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32C-104 (16) . ...... ._..._....7 ._....... __ ,..._................,...... .... ........7' . ... ..y....�., A` IMPORTANT if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) 3 �+ DATE;MM/DDIYYYI() ACORD CERTIFICATE OF LIABILITY INSURANCE � ,OP ID 0$J24/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AXiA Insurance Svc B.I.S. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 73 Market Place ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield MA 01103 Phone:413-205-2942 Fax:413-886-0190 INSURERS AFFORDING COVERAGE NAICit INSURED ---- INSURER K Il-I.tl_mutual Inauxance CF_ INSURER 8. MD Enterprises Inc. Joe Miller INSURER C. 56 Jackson Street INSURER —__-..-- Holyoke MA 01040 — INSURER E_ COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PCIICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF RICH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSK nDCTLI POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MNIDDIYY) DATE(NIMIDOtYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE I$ DAMAGE TO RENTED COMMERCIAL GENEP.AL LIABILIFY I PREMISES(Ea occurence) $ ICLAIM'MADE OCCUR j MED E#.P(Any one person) $ j -— - - - I PERSONAL tr ADV INJURY $ GENERAL AGGREGATE $ GEH'LAGGREGATE LIMIT APPLIES PER I PRODUCTS COMP/OP AGO $ �-1 POLICY ,RIERCOT r I LOC AUTOMOBLE UABILITY COMBINED SINGLE LIMIT ANY AUTO I(Ea accident) - ALL OWNED AUTOS I BODILY INJURY SCHEDULED AUTOS (Per parson) HIRED AUTOS I BODILY INJURY NON-OWNED AUTOS (Par accident) $ l PROPERTY DAMAGE (Per accident) GARAGE LIABILITY j AUTO ONLY-EA ACCIDENT $ ANY AttrO EA ACC OTHER THAN AUTO ONLY AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR II CLAIMS MADE ,AGGREGATE $ DEDUCTIBLE $ -RETENTION $ $ Wt.STATU- UIr- WORKERS COMPENSATION AND TORY LIMITS A EMPLOYERS'LIABILITY WCC 5005499012006 07/01/07 07/01/08 E.L.EACH ACCIDENT $500000 I ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED"-, E.L.DISEASE-EA EMPLOYEE $50000D If yes,describe under I SPECIAL PROVISIONS.below E L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION woi iz I'' SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE TFE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WROTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR World War II Club 50 Conz St REPRESENTATIVES. Northampton MA 01060 AUTHORIZED REPRESENTATIVE Michael Long ACORD 25(2001108) O ACORD CORPORATION 1988 t , The Commonwealth of Massachusetts Department of Industrial Accidents II >_ :l Office of Investigations =e ,1� ' 600 Washington Street °Fet_=. tl Boston,CIA 02111 l'4* www.mass.gov/dia :Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organi72tion/Individual): NA,Ik-L6 Address: Slip mil.( /C,S.0 t) -i City/State/Zip: ka't t.6- i `i's. Phone#: 4(3- S 5 2 4 l \4 e • . an employer?Check the appropriate box: Type of project(required): 1.V.1 I am a employer with (D 4. Q I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. • New construction 2.U I am a sole proprietor or partner- listed on the attached sheet 7. In Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any capacity. employees and have workers' comp.insurance.$ 9. Building addition [No workers' comp.insurance mp. required] 5. Q We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.Q Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself [No workers'comp. right of exemption per MGL 12.Q 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. :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: /11-51.50C ited t pr O y S J/ Jrc_Aiv e: • Policy#or Self-ins.Lic.#: 091 9 [O I o2O 0 7 Expiration Date: 0 7/0/ / ct Job Site Address: So 1. .yZ S• • City/State/Zip;)aZ(-t'.pre-A) ( & 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 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: -r---( tee-, Date: Ax 2 G 2c D'7 _ Phone#: q( • 55Z'4( 14 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 i.. SECTION.10=.:SrRUCTIJRAL.PEERREVIEW(780 CMR 1101t} Independent Structural Engineering Structural Peer Review Required Yes N SECTION 11 OWNERAUTHORIZ.ATION-TO-BE-COMPLETED"WHEN 3 OWNERS AGENT OR CONTRACTOR APPLIES FOR-BUILDINGPPERMIT 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 1,1 T"0T 1`l 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. Sisned under the pains and Penalties of•e'u . Printima 42 9 as Signatu - of Owner/Agent Date jam)(' 277 Q�7 -SECTIOICI2,-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: 1' Not Applicable ❑ ��. � M�U1� i Name of License Holder:� t 1 License Number Address 5 EonDa )te 4 4 0 l7r011..E. ik-A O 40 '9'/ tO? Signature Telephone SECTION 13-WORK S-COMPENSATION INSURANCE AF.FIDAVIT'(M G•L.:c;152A 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 0 r Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FORBUILDiNGSpAND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL;PURSUANT TO 780.CMR 116(CONTAINING MORE THAN 35;000.C.F_OF ENCLOSEDSPACE) 9.1 Registered Architect 10 l ; Not Applicable ❑ Name‘Registrant): 1 Registration Number Address I.u4' NjoitAlk d- ST 1 I Nor: 1�l7� Vim, i e 0Th 1 Expiration Date.. Signature Telephone 9.2 Registered Professional Engineer(s): ; Name Area of Responsibility j ; I Address Registration Number j I , Signature Telephone Expiration Date Name Area of Responsibility r Address Registration Number t Signature Telephone Expiration Date - 1 i Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date f 1 t 4 Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date 9.3 General Contractor M1Il/i t ,Vt.'O.0N K�/ b1 V1S 1 J Of Us L... coos-T. sive -Not Applicable❑ Company Name: ` i S s-Aucson3 s<"-- Responsible In Charge of Construction RD 1 Cf'l.:.■r ? &j 0 (.0 4 0 i Address ,f ,, ( , 5Sl- 41141 `Signature Telephone l-c.6'c-')k-35e-• *P- Q l 5 3 z)1 Versionl.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front 1 I Side L:' R:1--.--1 L:■ IR:i 1 I Rear r —$nildmg Height : I E } i Bldg.Square Footage i I i % - i f + j ,, ` Open Space Footage % (Lot area minus bldg&paved 7-7 parking) #of Parking Spaces 1 i Fill: ' I (volume&Location) �' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0,w4 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Re 'stry of Deeds? NO 0 DONT KNOW 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 0 YES er 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 I NO 0 - IF YES, describe size, type and location: ; 'Bt.', IA,,K,,V lj 1,t21,■1 D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 1Ct" IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing,grading, c tion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® ` NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. t e Version1.7 Commercial Building Permit May 15,2000 SECTION 4 G::ONSTRUCTION',SERVICES.FokPR.0 ECTSztESS THAN 35,000 CUBIC FEETOF ENCLOSE© PACE` Interior Alterations Existing Wall Signs IR Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description :Enter a brief description here. PP.r.�rJs-`1'-.4.9 , C (L4 G T► l.� , Pc'u`'��`'t' Of ProposedWork:i X� ..4 6e,e�1it _ (�(2•1 />..x.4 C.�►�i A -lp FA►n�Q'tt\J* / �4R, I�uA (. '"�y< ✓�"v L.t.wrtti.l. �c� 66v.ThL. C-COLenL. `SECTION 5--USE=GROUP AND CONSTRUCT ON TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly Al- ❑ A-2 ❑ A-3 ❑ 1A I ❑ ❑ A-4 ❑ A-5 ❑ 1B B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory E] 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 j ❑ U Utility ❑ Specify: I M Mixed Use ED Specify: S Special Use 0 Specify:I j COMPLETE TH1S SEC.TION7FEXISTING BUILDING UNDERGOING RENOVATTONS ADDmONS"AND1OR CHANGE IN USE i i t Existing Use Group: Proposed Use Group: i Existing Hazard Index 780 CMR 34):` I Proposed Hazard Index 780 CMR 34):i SECTION`"6 BUILDING HEIGHTAND AREA, BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION '- K -.- „ , �� `"X r ii Floor Area per Floor(sf) -c : -.__ ='LL ' , ,std 2.20 0 5c, c'r 2nd 2 j 3rd �� 3rd :�- 4th i 4th i �� Total Proposed New Construction(sf) ' .4% ,TZ; l Total Area(sf) Pt •� Total Height(ft) " :-4- „ '� r Total Height ft I I F "' . .. yq ,, 'z%�+74:- -r"' 9- -wed �'- • 7.Wate pply(M.G.L,c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone I I Outside Flood Zone❑ Municipal ❑ On site disposal system 0 Version1.7 Commercial Buildin• Permit Ma 15,2000 n r : ;T City of Northampton ' Building Department .f " - -� ;--__ 212 Main Street � fm. •g N - , e "Room'100 k - i L Pni\lorthampton, MA 01060 ®r.-q k' � phone 413-58 `1240 Fax 413-587-1272 - . ' "` _� -�:- APPLIGATION TO CONSTRt e ,REP• R,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING '--- ---- I THER THAN A ONE OR TWO FAMILY DWELLING SECII.ON _T"SITE'1NFORMATIONy` -- Y1 Property-A&Ji es >,-,;e-,'- `This section"to be corampleted by-office. S Q GOI■3Z ST ;t'Map .1.1.4.7 ,;Unit: • iNl7 ?'rn 0 1 .,,*,a',Tea. . .+ .....,.-.,.,._v., .z:tt"M �"x ,f r:_,. .:.s. •.�,» ,v s 1( °OverlaSl5r�ct: ..— C".EIm tDisc 2 , B District. SECTION Z.,-,PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) ' . Current Mailing Address: I i Signature Telephone 2.2 Authorized Agent: Name(Print) 1 � OF w W ' C, U.* Current Mailin•Address: I Signature o 4,4/ � / -1. Telephone SECTION.3-ES IMATED`CONSTRUCTION COSTS • ' Item Estimated Cost(Dollars)to be Official Use-Only completed by permit applicant • - ::-'.. " . _ - 1. Building ; - 1 (a)-Building'-Permit.Fee 2. Electrical 1 I (b)Estimated Total'-Cost of 8 000 I -Coh tru'cfipnTrorn(6) - )• 3. Plumbing I Building Pecmit Fee X000 4. Mechanical(HVAC) i r�7,,? , 5. Fire Protection 1 _ r ' } 6. Total=(1-+2+3+4+5) 000 Check Number ��� �G9 � - i This-Secfion For.Official-Use Only Building Pem t`Nuniber . - Date .„ Issued' r , Signature: Building Commissioner/inspector.of Buildings Date • The Commonwealth of Massachusetts Department of Industrial mii■rurri=.1! Office of Investigations • 600 Washington Street lif=_ Boston,MA 02111 s�•"" www.mass.gov/dia • -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 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.❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. El 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 3.❑ 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.❑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 Investistations 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 r,. SEC-T1.0[410 'S'RUUUR�ACP_EER,REVIEW(Z8Q CMWI1"01l Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 1t='OWNERAUTHORIZATION TO BE COMP..LECED Wk1E1t' : OWNERS AGENT OR'CONTRACTOR>APP.L:IES FOR BUILDING PERMIT • I ; ,as Owner of the subject property hereby authorize I Ito act on my behalf,in all matters relative to work authorized by this building permit application. { i Signature of Owner Date ) / � y0 ll L� /` �£S O z ■ ,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%er e ins andlti- • p- . i Print Nam 1 Signature of Owner/Agent Date SECTI0tt122 OONSTRII"CIION SE121GICES 10.1 Licensed Construction Supervisor. Not Applicable 0 Name of License Holder -105 re,. l''�.,tt.r C5 ois301'7 License Number SC, -"S tdssow 6+-cam} Hiroo, MX f ' `1- 7- ®8 Address Expiration Date Signature Telephone SECTION 13-WORKERS'COMP-ENSATION INSURANCE AF.EIDAVITAM G L.c.152,§25C f0 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 ,04-0,c1,L 1 $� trc.r�L4, le 1: �.'L r Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTF LIC1[Q0*1GES FOR BUIt DiNOS i4�1D- R140 ES�WB.IEC;fZO. 001(0000110N CON.TRO PURSU INT,rk 0 CMR 10.40 MONG 4,110 THAN :k1:40 C F,OE ENCLOSEDjSP ,CE) 9.1 Registered Architect Not Applicable 0 Name(Registrant): 1 Registration Number Address I Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): li ----- Name Area of Responsibility Address Registration Number I I Signature Telephone Expiration Date Name Area of Responsibility ' Address Registration Number I s Signature Telephone Expiration Date i Name Area of Responsibility I Address Registration Number l Signature Telephone Expiration Date { Name Area of Responsibility Address Registration Number I I Signature Telephone Expiration Date 9.3 General Contractor M;��cr 1�cwrth Lµ}c�Pn3� �L. i Not Applicable ❑ Company Name: f I 365e Ph. t c,r Responsible In Charge of Construction r 31. ;Jack3�- � ' pct} I�ekC /IA i Addres X113- 2 - pY Signature Telephone t . « ` Versionl.7 Commercial Building Permit May 15,2000 w ia -e . eat, :7,: 'f.. ° Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ! H R ' Frontage ` 11 , Setbacks Front i , I 1 Side L:' I R: L: R I I 1 i ,-- RearI P i Buildmg Height I Bldg.Square Footage I i F----1 % i ; i Open Space Footage __; % ; (Lot area minus bldg&paved I 1 j 7 I paridng) #of Parking Spaces i I l Fill: ' ; r (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: IF YES: Was the permit recorded at the Registry of Deeds? NO "0 DONT KNOW 0 YES 0 IF YES: enter Book I Page; and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 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 (3 NO IF YES, describe size, type and location: ∎■ i D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ej IF YES, describe size, type and location: i 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 Q , NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. w Version1.7 Commercial Building Permit May 15,2000 SECT N d ST 0,,,9 SE VICES f.P P)#OJ'.04%.0 THAN 35,0,00•' CLIBIIC`EEeritl0 NCl®SE� PACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs El Roofing 0 Change of Use❑ Other❑ Brief Description ,Enter a brief description here. T,►-}'.11 acw tIV h( 34-s 4m t MA') '.. f3. Ptww'c �k'J Of Proposed Work:1' 1- a- a^`-fit-vrk) -Z ).t" itcs., Sp' .frt-e Syskvh , HS II at,w CC*tcr.. ..u_Y —•, a1L...rt X A,C . ? si.s 7 .SECTION 5 .USE'GROUP-AN CDNS UC O Y USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly Al- ❑ A-2 ❑ A-3 ❑ 1A I ❑ ❑ ❑ ❑ A-4 A-5 Business ._..� ❑ 1 B 2A 0 - I ❑ B Bu E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A I ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential II R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B 1 ❑ U Utility ❑ Specify:I M Mixed Use 0 Specify:1 1 I S Special Use Specify: COMPLtittTk115SECTl01 'IF EXISTING BUILDING 1J.tD'ERGOII G RENOVATIONS,ADDITIONSAND/OR CHANGE-1N USE Existing Use Group: "^. ?Proposed Use Group: s Existing Hazard Index 780 CMR 34):; i Proposed Hazard Index 780 CMR 34): I SECTION"6BUILDING:HEIGHtANDR EA- ,I BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION � � � r --,,z.-sl. , Y --�� � W- Floor Area per Floor(sf) -o a Ar-rr -'�h- � .a.N St 1 Cie"a:'4 µ„V~ f�,v 3,-- 4.,,.e'.' '"^ 1st ; } 1 ,a .,'••.` .,a,, t g 5,»A :ter:' ,s..-. ^ F r gf'.._ 2nd 2 ,3' Fox • rd f I "tn”:mss' .--i "-. °+ v. .tea Ml I 4th * RigfET.: 4th 1 y E ap =�,k.r& Total Area(sf) i Total Proposed New Construction(sf) -Z. r � " $��`... I r � .,, ,. sue € Total Height(ft) r r � �� �� ' Total Height ft � I "° . "'< i - ,� �} x A 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone I Outside Flood Zone Municipal [✓r On site disposal system 0 Version 1.7 Commercial Buildin t Permit Ma 15,2000 F City of Northampton � ,-,P T -- r Building Department --.....c--..-.-... A -.a 4; " 212 Main Street Room'100 ,,, ,J `x Y � -- Northampton, MA 01060 ,�-r a ¢ gin - t phone 413-587-1240 Fax 413-587-1272 =-F ,r: h .7,.,-:--,„« 4:;, r %-ice ¢ c-. ` a- '-'?e.' `m'c4 rz,'.- APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING` _. - SEC ION ?;,SITEINE0[ 2MATIbt; i sectto fa*e o liti efed jgoffi z.A.k --jY1-Prot�er'ty-171 `�'� � '� �;-���J�_. Ie j .5-05.6,0617-6+- , w ., tzar r � .r dam C w-17.1-..-•;. rtj' on - i a:k SECTION ZPROPRTOwdESAP HORZD AGE}T 2.1 Owner of Record: 1 Name(Print) Current Mailing Address: I i i Signature Telephone 2.2 Authorized Agent: 1 `� i mootr-t i G4„i II ant_, 1 feSaAt,+1,l 1 Name(Print) Current Mailing Address: i° �f)` -, �zy /24--9-1 t Signature '�' � Telephone SSEGTION 3. STIMATED;=GONSTRUCTION COSTS Item Estimated Gost(Dollars)to be official Use{3raE completed by permit applicant . _ --- _ 1. Building I , (a)Building PempitFee• i 2. Electrical I ; (b)-Estimated Total Cost of 4 i Construction;;ffom(6). z` _' 3. Plumbing (ccol r2A)&l) 1 3,000.no 1 Bu lding,Permit'"Fee 4. Mechanical(HVAC) i S.c,,OLIO.av i _ 4 5. Fire Protection I `3. , goo•o a I •. 6. Total=(1 +2+3+4+5) 49c.,000.00 Check Number -.. „.< Thi .-Section'ForOfficfal Use Only :I- Bturd ngtiPermit N`uhi erz RDate''`„ .r�uea r Signature: Building Comrnissionerflr specfor of Buildings Date File#BP-2008-0234 APPLICANT/CONTACT PERSON MILLER DEVELOPMENT ENTERPRISES INC ADDRESS/PHONE 56 Jackson St HOLYOKE (413)552-4114 0 PROPERTY LOCATION 50 CONZ ST MAP 32C PARCEL 104 001 ZONE NB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid /j) Building Permit Filled out (7 / Fee Paid ��/l /�5 Typeof Construction: RENOVATE BAR AREA yl New Construction J r Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 015327 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: l 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 09 ' 0'1 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. r 4r BP-2008-0234 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: BUILDING PERMIT Permit# BP-2008-0234 Project# JS-2008-000347 Est. Cost: $130000.00 Fee: $605.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MILLER DEVELOPMENT ENTERPRISES INC 015327 Lot Size(sq. ft.): 25047.00 Owner: WORLD WAR II VETERANS ASSOC Zoning:NB Applicant: MILLER DEVELOPMENT ENTERPRISES INC AT: 50 CONZ ST Applicant Address: Phone: Insurance: 56 Jackson St (413) 552-4114 0 Workers Compensation HOLYOKEMA01 040 ISSUED ON:9/26/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE BAR AREA, NEW HVAC & SPRINKLER SYSTEMS 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 9/26/2007 0:00:00 $605.0050116 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo