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II 44 stet= � y" ',.-4.,2,4,,,,..31,0,1. * s „> -- - _ ,•, ;A.: J x �.._:a.''� a.-_ y ` _ s S'.?:'k.a•`s, '""R 3, chi `" 't s"c �;!� i t't YL - {n � ' ` „, aC° '1 +, ' t k".'€- C 9 �, amzs v -v, ", '} y. is s" 3 ,3"kM h s< r ESA, > „,,,-;,-4,w..1.� ?gip°#' '`S ;r,• _• s'k'is •€ nQ� r .l �;I. �r.� ' yo r �r ti w:.. xa. 9 ..x Y - # r 14,3> fie i�{i. ± A*'.' u t r 3, r 1 < 'f? _.t ., 'k'Y3.:a.,Y �c ,�.•iE'... .T.` 3. ' 4.1„:7,7...;,-.1'4 ylE' ' r. .' .'(,Z_�(j,..St ”.-'i,"-..x • '' S .,•.n ,. '� fi J+ �#.. _�.k '.:44;%„";:".'-,,, :t h,' . Xtb i. '. t l `f 3xi4k.:'iix xi:e i'^a^ ::�w!>L;M �."- t- ,; tr u,y > +-s'r •lt c;: ,..:yxs.. af. 1, --„,e 1 K`4 3.: ,..;;•: , s_ y x is .. 3 3. ,,,,, ,;, 'R.r --C +': x 't ...:( »i k ” ! a. x X w s . ��Wl9. t { ,s ,.� V •S fir'. a •t" ,' os I '`R`° The Commonwealth of Massachusetts , +�z Department of Industrial Accidents 4:Q�. .. Office of Investigations 4 , `, r' 600 Washington Street Al': Boston, MA 02111 f : \ztli.,-7,1: 17 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): J� b5, JJ _ Address: pl I V c) 'cr 0,,.A., /re i✓ 3 7 City/State/Zip: -e✓ II f Phone#: / (� p 5/. A Are you an employer?Check the ap,ropriate box: Type of project(required): 1.❑ I am a employer with 4. 1:1 I am a general contractor and I 6. ❑New construction mployees (full and/or part-time).* have hired the sub-contractors 2._© I am a sole proprietor_or_partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees 8. E]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 officers have exercised their 11. Plumbing repairs or additions 3.C] I am a homeowner doing all work ❑ myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §I(4),and we have n o employees. [No workers' 13.❑ Other 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: �e 441D Policy#or Self-ins.tL�icc.#: Expiration Date: n J / Job Site Address:/ // /V ��'1 3( �����Ct City/State/Zip: ` 55 0/dL 1" 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 vio . .r. Be advised that a copy of this statement may be forwarded to the Office of Investigations oft the DIA for .i.. ...ce coverage verification. I do here, ' ., rtify • t .40's and penalties of perjury that the information provided above isltrue and correct. Siena: :�iL� Date: /L' / — 0 Phone p- - ! P #: ,7Y ,j n 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 7 PEER REVIEW( 00.CNIR110:11) .:., .. ... . ....: ...:-' . Independent Structural Engineering Structural Peer Review Required • Yes 0 No 0 SECTION 11 -OWNERAUTHORIZATION--TO pE:compLETEp...yntuu. .. ... OWNERS AGENT OR CONTRACTOR APPLIES FORI3UILDING PERMIT . I, :_ - . ,,as Owner of the subject property hereby authorize i to act on my behalf, in all matters relative to work authorized by this building permit application. . Signature of Owner . Date -- se" 11q, 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 the pains and penalties_ofserjury. 4- ve_ RA;Nsaiv ...__ 45,,........_.._...._, ,........ i( P e.d2 nt Name ,irsr,.. &/0 Si ure of Owner/Agent Date SECTION 12-CONSTRUCTION.SERVICES Not Applicable El 10.1 Licensed Construction Supervisor: A16Yd ( t Name of License Holder:j,..,, r.1.. ____ f..",....„ — .1. _s__,.._:____.___-____—_________,.,: ; License Number ,--__-_,_---__________ _____ ____ __„ ______„_,__ ___________ _ __-----i Address Expir on Date 19.i " Ova A VI i v r— L 10_ 8-c- Si,ga- Telephone (/ ___,. _-.-- -■•011"' - 11. SECTION 13-WORKERS!COMPENSATION-INSORANCE. FFipAlin710:Q.L.:c:..152,§25C(6)) Workers Compensation Insurance affid it must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b "ding 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 E?JSLOSED;SPACE) 9.1 Registered Architect: i Not Applicable ❑ __._.__._____ Name(Registrant): t ---- Registration Number Address ._ __ ___ _. _ _..._____..: Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility t I Address Registration Number Signature Telephone Expiration Date I Name Area of Responsibility Address • Registration Number __ __ Signature Telephone Expiration Date Name __ Area of Responsibility 3 _...__.._._,._.. .. A Address Registration Number _..__ _ , ______ Signature Telephone Expiration Date Name Area of Responsibility t Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor .._.. J✓r. _.._.W_ U _ ..___._., j Not Applicable ❑ Company Name: _ _ r._. _ __. v to _a p 10 Al-t _ _______._._ Responsible In Charge of Construction rn0 v Ai-.grata ; S__ _ILL 21.10 Io? Ai ,. __�> KID`1� "1(S /i Signature �� Telephone A ,rZo 1rc a/Ass 7 4c- 3 90 Rive /folyoff( n1 - 7/) L53227 57 Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON.ZONING Existing Proposed Required by zoning , This column tb lie filled in by Buil ing Department Lot Size _ .m___ _ ' _ ---. Frontage _ _ _..__.__ ., Setbacks Front ' I f Side L:= = R:_ L:l 1 R: _ �j _ I Rear ___.. ~. • Building Height .. . _ Bldg. Square Footage ? ?` _ % # _. . Open Space Footage __ l Lot(Lot minus bldg& ed r Iw. parking) #of Parkin; paces --- i 1 Fill: ; ; _.... (volume&i Location) _. _._._ _ w_ --- 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: ' i I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES _,_. _, _,_......_ 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 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: A__ C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: r D. Are there any proposed changes to or additions of signs intended for the property? YES (3 NO 0 IF YES, describe size, type and location: u 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. Version1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 't CUBIC FEET OF ENCLOSED SPACE .w.. Interior Alterations ❑ Existing Wall Signs ❑ Demolition 0 Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Descriptio ;Enter a brief description here. Of Proposed Wo 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-i ❑ S-2 ❑ 5B I [T-- U Utility Specify:W _.-. M Mixed Use ❑ Specify:1 S Special Use ❑ Specify:i _. ....._.._-..._....._�.. ........_...�..._..�._.__.._...-_.,_.___...,..__., µ 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): .M._W _.:,,______ Proposed Hazard Index 780 CMR 34): _ .,,..,____ -,. ____j _. SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st ...... .. _.. _ 151 ;mm - 2nd 2 3rd 3rd ... 4th _ 4�' ____—__ _______.._._.._______..___ Total Area(sf) Total Proposed New Construction(sf)_ Total Height(ft) -- Total eight ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zoneelnformation: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone _______ , Outside Flood Zone❑ Municipal ❑ On site disposal systems Version1.7 Commercial Building.Permit May 15,2000 - ' r y 7AV 3 r ran-'� �`�Departmeht use#orilyr` '•..�� it:(11` Gi of Northampton tatic§f PerrrEt ' y k 8 "e '0 s� `:3 t p �.._ r -rat,,' ,-, 'kd r .�` ? ,,1„,,+ s #,# ,� Qv I I �►3 Bt 4.� ing Department Curb Cut/DnueWay�Pererut.: ,, - r ; ..�L 2 Main Street SewerfSept�cAva�labilr#y f �[° Electric, Plumbing f Room 100 Water/Well Availability " 9&Gas Inspq�q 3 ' Northampton, M. 0706tl" h mpton, MA 01060 Two'Sets of Structural Plans: phone - 7-1240 Fax 413-587-1272 PloUSite Plans Other Specify f « , 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: V 11.'( N• ✓v.A1.N ST , s Map Lot Unit i F 10I C nl e'C ✓Yl/1 % Zone Overlay District Elm St District. CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT .• • V2.1 Owner of Record: __ ..,....„._.kow1/4-S N2 v to`-..._.._ Name(Print) Current Mailing Address: Signature I� Telephone hH W 2.2 Authorized Agent: _ ,5-4-GVt- D iS ,.. od/Qsfi/ X Name(Print) Current Mailing Address: ,._.�.._ �f 3 —�-L q-a-1..Dµ M__ x_ ___....mm._ ' Signature Telephone SECTION 3-ESTIMATED:CONSTRUCTION-COSTS Item Estimated Cost(Dollars)to be Official Use,Only completed by permit applicant - 1. Building - a/A S S �.o q o O —1 (a) Building Permit Fee 2. Electrical ; (b)Estimated Total Cost of Construction from(6) .__.._____.__ 3. Plumbing Building Permit Fee ii,...........Es..„__..__,, 4. Mechanical(HVAC) 5. Fire Protection /i _ 6. Total=(1 +2+3+4+5) (A Q Q 6 Check Number $/3 r This;Section For Official Use Only. Building Permit Number Date -•Issued Signature:__ Building Commissioner/Inspectorof Buildings Date File#BP-2014-0409 APPLICANT/CONTACT PERSON LIZOTTE GLASS INC ADDRESS/PHONE 390 RACE ST HOLYOKE (413)532-2737 PROPERTY LOCATION 141 NORTH MAIN ST MAP 16D PARCEL 022 001 ZONE URB(292)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out D 16-5— Fee Paid Typeof Construction: REPLACE FRONT WINDOW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 072931 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ON 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 �- . it�•lay a - r—/LS Signs f Building i f icial 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. 141 NORTH MAIN ST BP-2014-0409 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16D-022 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-2014-0409 Project# JS-2014-000700 Est. Cost: $6900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LIZOTTE GLASS INC 072931 Lot Size(sq. ft.): 24611.40 Owner: KIRKPATRICK REALTY LLC Zoning:URB(292)/ Applicant: LIZOTTE GLASS INC AT: 141 NORTH MAIN ST Applicant Address: Phone: Insurance: 390 RACE ST (413) 532-2737 HOLYOKEMA01040 ISSUED ON:10/7/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE FRONT WINDOW 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 10/7/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner