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C)I0 0!C)1C)j0 0 coo N k 1ILAJfp • T ..0'. 2,........ ,,,,,04:1... (riff cif pct fllainpton $ *`-= 45, '1 il yPi E „R�assacEintctts' —_ ' ©- DEPARTMENT OP BUILDING INSPECTIONS ct,L-212 Main Street ' Municipal Building Northampton, Mass. 01060 r,. WORKER'S COi1Q'ENSATION •ENSURAN(.h. Ai'PI:DAVIT. I' -- -n124— y _T yit'Al 7 cif — -- (ii cone elperrni ttec) with a principal place of-business/residence at: /i/ vri7rJ2-, 7s? -i;r27' tX'x /i0 L.,e,r0 at/7 / hone') 6-5y—y757) (sn-c[/city/suiJzi p) do hereby certify, under the pains and penalties of perjury:, that ( ) I am an employer providing the following worker's compensation coverage for my eluployces worling on'tJlis job: - (Insur_nc Coor,any) • (Policy Nu cr) --_ (1 :-pinion Date) ( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired the contractors listed below who have the following worker's comoenszdon policies: cNaf]c of Coco:, (Instlranc: Compan)'/PoUc; Nu.mbcr) -- (x.)ir on Date) (Name of Contractor)— (Insurance Compaav/PoUcv Nuinticr) (Eyniration Daze) . (Name of Comma or) (Insurance Company/Policy Narnb•:r) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date), (anaCh:G7.i;:oca.l rbcC if ococ-ur to meive.inforcua oa pertaining to.11 ooanr...c.ors) - I am a sole proprietor and have no one wor4ng for me. . ( ) I am..a home owner performing all the work myself. NOTE:p1c44 be acrarc tb.n,..'n_.);e bemoo..ven v.'bo employ pctoaa to do r,.:,-,.•,•.,-. ee�raoo c rrnir••'o,- ao.d..tn_4:or not most than the.:tmfr in u'hiela the botnnoawc rmdo or on the c ouarh z,,purtca:t7 1.12 ....0 Z: ooc -.- lly nor:sit:la-al to be earpioyen'„'-c the wtaich alien Act(GL152ssI(5)).applicuiao by a botn000vc car c li sews.or pama ray r.ideoce the IegaJ ctaau of an ex?loyer under du,Worl,oe.Comp000.tion Aax I uodersttad tart a copy of this mtemcm may bo for worded to ciao Departuam¢of L.,,k,e,,J,Lcodearj'OLOoo of t o%coo for th. ' oovcrizt vcriGcaion,nod t ."Lutz..to soauc`covrrage trader roetioo 25A of MOL 152 an lad to the imposeiw of criminsl prniltirs 000srsrug of a Goc of up to S1.300.00.ndfor imps-tsoobsccrt of up to ooc year Lod ci,.il pa:vatic+is tSc focal or.Stop Wok Order and■ Gan o(S 100.00 a thy agp icl me For�, ,.sl uac ooty • Pcrmit Number -It. .4./.r_ Map::__ Lot " i. Sitxrat of J.. lrmiucc Date -.._ .J /;;s• Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(78O CMR I10 11j' Independent Structural Engineering Structural Peer Review Required Yes ❑ No �. SECTION 11 OWNER AUTHORIZATION-TO.BECOMPLETED; WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT vi- , as Owner of the subject property hereb -. on-e YaL-'di SG1t to act on m .eh. f, in .I - . '. work authorized by this building permit application. V//° :nature of Owner Date I, /1-4-y yevi/r 5 /I , 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. 1TI 1241.-y Print Name t� 0 Signature of owner/, nt Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : (2-A-`7 .T yF'/14-5ciI ' D 9 6 66 ao), / 7-0 License Number 1/l 1474-r44 ��n i, �u� ��� d/05- 3 66-7///.Address Y y� Expiration ate Signature Telephone SECTION 13--WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L c 152, §25C(S)) 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 f No ❑ rcn K I o o , 0 z- cn z m • i m i I � ` m D p p m 1 ` ' • 1 ,,1 'm t D T . I,) m 47T ‘ m R o Q ' "z ii Z' m o cM w K mzm> › bC # r. o au, Q, 2D m aZ m > r CJ CI r- c c0 p D r-° ° f/ P. e. / 1 . ,/ • • Versionl.7 Commercial Building Permit May 15,2000 SECTION 9= PROFESSIONAL DESIGN AND CONSTRUCTION`SERVICES - FOR BUILDINGS ANDSTRUCTURES SUBJECT TO CONSTRUC ION.CONTROL PURSUANT TO 780 CMR 116(CQNTAINING 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 ‘>'CiV/ `,?c 46/1'/%izt"67-24.ai,/ Not Applicable ❑ Company Name: G,9 RA12-Y y,T Ur ' Responsible In Charge of Construction /1/ 6+/4 1127/2- 5T 72../. /-/- / /n/,/ 6)i 2S 3 Address I 3 - 9 75 V Signature Telephone Version1.7 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 yi 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 W° ''',4'7.-.6t3/4.c.44 5 Lot Size /.1/ . -4/ 5/1 h�C � i G X15 ee Frontage 9.25 p �j. 2-5— (�� 'S inS. Setbacks Front �- ' 2> l a 0 4 vi i-di,vG Side L:i/.3( R: L: R: G ! Rear 3 6 i(05,(.7 /11:4 !fb c51 Building Height Z`1' -t 2- -5-77/2-y slob Bldg. Square Footage 5-D 4,50 Open Space Footage (Lot area minus bldg&paved y/s 0 410225 1 �v M/.v ' /3 U/�i,4-S parking) LIMO V t T�. !l/✓n��rJ- #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW `y`7. YES IF YES, date issued: 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 , Date Issued: C. Do any signs exist on the property? YES r/ NO IF YES, describe size, type and location: g5/ r55 Ste. c4 /1 /2 nn'o,',q'I- SRze v5 634/ D. Are there any proposed changes to or additions of signs intended for the property?YES_ No J/ IF YES, describe size, type and location: Version1.7 Commercial Building Permit May 15,2000 ' SECTTON4-tijtiSiRtJMCfftSEFORiPRg3ECTS USS,THAN45i000: .„. , ,..., CUBIC fgEtOFENCL9SEDSRACgfM Interior Alterations Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0 0 0 Exterior Alterations Demolitior1131 New Signs [ ] Change of Use [ ] Other [ 1 0 Accessory Building [ ] Repairs [ ] ro 2,-/130.-2/2-1 DC/2/47 e 2-02 Pe/4.S77---,-).--,1v4-21-S ei Cario/i.4.5 elai ii". ,A7z-oc-%;C....////4/4'4,3 4 kPivr i•v-- vt44,9,44.105 BRIEF DESCRIPTION: *Li '1-'‘--4--it, el,7441,444, P--‘f.1;74-e/i.07, "i)//"Orer-72Z'e..4e- l24//1-1-: 4 OP 'Ve441 2-4/0 4.` ei<e:'';5 1)4'c)a- - • .->oi Arz-; f:7,4, 4)-,,F (4d12.4P/o4R-r-e.4--4.0 DO/4"A/CP /..Cec',,--ed',',0 6026,4_40a;g-ev. . ,,....-•,,., -','","!..." ;;:.,r.'''''',,,--:',.''''',,,i'>',-,4;;;,',;•=:;,,,,-;.!"""ti:,:' '''1"',"::: Avkl-Ksmit-z, 0 v.i,--_-'7,-corn...01)-c 4 i 4,,o.e...,/ is,■Cl st-hiV6 i>•ez--Ar SECTION 5-rUSE tRouP.AND,coNlittructiOnnIrpr :,..--_-,,-,- - USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly I 0 A-1 0 A-2 0 A-3 0 1A I 0 A-4 0 A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B I o F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A 0 I Institutional 0 I-1 0 1-2 0 1-3 0 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 12( 5A A S Storage 0 S-1 0 S-2 0 5B 0 , . U Utility 0 Specify: M Mixed Use 0 Specify: S Special Use 0 Specify: .---.-___-- .-;L. ___-:-:,-''------",',1--,._-..:.-...-,,-;.-,,..c.-_:..„,'.... .....-", -----..-<, _,..;-;--,-..:T,,,,--,:r.".-7.---.-L.-,-.--- _- - ---,COMPLET-E'RIISSEOPtIONAKENGBIAIDING;tiNDERGOIt4pAENOvATIONS;APDTTIONS mpjbA-CHANGE IN USE Existing Use Group: '5/2 Proposed Use Group: -5.4 Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SkCTTON".6"..BUILDXf4G1WGilt ANDIAREk" :&?;_ILINZAZia.c.A4-z e .'7. SEVONLYViggitliVQ,'ji.;', BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) st , '7 62/ke ,,,..,,„741.0.,•„,„,„,,,-r,,,,,,go 14:400•4440„0-.04,4k4:'0:4-'''''' _ '411:4‘,4=t"0-5,--je kr45r4g(,,Zta:Jelt,:i-iktc;A 1st c.,2 6 5Z.) 2nd kovt14.41r44-,-,7-..,'4;41.,„.;-.q..... ,./Ibv,P "4A,,,„,,,hper,116,4,a,-,71,4t,":`,■,' :"7.1174.'"V1/41":;^"VVF'VPS, • ''''',1e-V, S,,,,_:1'`qerif,,:':",X;4,1,':',.4,..,..:,%:',•,.. .-- trt,itriatitit:3;c;KI'Cg..:C.- 444TiSTI;e:'14nclICqif„/4,04,7Ka'''''',„' .;.,„,,z*tief.,-.*-104.4 .1,.,,, rp,;„,„,--..4.41•Dpe,,,,log,:•:-.;"-'::. i q 7 2nd 1 3rd :.>"4-Ait4,04.1*0.7.''''''VW3r;i•Ai tNhhC1'5%''' '' :"-";::'- 4 4,44r,",1404..c,*44,,r.,. ..,..0•,P44-44,444',Vki',41.i.41,*,14,.'3;:444,Ar, 4=-,4''4' - 3rd _ rW0-14: "".74;..:',Va ;ViNt440`.14;14-1 :4'4"r'•"' 4th 4th 4 .4;ii-i'fl'':-. .,:;,:,?;,,,7.-'ciAltveligt,44,,,,,,?y, ,•:. ,!..4,,,,, Total Area (sf) 3 '1 i)- ;) Total Proposed New Construction (sf) es.:i',.if:9P-14,'W,Z:''if-.il,"''I'r...'ItAra:t-i,"W:.'-Wr=:;-,... $)',•;-,-• Total Height(ft) 2 e ,-). --,- - tt:gft,-A• froro:n:,rivsAt,,,;,_,,,,h,',,,•.‘c_,:,A„,..,overleoii,,tr,,...,,,,,,,,zitt,iNeyifLH,, .. 2 r-AtWotadit.,koriw4N,,,,L.:•.xx',/ilstz,,,-,,.--6F0',-- Total Height ft .i-$1,44-:'''''f-q*.:ig. ,;.,(1',k-"ii,:=-:,FA:J•--,;:',1-,telliffIg.'.',-P., ;-,, Version1.7 Commercial Building Permit May 15,2000 City of Northampton Building Department t a- i1r 212 Main Street t � w Room 100 r � Northampton, MA 01060 .... phone 413-587-1240 Fax 413-587-1272 :-� •.-. 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,- R is section too ,lip eted by °��1; 1.1 Property Address: �" r r44", 5yG�/ 6 an JJ t 4 h��Gv k dt sit ht�� ?kin w#f ft 4*fit , . -'} N42612.00/ fi ro/" // " .�.� SECTION„2,-,;PROPERTY OWNERSHIP/AUTI1ORIZED AGEN T 2.1 Owner of Record: Name(Print) Current Mailing Address: /I2J`l. O/4-)66) Signatur ipr- / / Telephone 2.2 Aut orized Accent: L/i/g y J . 64/7-5-c5/71 d�©u / 0 , �'J�S .-nn Name(Print) Current Mailing Address: 1-// 3 - Signature / Telephone SECTION 3. .:ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building q (a)Building Permit Fee 2. Electrical L (b) mated Total Cost=of'. Construction fromx(b). 3. Plumbing $ Budding Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3+4+ 5) s5S U � Check'Number / 3 0'2 7(3- ' Thi Section ffar Official Use Only Building enniNumber 6 Date issued Signature: Building Commissioner./Inspector of Buildings Date File#BP-2004-0969 APPLICANT/CONTACT PERSON Larry Yentsch ADDRESS/PHONE P 0 BOX 120 LEEDS (413) 584-4750 PROPERTY LOCATION 59 CONZ ST MAP 32C PARCEL 113 001 ZONE URC 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: RECONFIGURE 3 FAMILY,ADD 2ND EGRESS&LANDINGS,BULKHEAD,& ENCLOSE CARPORT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 048666 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO NATION 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 mmission 71.4) 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. 59 CONZ ST BP-2004-0969 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 113 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-2004-0969 Project# 3S-2004-1443 Est. Cost: $55000.00 Fee: $275.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Larry Yentsch 048666 Lot Size(sq. ft.): 12893.76 Owner: HEBERT PAUL E Zoning:URC Applicant: Larry Yentsch AT: 59 CONZ ST Applicant Address: Phone: Insurance: P 0 BOX 120 (413) 584-4750 LEEDSMA01053 ISSUED ON: TO PERFORM THE FOLLOWING WORK:RECONFIGURE 3 FAMILY, ADD 2ND EGRESS & LANDINGS, BULKHEAD,& ENCLOSE CARPORT 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: Receipt No: Date Paid: Check No: Amount: Building 4/12/04 0:00:00 1883 $275.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo