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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 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Janet Gezork
S c'e'/ L L
�j C as Owner of the subject property
hereby authorize Richard H. Stanton to
act on my be If, in all matters relative to work authorized by this building permit application.y �1I
Signature ner Date
Richard H. Stanton ,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 pains an/d/ enaltiies of perjury.
Print Name,
Sig ature of Own /Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction eSupervisor:
Not Applicable El
of License Holder: A fT'Ci✓` • ✓�t 4 4 r ��
License Number
141,541 c s• S 7 g
Address/7 G A 1 y v ✓ Expiration Date
yrS7F,,Ec �� rrr eft3 • S31- t2Gg 6 . 24 - o14
Signtyre, ` Of 0(+ s Telephone
/10/Z —
SECTION 13-WORKER 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 O
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 0
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
Stanton Contracting
Not Applicable ❑
Company Name:
Richard Stanton
Responsible In Charge of Construction
147 Tanne Rd,Westfield,MA 01085
Add -ss ,
/ /r/ (413) 579-7489
Signature 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 Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T 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 0 DON'T KNOW ® YES 0
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 o NO 0
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,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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 0 Existing Wall Signs ❑ Demolition 12 Repairs 12 Additions NI Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Demolition and replacement of two sheet rock walls,build one closet,installation of flooring and baseboard,add
Of Proposed Work: one door,level floor in front office,relocate receptacles and lights as needed,relocate one vent and one return
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business 0 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 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 740 1St 740
2nd 2nd
3rd 3rd
4th
4th
Total Area(sf) 740 Total Proposed New Construction(sf)
740
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 p Private ❑ Zone Outside Flood Zone ig Municipal a On site disposal system 0
Version1.7 Commercial Buildin%Permit May 15,2000
Department use only
ty of Northampton Status of Permit:
I B ilding Department Curb Cut/Driveway Permit -
A��i 2 99 212 Main Street Sewer/Septic L GYW Room 100 Water/Well Availability
No hampton, MA 01060 Two Sets of Structural Plans
DEPT.OF Eu LDiNG∎%:>i-ECTIO
NORTHAMPTON, F 5413 .87-1240 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
4 Market Street Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Janet Gezork ft,.-9-6 Mn..l{e J- ���f 1...i._C. 26 Market Street,Northampton,MA 01060
Name(Print) Current Mailing Address:
A47501._ (413) 586-9231
Signature 7 �'- Telephone
2.2 Authorized Agent:
Richard H. Stanton 147 Tannery Rd,Westfield,MA 01085
Name(Print) Current Mailing Address:
(413) 579-7489
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $8,275.00 (a)Building Permit Fee
2. Electrical $1,000.00 (b)Estimated Total Cost of
Construction from(6)
3. Plumbing $0.00 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection $1,000.00
6. Total=(1 +2+3+4+5) 1 2), ) '• 1 Check Number lQt& to
This Section For Official Use Only f
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0219
APPLICANT/CONTACT PERSON RICHARD STANTON III
ADDRESS/PHONE 147 TANNERY RD WESTFIELD (413)579-7489 0
PROPERTY LOCATION 4 MARKET ST
MAP 32A PARCEL 100 001 ZONE CB(99)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST z
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
6
Building Permit Filled out
Fee Paid /0/L `g
Typeof Construction: DEMO&REPLACE 2 WALLS,CLOSET,ADD DOOR
New Construction
Non Structural interior renovations
/Vie A/'Addition to Existing (((,,,///
Accessory Structure
Building Plans Included:
Owner/Statement or License 082078
3 sets of Plans/Plot Plan
THE FOL OWING 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
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
o iti•n Delay
411110°.:/, or-l3
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.
4 MARKET ST BP-2014-0219
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 100 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-2014-0219
Project# JS-2014-000363
Est.Cost: $10257.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD STANTON III 082078
Lot Size(sq. ft.): 3484.80 Owner: FOUR MARKET STREET LLC
Zoning: CB(99)/ Applicant: RICHARD STANTON III
AT: 4 MARKET ST
Applicant Address: Phone: Insurance:
147 TANNERY RD (413) 579-7489 ()
WESTFIELDMA01085 ISSUED ON:8/30/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMO & REPLACE 2 WALLS,CLOSET,ADD
DOOR - NO CHANGES TO EXT FACADE
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 8/30/2013 0:00:00 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner