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32C-177 (17) L_ A N G E CHIROPRACTIC Northampton Building Commission Re: Permit#BP-2007-0746 March 13, 2007 tJ,r,�i �L?� To Whom It May Concern; Effective immediately I wish to change contractors on permit number BP-2007-0746. Please issue a new building permit for Choice Property Enhancement with Sheri L. Green as the contractor(contractor number 082702). The plans for the build out of 304 Pleasant Street(permitted space)will remain the same. The only change will be the new contractor. Should you have any questions for me please do not hesitate to contact me directly at my office. Sincerely, Dr. Kimb- Lange D.C., C.C.S.P. Certified Chiropractic Sports Physician 141 Damon Road* Northampton, MA 01060 Phone: 413-582-9889* Fax: 413-582-9886 I • 0 osa e f � '� O 2•111 .3 W�M°. ° o c5oC c m z 4241 it 1 ICI CC N O Civ co L m� d Z OZ -o o . „n 11314 \V' v. o i I 41..-1:170,-.:n-S...,--....-- 4 Z m °c ccj o-y 0dJ 7 1 E I M °„ -. ' e N..e O 0 co N W Q. ,_U 3 �4 -: �o e o.a 4. Z , `� A w. - g A s 0 al 0 p Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the. dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." ,r Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of • Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit ... ' _ The Office of Investigations would Jib>to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts • Department of Industrial Accidents- Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 4'617-727-4900 ext 406 or 1-8877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass_gov/dia a • , The Commonwealth of Massachusetts -- Department of Industrial Accidents A 1 Office of Investigations ==olel= i 600 Washington Street • —=.-....:1F-_-. y Boston,MA 02111 www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CA,, , e Pcop e -/y e!rITr9,to,c ill C 4,r _775/L` Address: /S //4,e,' j S 77_ City/State/Zip:3-4,7i9. /i0-itTAA e/o75 Phone#: v3 ��, "- Are you an employer?Check the appropriate box: Type of project(required): / 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors •� listed on the attached sheet. 7. Remodeling 2.II I am a sole proprietor or partner- ship and have no.employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.: required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.Ill 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 employees.[No workers' 13.0 Other comp.insurance required.] *My applicant that checks box#1 must 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. tContractors 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. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date:- Job Site Address: City/State/Zip:. 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 Investizations of the foo uranc- a veraze verification. I do hereby certi,, "ire e pai . an penalties of perjury that the information provided above is ue and correct. Si_. ., �>Sj" / ,— Date: T 7 Phone#: V/-3 53/—PC-°7 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#: k - A The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations jj 600 Washington Street • �°Il= Boston,MA 02111 . . www.massgov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. 0 I am a general contractor and I have hired the sub-contractors employees(full and/or part-time).* 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have. g, 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance. $ 9. 0 Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152,§1(4),and we have no 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 file 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 pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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,_STRUCTLIFiAL:PEEkAtitIEVVItgo CMR 110 1f- Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION-14=OWNERAUTfiORIZ.ATION.:-TO'BECOMPLETE11-7.WHEN OWNERS AGENT OR CONTRACTORAP-PLIES.FOR BUILIDINGTERMIT I, I,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, ,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. Si.ned under the sains and .enalties of se*u . Print Name Signature of Owner/Agent Date -8gc110432.4clotitat110170Nztg:04: ---- 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: I License Number Address Expiration Date Signature Telephone SECTION 13-W-cmkKErtsectiMPtatATION'INsuRANc *Etiiikyrt-401,:sx.:4,t54s25-cmy . _ 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 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND=STRUCTURES SUBJECT.TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35x000.C.F.OF ENCLOSEDSPACE) 9.1 Registered Architect i Not Applicable ❑ Name(Registrant): I Registration Number y ; Address { Expiration Date I Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility { Address Registration Number I _Signature Telephone Expiration Date , Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date f Name Area of Responsibility Address Registration Number [ i ! Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date 9.3 General Contractor { Not Applicable❑ Company Name: { Responsible In Charge of Construction I r i Address Signature Telephone e Version1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ! Frontage f € Setbacks Front 1 1 ; i I Side L: 1 R:1 1 L:1 i R:1 I t- Rear ; ' i -BuiTdmg Height i 3_j � , 1 Bldg.Square Footage i i % f I l l Open Space Footage % ri. (Lot area minus bldg&paved ? ` I 3 parking) #of Parking Spaces 1 1 I ' r Fill: ' i ! , li i (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: j IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 I Page! and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 NO (0 - IF YES, describe size, type and location: 1 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,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 , NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15,2000 r.. SECTION 4-:,CONSTRUCTON SERVICES FORPROJECTS>•ESS THAN 35,000 CUBICFEErOFENCLOSEDSP..ACE • , Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ i Brief Description Enter a brief description here. Of Proposed Work: SECTION'S-USE GROUP AND CONSTRUCTION'TYPE , - USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ IA i El A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ 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:I ' j M Mixed Use 0 Specify: i S Special Use 0 Specify:1 r COMPLETETHIS SECTION iF.EXISTING BUILDINGU NDERGOING.REIyOVAT1ONS,ADDIT(ONS.AND1UR-CHANGE IN USE _ t ., . Existing Use Group: I I Proposed Use Group: Existing Hazard Index 780 CMR 34):` I Proposed Hazard Index 780 CMR 34): d l SECTIORSBUILDING HEIGHT:AND AREA; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION c ,.: Floor Area per Floor(sf) = " � ��- st . ' Wes.. ,8 ,o "`` 1St 1 ��. w ,,,' -y -'=^a ; ,, ry k nd j i : .s+?; 'r r' .,3 - 2 y8, ;" 3rd I km €1 i 4tn i 4 I ,r -" , Total Area(sf) l I Total Proposed New Construction(sf) 4i. + its ` Total Height(ft) �` - � 17 Total Height ft ,.�- ,� 1 . t 4.t 2 arm w 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone l ! Outside Flood ZoneD Municipal ❑ On site disposal system Version1.7 Commercial BuiIdin_Permit Ma 15,2000 I: City of Northampton 4�Q 1-- ,21'741',..1-7,7-. Building Department ;.---- ,- z 212 Main Street °c '1 - , '1, ,i - -- i Room 100 s 1-F4,-{ . Northampton, MA 01060 b� : '�:mmm c. a ram s �rfi'l'=`� � � ..� r` w phone 413'-587-1240 Fax 413-587-1272 �F� � a - A` = APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING .,SECTION- SITTFINEORMATIOM . ",, s�section,tole.completed;by-office ----A TI-Property-Address- n.. s..._ __-. : , - %---:-F, -i ,,,,,,,,,.. -- f ..3 ?,� M /r© f/t i P i 4. tO r 3 'rte _ r e/o/6 v i,� '. k"..,,,w"` ., E .IS .+... : . ' a .. ,.tsP- of t Distnc --CBDist ictL SECTION`2 PROPERTY -:=,-Z-7.-'..- 2.1 Owner of Record: t Iii '".. I /`/— ° r i I Name(Print) ' . Current Mailing Address: D / I j Signatu/- ` _. Telephone 2.2 Authorized Agent: .- .e/ G P-Een/ Name(Print) Current Mailing Address: Signature . `,,.A/ Telephone 7131 .......31-C7 4-0/ I --SECTION 3 'EST1MACONSTRUCTIION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant .:°_. ._ I. Building / i -----j ( Perm a)Building it.Fee ' 1 . f Y 2. Electrical ,.. i (b)Estimated Total Cost of 7,5 Oa I `Construction from(6). 1 3. Plumbing O� ---3 Buildings/(.a ,it__ ee /.Q•!Z' 4. Mechanical(HVAC) l ,�– ; � fp�� � 5.Fire Protection 2 J' J, j „�'7 � i 6. Total=(1 +2+3+4+5) Z4 — -Check Number . . . :.._ •_ _ f. This-Section"ForOficial Use Only Buildi ng Per nit Nuiiiber� Date ts`sued Signature: SS.[.- /MAT `Y/ (_,E/ 5 i s Building Commissionerllnspecfor of Buildings Date 4 • Versionl.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 ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Sheri L. Green , 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 un the ns a penalties of perjury. C: Print Name 03/14/2008 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Sheri L. Green CS 082702 License Number 15 Harva d St outh Hadley, MA 01075 ® 01/17/2008 Address Expiration Date (413) 531-0807 c . 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 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 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 Choice Property Enhancement Inc. Not Applicable ❑ Company Name: Sheri L. Green Responsible In Charge of Construction 15 Harv. d St South Hadley MA 01075 Ads rei - , _ (413)531-0807 ignature Telephone Version1.7 Commercial Building Permit May 15,2000 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 0 DONT KNOW 0 YES 0 IF YES, date issued: 01/26/2007 IF YES: Was the permit recorded at the Registry of Deeds? NO C DONT KNOW 0 YES 00/13"-ti IF YES: enter Book 32c Page 177 and/or Document# JS-2007-0011 B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 Q , Date Issued: C. Do any signs exist on the property? YES NO (3 IF YES, describe size, type and location: C J SPRONG 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, excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version!.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations GI Existing Wall Signs ❑ Demolition❑ Repairs o Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Enter a brief description here. Construct office Partions Of Proposed Work: 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 ❑ F Factory ❑ F-1 ❑ F-2 El 2C ❑ H High Hazard ❑ 3A ❑ 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 El 5B l ❑ 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) 1st 1st 2nd 3,600 2nd 3 3`d rd 4th 4th Total Area(sf) 3,600 Total Proposed New Construction(sf) 2,448 Total Height(ft) 12 Total Height ft 12 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public p Private ❑ Zone Outside Flood Zone p Municipal p On site disposal system❑ Version1.7 Commercial Building2Permit May 15,2000 Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability 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 304 pleasant St Map Lot Unit Northampton MA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Mark Naidorf p Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Sheri L. Green ® 15 Harvard St South Hadley MA 01075 Name(Print) Current Mailing Address: (413) 531-0807 Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $5,000.00 (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 #52)6. Total=(1 +2+3+4+5) Check Number 5 1 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date . t BP-2007-0746 GIS#: COMMONWEALTH OF MASSACHUSETTS %v , . CITY OF NORTHAMPTON o:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-0746 Project# JS-2007-001159 Est. Cost: $5000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SHERRI L GREEN 082702 Lot Size(sq. ft.): 18338.76 Owner: CHERRY REALTY INC Zoning: GB Applicant: SHERRI L GREEN AT: 304 PLEASANT ST Applicant Address: Phone: Insurance: 15 HARVARD ST (413) 531-0807 SOUTH HADLEYMA01075 ISSUED ON:1/26/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 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: 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 1/26/2007 0:00:00 $100.001004 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo