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32C-108 BP-2008-0599 GIS #: COMMONWEALTH OF MASSACHUSETTS 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-2008-0599 Project# JS-2008-000927 Est. Cost: $13000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT PEABODY 091989 Lot Size(sq. ft.): 14374.80 Owner: SMITH STREET ASSOCIATES LLC Zoning,: SI Applicant: SCOTT PEABODY AT: 36 SMITH ST Applicant Address: Phone: Insurance: 30 SUGARLOAF RD_ (413) 695-3344 SOUTH DEERFIELDMA01373ISSUED ON:2/26/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO & RENOVATE OFFICE SPACE 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 2/26/2008 0:00:00 $65.003359 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2008-0599 APPLICANT/CONTACT PERSON SCOTT PEABODY ADDRESS/PHONE 30 SUGARLOAF RD SOUTH DEERFIELD (413) 695-3344 PROPERTY LOCATION 36 SMITH ST MAP 32C PARCEL 108 001 ZONE SI THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 33 6-Q Fee Paid ''JJ (B Typeof Construction: DEMO&RENOVATE OFFICE SPACE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 091989 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: L —T 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 Demolition Delay 0 2/2_0 e, 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 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 _ __{ ._Q eify_-: APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OC P4NCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWOTAMTCYDWELL7NG 1 ISECTION 1 -SITE INFORMATION i . 1 2008 ' This section to be completed by office 1.1 Property Address: J _ • pr - C , ,J Lot Unit sm��� S�, p I-9 ° 0i0o0 \iOr A'r\4/19 tiiil, 004 4 C Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OW■ERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5 el a el‹..>1. s 6.1 mac,... 14r S r,,Ic- . sz Name(Print) „SCtiA•\n S Irntjul% rbo 2,10G.` `" Current Mailing Address: �-"\\ — 51.67 2,55' Signature 4—Sa.."^-1--- -------- Telephone 2.2 Authorized Agent: ..A.. ,- ZvV S tom,%k*k•-■. b-c" Name(Print) Current Mailing Address: L\- - 5 v 353$' Signature J Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building /; (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of j10G� Construction from(6) 3. Plumbing 7s_ �� Building Permit Fee 4. Mechanical(HVAC) ®s 5. Fire Protection -75-(2`� 6. Total=(1 +2+3+4+5) ` Check Number 3&5 046--"---- This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version 1.7 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 0 Demolition❑ Repairs El Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other 0 r Brief Description Enter a brief description here. Oerr l �ior1 c - S�rw1 )r) rwr lam/ S '0 Of Proposed Work: a.ceOm og le newi-r . ert.41{lei' O -cearei. , . SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly n A-1 ❑ A-2 ❑ A-3 CI I 1A 1 ❑ A-4 ❑ A-5 ❑ 1B LJ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 X 2C ❑ H High Hazard ❑ - 3A ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 0 R-3 ❑ 5A i ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ 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: GIG F^vG „ Proposed Use Group: Existing Hazard Index 780 CMR 34): 3 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) f) GI 1 Pk) Gh`on e- jlw c� 1' 151 2nd 2nd 3 d 3rd 4Th 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water upply(M.G.L.c.40,§54) 7.1 Flood Zone information: 7.3 Sewa e Disposal System: Public Private ❑ Zone Outside Flood Zone Municipal On site disposal system❑ Versionl.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 in er toc 11CA 1 3-i41^� Setbacks Front �el 7- / Side J W zoh n or Vise j � Rear C7 roH C e Building TTaighr 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 CD DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (9 YES (3 IF YES: enter Book 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 (3 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 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. 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 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 Not Applicable❑ Company Name: Responsible In Charge of Construction Address Signature Telephone 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 Q SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 IAgent 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 ❑ Name of License Holder: lt I+- GS !i9 License Numbe Address Exp.ation D to iL,.._ �/36 y . Signature Telephone SECTION 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) I I i 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 The Commonwealth of Massachusetts ;-,,, - Department of Industrial Accidents Office of Investigations , .~l 600 Washington Street "! Boston,MA 02111 " www.mass.gov/din -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (r�t Please Print Legibly fl ame(Business/Organization/Individual): 3 n d i c C.. Sit`... Address: -- („ S M‘,N b T r\.) I. .-- p-ch o„Oc.o City/State/Zip: Phone.#: L---\\c1 - S ii-(v - d S Are you an employer?Check the appropriate box: Ty-pe of project(required): 12^I am a employer with ''yS 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Q New construction 2.❑ I am a sole proprietor or partner listed on the attached ghee 7-AMR.-modelii7 ship and have.no e.:loyees These sub-contractors have S. ,®''Demolition 1 working for me in any capacity. employees and have workers' 9. []Building addition [No workers'comp-insurance comp-insurance-} required.] 5. Qe are a corporation and its 10-Q Electrical repairs or additions 3.Q I am a homeowner doina all work officers have exercised their 11.Q Plumbing repairs or additions myself. [l�o workers'corns- right of exemption per MGL c. 152.§1(4), and we have no 12-[]Roof repairs insurance required.]t ' 13.❑ Other employees. [No workers' comp-insurance required.] Any applicant that checks box#1 must also fill out the soon below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and that hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must arn+ched 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: fl L AA„.mot.\ a �1 S ,. Go \ ? S/?C,.- Policy#or Self-ms.Lic. il: W C 72.S O\( Expiration Date:- "_\2 Q'\off' Job Site Address: '. L .,Mt` 11-• -- ©\C C 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement Tray be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the pains an. ••n• "ivy that the information provided above is true and correct Sienarare: Date: Z� •B Phone T: - `J Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitfLicense T 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=: