32C-104 (17) I
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��_" DEEP/`.RT1.'rELsrT pP 3.uIw nC INSP3CTrol%s
2-12 1\1aic St_cct 11Tuc;cipai Bu;ldir.
Northampton, 7\1-ass. 01000
\T'OPJCiRS CO\•Q'ENSt_ 1LON >NSURAJ' C: v17
CI;CCIlS^Jpc I7Jit )
vnth a principal place of businesJresidence at:
/DL/ /
/U• �✓rl r id; � L l ti /y �i h o o e
(si/ci ty/suir.fp)
do hereby certiF , under the pains and penalties of perjury;
(v�I am an employer providing the followint orkcr's comocnsauon cove:2s.° For my
empp�toyees ,vor ng on this job �� p<�97 /7-1d /V OS
(-suss=Com v) C.?cLicy N -abcr} (=:"nircon/Ds
I
( ) I am a sole proprietor, general conrracor or horrieow er (cicie one) a.nd have hired
tine contractors ;.1.St below rho have the follow-n2 worker's co=en noon pokies:
(`{emc of Co^,-,c-tor) (In uronc Cctno n} cue Numb,.:7) (t.\:pl: luoe Dn c)
(N me of C000acor) (insuranco CampanyiPotici N tm r) (ivoiraion Date)
(Name of Coninetor) (Lnsu anez Company/ oIc- Namb‹.5) (E_�pircioo Date)
•
(Name of Contractor) (LPsurancv Comcauy/Poticy Numvcr) CE\-oirztioo Dale)
(ac.a.c�:f:t.:oca1 yuco if acco.i'-;to e,c'u�tofu oc pcc=as to.11
( ) I am a sole proprietor and have no one woin,__pg for me.
( ) I am a home owner performing a14 the work myself.
No i t:plcoc be t..,.4{Jc b.cocou.-x-a o•bo ctcaloy pc'.-cci to .o-c c rs Marc az or
not eroco:h:a t.l--v i a tic$the oomo.a•oe r�'c,`—oc cc tr c Co r 5 icy^the-n ax to
the .xSd c p—lion AG(GU.51..=t(5)). cc pc-mit�r c",T6=cc cc=
Ic^y.l rrc of ca ployar uodcr d:a Woc' Co• p.o.--a;;.on Aoc_
Dopy of y b.tor-o-o-d d to r_So Gopa.r c of 7••.••■,--iJ Acc1. .OLoo of Ir.��om for:S.e
.-pve'io,.vhf c tca ono Itt::Litt-e to caur='ca'o o o t.-'r t-o cc 2:5A of 1.tGL In cam ic-d to the:mac"la=w of c-,:,--1 per!�ic
ox of a rioo of top to S 13oo.Co'c-t--� r'�-o� or up Lo cs y-�-c�c,'coil x^...-moo�c�c rocs of.Slop Wort
tt-0Ofatoo.oa,�y. c.n
/( 5/161?)
cr�v N 1.1.m
��
of L; ._t-�✓�ct-i.ict�:. T!s'Ce ` �� Lot
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:
104 N. Elm st. Northampton, 01060 Not Applicable ❑
Name(Registrant):
104 N. Elm st. Northampton, 01060 Registration Number
Address
(413) 204-9880 Expiration Date
hi
Signature Telephone
9.2 Regis red Profession I 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
Route 9 Design & Build Not Applicable ❑
Company Name:
John Landry
Responsible In Charge of Construction
104 N. Elm St
Address
i (413) 204-9880
Signature / ✓ Telephone
Versionl.7 Couuuercial Building Permit May 15,2000
f •
SECTION 10--.STRUCTURAL:PEERREVIEW.`(t80 CMR 1 i 011)
Independent Structural Engineering Structural Peer Review Required Yes (,) No O
SECTION 1'4--OWNER.AUTHORIZATION TO-BE COMPLETED-WHEN
. OWNERS AGENT OR CONTRACTOR APPLIES.FOR BUILDING`PERMIT
I, .e0 G ( N 1.:, Il, ,,P ',as Owner of the subject property
hereby authorize' "C J'i0 i-f fvPiZY to
act on ehalf,in all matters relative to work authorized b this building permit application. /
% - /— „..../...„0,--_,.. ..- - -_ ..... e.'... I Signatu of Own-r Date
i n7ti�� hiD .y ,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 of perjury.
TYZ f?&i L-A'JP?V
Print Name
4.1,-- ,'i\IA/ 3/7A7 I
Signature of Ominer/Agent f / Date
SEC'TTON_'C2 CONSTRUCTIONrSERVICES _--
10.1 Licensed Construction Supervisor:
>r J Not Applicable ❑
Name of License Holder: 0 M t OY I i CS e9-3 1/5 e
License Number
/1i/ A. z=1„,„ 5 t . AMr 1►'wt ,t,4 i i Vp9 f 3c ie
•
Address Expiration Date
,,..L(„ /Li,,,7 k/13.-dig-93S 0 i
Signature r Telephone
V
SECTION 1'3-WORKERS COMPENSATION>INSURANCE A)=FOAVIT NI G.L c-t52 §2C(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 No 0
r
•
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Versionl.7 Commercial Building Permit May 15,2000
S. 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 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q 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 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location: On front lawn, roughly 30x 60
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations J Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration 12 Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other El
Brief Description Cut out opening in existing facade and install new door to smoking deck. Install fencing with gate
Of Proposed Work: around smoking deck and adjacent mechanical area. Wire new door to existing alarm system.
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 ( ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 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: A Proposed Use Group: no change
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): no change
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st
1st
2nd 2nd
3 3rd
rd
4th
4th
Total Area(sf) Total Proposed New Construction (sf)
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 ❑ Private ❑ Zone Outside Flood ZoneD Municipal ❑ On site disposal system❑
Versionl.7 Commercial BuildinPermit May 15,2000
-� Department use only
h _ �� � ;City of Northampton Status of Permit:
�t�ilding Department Curb Gut/Driveway Permit
�� X12 Main Street Sewer/Septic Availai illt r
�ra 1 / c,,8 Room 100 Water/Wel1 Availability
Niorthapton, MA 01060 Two Sets of Structural Plans
phone,' ' 3-587 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
WW2 Club- 50 Conz St. Map Lot Unit
Northampton, 01060 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
World War 2 Veterans Club Association
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
John Landry- route 9 Design and Build 104 N. Elm St. Northampton, 01060
Name(Print) Current Mailing Address:
(413) 587-3050
//%
Signature Telephone
SECTION 3-E i IMATE/ICON•TRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $2,000.00' (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
` ,' (iJ Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3+4+5) Check Number ��r �
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-0793
APPLICANT/CONTACT PERSON JOHN LANDRY
ADDRESS/PHONE 104 NORTH ELM ST NORTHAMPTON (413)204-9880
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
Building Permit Filled out 77 gFee Paid V�e
Typeof Construction: INSTALL NEW DOOR TO SMOKING DECK&INSTALL FENCING W/GATE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 093450
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN ''4 • 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
Demolition Delay
. - oo8
Signature of But mg 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.
BP-2008-0793
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-2008-0793
Project# JS-2008-001220
Est. Cost: $2200.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN LANDRY 093450
Lot Size(sq. ft.): 25047.00 Owner: WORLD WAR II VETERANS ASSOC
Zoning: NB Applicant: JOHN LANDRY
AT: 50 CONZ ST
Applicant Address: Phone: Insurance:
104 NORTH ELM ST (413) 204-9880 WC
NORTHAMPTON MAO 1060 ISSUED ON:3/19/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW DOOR TO SMOKING DECK &
INSTALL FENCING W/GATE
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 3/19/2008 0:00:00 $50.003502
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo