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32C-030 (10) • IS BREWSTER CT BP-2002-0577 GIS#: COMMONWEALTH OF MASSACHUSETTS `,. 1+ :: C} xyi ; CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0577 Project# JS-2002.0897 Est. Cost: $500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS KORYTOSKI 070047 Lot Size(sq. ft.): 4268.88 Owner: BESSEMER TRUST CO-TRUSTEES Zoning: CB Applicant: THOMAS KORYTOSKI AT: 15 BREWSTER CT Applicant Address: Phone: Insurance: 95 FERRY ST (413) 582-9970 EASTHAMPTONMA01027 ISSUED ON:12/17/01 0:00:00 TO PERFORM THE FOLLOWING WORK:MOV E INTERIOR DOOR 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/17/01 0:00:00 6228 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2002-0577 APiPLICANT/CONTACT PERSON THOMAS KORYTOSKI ADDRESS/PHONE 95 FERRY ST (413) 582-9970 PROPERTY LOCATION 15 BREWSTER CT MAP 32C PARCEL 030 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �� Fee Paid Typeof Construction:_MOVE INTERIOR DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070047 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF I7ATION 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 Stree s 'ssion /21.7/iC)C9 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. Version1.7 Commercial Building Permit May 15,2000 ,� t-- L t F'.--3'1 `:�0 s C \ �1 \'I .,4& �.. �, a�s ' - �- , .35t.'� �; '1 �� , i of Northampton . ,4.Y ,� n �, : v 4 S , 1 hgx� :. � i� Ling Department _ x 1 1 i! ' 2 Main Street .t.l DEC 1 m T j � Room 100 i� L-- rth.mpton, MA 01060 T +$)-'1, ; :r,¢ `_. pf!iD4,4;13-58 -1240 Fax 413-587-1272 Plo -Sate 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 /1 . 6 / Q/� (} ( _ Map 3.i090 Lot '3 6 Unit 4-if 4�s 1,1,,f r -4A III 4 di 41 , e Overlay District • f Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: )7i A I 4, 1 ,."' • ,Irla& Qcto)Qc ,g(, :,t iit6e3 (:(c( ( Name(Print), urrent Mailing Address: `-, 7 JO `C( � 54ga ee3 Signature Telephone 2.2 Authorized Agent: eQ X 06 ame('rint) , / Current M Gaellie- g Address: 1 ,yt f4©<an/J_; A / ifiJI Signature /411:1,m ,N.,`— Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ----CC s (a)Building Permit Fee 2. Electrical •J (b)Estimated Total.Cost of Q Construction from(6) 3. Plumbing dLC5LO/ 711J ' ' } Building Permit Fee 4. Mechanical (HVAC) _ �CJ�— 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) Check Number ,� '"'" This Section For Official Use Only Building Permit Number: 06 7 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Version1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE terior Alte - on Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ ❑ erior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] S DEC2 - —Tr '3; S •r . 0 , .�1► •• SECTION 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 El 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ 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 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 <, --q',0,/,`", 0 OFFICE US ONL' k %, ay / .E ,xs b, Mi 4 rt'i/4T �'x' J�y y Floor Area per Floor(sf) xf``y ' r iw 1st i f �v ,, / ai�€< � a�l l ",,,!/2...,- r"p. �,�, + ti y , 1st 3rd s 3rd 4th y �' y4 9� "1 , 4 �; .4th -5--'0r- , .� Total Area (sf) Total Proposed New Construction (sf) -'.$} a Total Height(ft) g''m $� g � Total Height ft �� s =y Versionl.7 Commercial Building Permit May 15,2000 7. Water Supply(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: • . L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: _Svolume&Location) _ A. Has a Special Permit/Variance/Finding ever been issued for/on t site? NO DON'T KNOW YES IF YES, date issued: 1114 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 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained ate Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: 4-e)1ACLANS S (.r '1,Q 4.Rwvi- D. Are t e any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: 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 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 1 /Au/ . � I - Not Applicable I=1 C.mpany e: / Responsible In Charge of Construction dIP Ad.res/ Sig, ure Telephone • 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 ❑ SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �- I, ✓& ( / / -1 , as Owner of the subject property hereby authorize .I to act or my behalf, in all :tter� elativ- -: wo, authorized eldig/�erfnit ppli ton Signature of • Date c / I, AWL,.4fLO ■ IA Lai/ /_. y �i 1'i / , , as Own- l is • -d A_ent hereby •eclar. that the statements - ne inform.-tion on the forege/ng application are true and accurate, to - _ : - . knowledge and belief. Signed unr the pains and penalties of perjury. Print Name d,o, / J O Signature of Owner/Agent _111111�, s4 — Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Su./ rvisor: Not Applicably Name of License Holder : .4111/Midi 4 I p, • 4& 1 C KO—(7 , I 7/14•3 —",,,,..1_2-7 License Number - / /7/0 Add (1:74............_11 I - 4(11 t/ Ql Expiration Dat ignature 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 affidavi. will result in the denial of the issuance of wilding permit. Signed Affidavit Attached Yes No ❑ B E. Crztg xrf Nt r#IJam ttttt 1 =*°b"Pt AA:4k 0 f. aSSac rttS °_: y/-f•°* °11 s = DEPARTMENT OF BUILDING INSPECTIONS •_,;1t1 212 Main Street • Municipal Building 'e Northampton, Mass. 01060 �' to WOREERIS COMPENSATION INSURANCE AFFIDAVIT I-, s :11.(A0■wit.i I /L�1 0. !_'a 1LJ �rd' • . I (licensee/,, es i ttcc) with a principal place of business/residence at: /5 ZAge,ui/ e g l a l0� (phoney#) 0 Opl 70( city/state/zip) do hereby certify, under the pains and penalties of perjury, that: .- ( am an employer providing the following worker's compensation coverage for my employees working on this job: /k-C) a1/1- r-6'"A % Wee :14 0, (.4 ' /7 0 a (Insurance Company) (Policy Number) (Expiration Dare) ( ) I am a sole proprietor, general con actor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Compa.ny/Policy Number) (Expiration Date) 'r (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Com-pany/Policy Number) (Expiration Date) (attach additional sleet if necessary to include infocmuion pertaining to all contractors) ( ) 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 rrraintrnxrur,construction or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally considered to be employers under the worker's onmpeusation Ad(GL152,ss 1(5)),application by a homeowner fora 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 rho Deparmsast of Industrial Aocidmts'Ofoe of Insurance for the coverage verification and that failure to secure coverage under section 25A of MCL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S1,500.00 and/or' ......... of up to one year and civil penalties in the form of a Stop Work Order and a fine of 3100.00 a day t... me. For departmereal tae only i Permit Number A _= I l_l �/ Map# Lot# Signature .f Li / M: ire a:1:-;:a Licensee/Pc n,. . . . �7 Si ` A L- ____---------J -,'`- �. �`� '? �?� | ' ' ' ^---- --� ------- ' r--- ` -_`� c...' \,.............. J\ 111:7) -7- ) ` ... 1:) \ ~~---- ....3___ v p_....c, ` ~ c5> r