The URL can be used to link to this page

32C-177 (11) • Ag 451€. (yrti crf ir3:fli&lllpfolt 1 *— DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street • Municipal Building _ Northampton, Mass. 01060 to WORKEIZ'S COMTENSATTON LNSURANCE AITU)A\TIT • (li censcdpermi ttcc) with a principal place of-business/residence at: (`-1‘ ) . �e y rot 1-(JL� rt!-2_ K\ hone) 53�" (strticity/stalrrap) do hereby certify, under tile pains and penalties of perjury., that • ( ) I am an employer providing the following worker's comocnsadon coverage for my • employees wor•ang this job: (lnsti _n= Corer,:.•) (Policy Nt1_nbcr) (Expirdon Da) ( ) I,am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below wbo have the follokvinQ worker's coopen.sadon policies: (Name of Con'::?c wr) (Insuranc Cornpan}•i?ouc Numccr) (E\ph-deon Dntc) (Name of Contractor) (lnsurznca Company/Policy Number) (E oirauon Date) (Name of Coturano,) (Iasuranec Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance ComoacyfPoticy Number) (E■pi.allon Date) (arid-d•!iaocal deer irnc�..�•to iociu infortooro pertn'i to.J=eta- o:a) I am a sole proprietor and have no one wori;3ng for me. ( ) I am•..a home owner performing all the work myself. NOTE:piece be exyre tht .1<Jc bomoo•.vvcro ubo employ pewas to do c - y} a oo r trnir"'ors oa.d..'tJJi,of ant more tbca LS-D:tmiJ is ter-yich the bomeo4•ac reside)or oo the p•oua6 eppu.rtea c ax vex-12y occrdoal to be cmploye� 's he woet a Sion Act(GLI52.373 I(5)).e.pptinrioa try.botitcou-Der Ice a Gam or permit rosy etidexc the Icp!clans of ea asaloyr under dso Woel or.Compomition not I copy of obi,ewes.=may to the Poporoz000l of lod.zrid Aoodaal OILoe or to,o'000 for lbn cove>gc vert13c tioo end th_t L-ilta c to caurc No:A-et-ace under cocoon 25A of MOL 132 an la.d to the imposition of criminal pcvillie) cocrisixg of a[tae of up to S I..100.00 etdfor Moprisoarocat oCup to*cc y er rod civil pat:utin,in the form of a Stop Wort,Order.od. sm o(S100.00.ety direst me. For dop.rus u.c only ----'—`� `t(2k D� Permit 1lumixs MapS Lot Signature o i ., •ermittee Lice ' 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 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property LA freNL hereby 'fie Ivy to act on my ehal, all matters relative to work authorized by this building permit application. 61 28 t// Signature of 0 e Date l ,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. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION..SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ w1 . L�C>tr t O C( Name of License Holder:! License Number jam, cNr�-i, I c3\6. Address Expiration Date _ Li c!,i` 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 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: 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 1I Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date fi t i Name Area of Responsibility Address Registration Number 1 Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Addre 44 c-3 Signature Telephone Versionl.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 0 Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work c r G. �� SECTION 5-°USE GROUP AND CONSTRUCTION'TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ IA CI A-4 ❑ A-5 ❑ 1 B ❑ B Business N 2A 2B � E Educational F Factory CI F-1 ❑ F-2 ❑ 2C CI H High Hazard CI w❑ I Institutional CI ❑ 1-2 ❑ 1-3 0 3B ,pal M Mercantile ❑ 4 Cl R Residential CI R-1 CI R-2 ❑ R-3 ❑ 5A CI S Storage CI S-i CI S-2 ❑ 5B I .PCP U Utility CI M Mixed Use ❑ Specify: E S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOINGRENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: I I Proposed Use Group: Existing Hazard Index 780 CMR 34):___ I Proposed Hazard Index 780 CMR 34): i --SECTION<6,BUIILDING'HEIGHT-AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Y f C Floor Arerlloor..(0 7)''._) --4- '� Saor G- 1st 1st — 2nd 2"d' rZ.,r -1, x a 4 yam, 3 th i -s ' -T to l� . Total Area(sf) `',��t-: ") Total Proposed New Constructtiion(sf) ; • Total Height(ft) e)p.cJ Total Height ft _ /-• 7.Wat r Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: Public�q Private ❑ Zone Outside Flood Zone❑ Municipal On site disposal system❑ � TTT"` Version1.7 Commercial Building Permit May 15,2000 8 NORTI AMPTON ZO1tING :_i . Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I , , Frontage I -- ' ' Setbacks Front Side L, R:' L:_ _ R:t Rear Building Height V Bldg. Square Footage I-- % j , Open Space Footage % r-- (Lot area minus bldg&paved E 1 1 1 1 ' parking) r—= #of Parking Spaces Fill: (volume&Location) i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 41i®, DON'T KNOW 0 YES 0 IF YES, date issued: , i IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW (C) YES 0 IF YES: enter Book Page; and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained © Date Issued: C. Do any signs exist on the property? YES 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 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,eation,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. . , . . . , T., . . Version1.7 Commercial Buildin:Permit May 15,2000 - = City of Northampton 't,'-'-.?•-•,',,,,n'',:-..,'----,isAi.„74...;;W14,4t, ,,„,..n.r :7,06c.:::-.:;;',y,t.,,,,,V.; ,t3tAiding Department 212 Main Street Room 100 -. ? .- 44:1f41W -4114;43t'1;: ::+ :4',-','-'4',:-i';,'V''':: 2 k, lortha-mpton, MA 01060 1 . '7,71f7=2:::;.;—:;&-1,-.4:::;i:kil;;IV4i phone 413-587-1240 Fax 413-587-1272 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 -;',.,_, Ttit*,sectidAwbP,c010,01,q41*-0T1-0 .-:7' 1.1 Property Address: ,__ 3c)6) pt-ea.(c.i4-14.1-- 6117-- I'Lg----r- i,3:04* 3,, 7.-. Lot (--17 =unit-cot : ,, : '-1.N.,.,... , ,;;. 4 ;,:„.::4.;411 ,,,,i,...".:',Z..,E.-2.:. .,„1141:0,,,,f9g'g$A2001f. :St04114.,Itiv.igie.:14,.i.:-,-,22ick.4444-if-,4, ■--graittitifa ,stzoitFet.ii-iiikit -4,,,,. .'3,F:=,:-:-.A-, SECTION 2 PROPERTY OWNERSHIF/AUTHORIZED4■GENT.- 2.1 Owner of Record: :. e, k ee _ Pb Oby 1t)d-i-15; H. OL•i6K -(1 ) I Name(Print) Current Mailing Address: ,.•-'. ! '1i S 36- ---(IT-2-7.`F- Signature Telephone 2.2 Authorized Aoent: le___ '14 i'. ■ VC?WF-- : 17;C-,,,, , if>D--/:- lb Li-tC q0Lk.it:) ..v\\?,:c.,IciA/ Name(Print) Current Mailing Address: --- i --;-,L ' - Signature if Telephone SECTION 3-ESTIMATED/C 0 STRUCTION COSTS Item Estimated Cost(Dollars)to be _ Official Use Only completed by permit applicant 1. Building 1.5-60 1 '..(4Building:Permit.Fee 1 1 1 , - ■ ____... 2. Electrical 1 (b)Estimated Total Cost of .1 I Construction from(6) ! ; 3. Plumbing 1 --Building-Permit-Fee 4. Mechanical(HVAC) — ' . i . ! -- 5. Fire Protection ' - .! . 6. Total=(1 +2+3+4+5) Check Number e 74 This-Section-For-Official Use Only Building Permit Number Date issued Signature: Building Commissioner/Inspector of Buildings Date • File#BP-2007-0363 APPLICANT/CONTACT PERSON MARK NAIDORF ADDRESS/PHONE P 0 BOX 10475 HOLYOKE (413) 536-8888 PROPERTY LOCATION 300 PLEASANT ST MAP 32C PARCEL 177 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 67079 1515°Fee Paid Typeof Construction: REPAIRS STAIRS&SIDE SOFFIT 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 THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan MaJ'or 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 65/2 /a 6" Si re 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. 300 PLEASANT ST BP-2007-0363 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 177 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-2007-0363 Project# JS-2007-000529 Est. Cost: $1500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MARK NAIDORF 001083 Lot Size(sq. ft.): 18338.76 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:9/28/2006 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIRS STAIRS & SIDE SOFFIT 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 9/28/2006 0:00:00 $50.006729 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo