/ ��� Date
SECTION 12-CONSTRUCTION,SERVICES
10.1 Licensed Construction Supervisor: /�/�Q�- Not(Applicable ❑ Z
Name of License Holder : i'` 1/` °`-`v `B 60 10E
License Number
Address Expiration Date
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 No ❑
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 CNIR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 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
(v\A-42_1L 11`1et.' ,C)Y' - Not Applicable ❑
Com any Name:
Responsible In Charge of Construction
D ( I T {-4 t s)l Y h V—.( t\\�l-` a 1014 (
Addre s _
Signature Telephone
• Version1.7 Commercial Building Permit May 15,2000
7.Water upply(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 ❑
8. NORTHAMPTON ZONING /
Existing Proposed Required by Zoning
This column to be filled 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 DON'T KNOW ✓ YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO VV.
DON'T KNOW
YES
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
. 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 Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior terations Demolition❑ New Signs [ 1 Change of Use [ ] Other [ ]
Accessory Building[ ] R pairs [ ]
// ' / gOVe- 01 �m 'CQ2 a
SE 'TION 5- USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly I A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B I ❑
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 " n 0) ,
ss
Floor Area per Floor(sf) a..U V v 1st V. , A
2nd
1st /i -
3rd i k 3 /i
�`...
4th �1 F�
3rd :
4th
Total Area (sf) Total Proposed New Construction (sf) 4 ' .
_ 4
Total Height(ft) 6 x/s /"
Total Height ft ,
• , Versionl.7 Commercial Building Permit May 15,2000
r• Depart rent use only
I f Northampton Status of Permit:
l • Biacing Department Curb cut/Driveway Permit
SEP 2 6 2000 X22 Main Street Sewer/Septic Availability
i iRoom 100 Water/Well Availability,
DEPT OF Siff '}Sr_„E 16ptha'npton, MA 01060 Two Sets of Structural Plans -
i' • -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
This section to be completed by office
1.1 Property Address: !�
3.bn -PipaS-evvi- St- Map &C;:? ”- Lot / / 7 Unit_
Zone, -8 Overlay District
Elm St. District '.. CB District. _ -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r
P/I l " % ; .(4<e=47� ,.(4, s "11\� ' .c c (0(1 c -146t V-e C(04 I
Name(Print)
�- Current Mailing Address:
,
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building crsoo (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
6. Total =(1 + 2 + 3+4 + 5) _ Check Number Flo L -o —
This Section For Official Use Only
Building Permit Number: ,-.3a 7 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2001-0327
APPLICANT/CONTACT PERSON MARK NAIDORF
ADDRESS/PHONE P 0 BOX 10475 (413)536-8888
PROPERTY LOCATION 300 PLEASANT ST
MAP 32C PARCEL 177 ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out f��
Fee Paid 429 (
Typeof Construction: REPLACE(2)SMALLER WINDOWS WITH(2)LARGER&NEW REPLACEMENT
WINDOWS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 001083
3 sets of Plans/Plot Plan
THF,1 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
ll��Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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 Comm , Permit from CB Architecture Committee
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.
S
300 PLEASANT ST BP-2001-0327
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 177 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0327
Project# JS-2001-0539
Est.Cost: $800.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK NAIDORF 001083
Lot Size(sq.ft.): 1 8338.76 Owner: CHERRY REALTY INC
Zoning: GB Applicant: MARK NAIDORF
AT: 300 PLEASANT ST
Applicant Address: Phone: Insurance:
P 0 BOX 10475 (413) 536-8888
HOLYOKEMA01041 ISSUED ON:10/3/00 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE (2) SMALLER WINDOWS WITH (2)
LARGER & NEW REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/3/00 0:00:00 MO $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo