32C-140 (39) COQ TO --
a `E Crit of kTortljuiliptoll
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DEPARTMENT OP BUILDD\IG INSPECTIONS
212 Main Strcct ' Municipal Building
Northampton, Mass. OIOGO
W O MCE R'S C O NT EN Sa'i`l O N M S URA-N CE
(1icc�su11xr'rnittcc} - --- ---
�� ith a principal p
lace of business/residence at
3� L�+�✓. �1 fit%-s'r r,/c/ (d�'�fiT �(�' � (I;hone )
Asa-�cratyis�.t��nn> C�C(J-3 i
do hereby certify, under Lh.e pains and penalties of penury, that
O I am an employer providing the followinL worker's colnnensn-Don cove Ige for my
tmplovccs wor!ong on"Lilis job_
(Lnsur_a� Conp:�.) (Pelic: NtL�r) --- (r';-pir�uor Dat.)
I,am a sole proprietor, general contractor or homeowner (c cie one) and Lzve hired
the conz a(nors listed below who have the following woFkef's cOmOenSa6on pe!icies:
("Namc Oi Cony .c-Lo-) Onsuranc Compan)-Pi obc ?�t11Q1�Cr) ?:_)liJ DaIC)
(Namt of Coocrzaor) _ (lnsaranc- Compaz"-/?o!ic1' N-Umb^f) (EsppLMuon Date)
(Name of Coarmc-10,) (Franc;. Compan)•/Poliq' NUD21),.r) (Exp�mkn Datc)
(Name of Contractor) (Inslran=Compa> [Pobcy NumbJ) (Expirtion Dale).
(&rich Aitioc3l c ifnoc–ury to a cudc iaform�noo perm�w'U oo= on) -
am a sole proprietor and have no one woridng for me.
( ) I am,.a home owner performing all the work myself.
NOTE:plea be ew t tbx kjjo 6emeo.�vcn..•yo c=ploy peso=w da m•h^ ,cc-,=:ejo c rcpaa work on.d..c.11-;of
not snort lb--m t`so a in ubeb the bornoowver rcvda or oo t}x Qou�z,�purtcan tbedo ere ox –ally oec�6 io be
�ployc�once ttx wui ds c,_-,�=Act(GL157.s1(5)),zppUc:,6co by n bomcow=fcr-tic>:.a p=mh rs_y c idmcc the
Icg�l K-n,,of an czployx under duo Wort' ,Comp000at Ad-
I uodcst.and dva a Dopy of this=U-mmi m,.y t-forwwrtled to tbn Dcgnrtmcoa of I.&"-ricI A—drtbi'Onion of tra,nnoo for�.
eovetsc�ciCenioo rL�d that L-iJtnt to sctwc`eov��under souioa 25 A of k(dL f 52 na tad to the i�ctioo oleimiasl pca�liia -
ooc i;3: g or a rux of up to S 1 S00-00'rwor im p o f up to Doc year tad a%il p=e tjo in be form orn Stop Wort Ondcr end.
Cure of S 100.00.dry tea=me
For dq --•J use only
Permit Numb=
�. Lot
of cxTSCCJPctmiucc L53EE� ';r:
+ Versionl.7 Commercial Building Permit May 15,2000
SECTION 30 STRUCTllRAL PEER REVIEW(780.CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......
SECTION ll,; OWNER AUTHORIZATION T0513E 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
Yom.-- _....._...._...._...�
I, r �: «: �;, .��r as Owner uthorized Ager3-t--'
hereby declare that the nts and information on the foregoing application are true and accurate, to the es
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
4.
ire of Owner/Agent to
SECTION 12---CONSTRUCT N,SERVICES-
10.1 Licensed Construction Supervisor: /_ /� Not Applicable ❑
Name of License Holder : , d J��5 J kloeC 'y
License Number
3!2 L�v�o/' ,,vim. �, �Tr/y .��drU CS 0200 Y
Address Expiration Date
y/3 - G5�- 2 /� G
Signature Telephone
SECTION 3-WORKERS' COMPENSATION INSURANCEAFFI DAVIT,(1N1 G L c,152,,§25C(6)) F
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.
Fs Affidavit Attached Yes........ No...... ❑
Version 1.7 Commercial Building Permit May 15,2000
SECTION"9=iP ROFESSIONAL DESIGN,AND•CONSTBUCTION,SERyICES - FOR BUILDiNGST,AND STRUCTURES SUBJECT TO=
CONSTRI7CTION C0'NTf?OL PURSUANT T0;78p GMR 316(CONTAINING MORE THAN"35 400 :'OF.Et�1CLOSED.SRACO
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
C Not Applicable ❑
Company Name:
~02>-T )-5 L�,j
Responsible In Charge of Construction
3 1
Address
Si nature Telephone
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: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arldn )
#of Parking Spaces
Fill:
(volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT 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 NO
IF YES, describe size, type and location:
D. Are there 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
SI=G'iflN =- NSit1iClflNIfSQR1P�tOECISSS-1AN35rt1Dt1 M ;
CUBIC f EET FIENC 4SEOSPACf ,
Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs
BRIEF DESCRIPTION:
«t e 0 M A40,.— o v(f"-L
SECTION 5 USE GROUP;ANDW NSTRUCI'IONTYPE
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 I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
N High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use X Specify:
S Special Use ❑ Specify:
COMPLETETHIS SECTION iF E�NG BIUIW- G IINDEItGOING REN0�7A�IONS,AflDITIONS A<>iDjOR CHANGE IN ll5E
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECT1,ON 6 W1-1LQ1N,G HEiG11T AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Mo.
a WIH' i�I
Floor Area per Floor(sf) s< Y
Mii
1St 2"a iii ^,yntLk9A •r"`'�• lY` a..S
nd
r
2 g� X;
3
fd
4th
4th
4
Total Area (sf) Total Proposed New Construction (sf)
y�. ," �1^�r1'"n" Fad$�, ;•.
_• 1 'lz # .
Total Height(ft)
Total Height ft-------------
Versionl.7 Commercial Building Permit May 15,2000
Northampton
EB I g Department
FAU'D
1 Main Street
, om 100
G - 6 2CO0 0 ton, MA 01060
L--
phone 413- 87- 240 Fax 413-587-1272
DEFT OF E�IJU INSPECTIONS
Ap ,-REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
-SECTIQrt� SITE INFORMATION
1.1 Prooerty Address: � �
J�� 1 ��� P!1..=✓7 �� � - �> ;gyp, L4 "
("� d i Y i �•1✓�- b ^`' �° d„ t� .:-v '". aa `,cf
y�IA 15I3YC# 3 Ct `
y
SECTION 2. ;PROPERTI(OWINERS1 I�JAUTi�ORIZfD,'ieIGEN .=
2.1 Owner of Record:
ame(Print) Current�Mailing)Adddr-e-sss, 7, 4 X
i re Telephone
2.2 Authorized Agent:
ame(Print) I �r Current Mailing Address:
re Telephone
SECTION.3-"ESTIM71. CONSTRUCTIO1 COSTS
Item Estimated Cost(Dollars)to be Official-Use Only
co leted by ermit applicant
1. Building Uc� ` (a) Building Permit Fee,
2. Electrical (ti)Esdrnated Total Cost of ,
���-Coiastruction`fron `fi.
3. Plumbing B �1c�mg Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 + 2+ 3 +4+ 5) °Ch6ck;Number
.:;ThisSectionor Official l)se i0nt
Building Permit:Number `Date fissued:
Signature: Date
Building C-ommissionee/Inspector of Buildings
File#BP-2005-0176
APPLICANT/CONTACT PERSON THOMAS KORYTOSKI
ADDRESS/PHONE 39 LAUREL MOUNTAIN RD HAYDENVILLE (413)665-2106 Q
PROPERTY LOCATION 351 PLEASANT ST
MAP 32C PARCEL 140 001 ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: REPAIR WATER DAMAGE FRONT OVERHANG
New Construction
Non Structural interior renovations
Addition to Existini
Accessory Structure
Buildini;Plans Included• -
Owner/Statement or License 070047
3 sets of Plans/Plot Plan
THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
TATION PRESENTED:
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 Co ' sion
Ldd
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.
351 PLEASANT ST BP-2005-0176
GIS#: COMMONWEALTH OF MASSACHUSETTS
MgR-Block:32C-140 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-2005-0176
Project# IS-2005-0197
Est.Cost: $2000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THOMAS KORYTOSKI 070047
Lot Size(sa. ft.): 0.00 Owner: HAMPSHIRE PROPERTY MANAGEMENT
Zoning: GB Applicant. THOMAS KORYTOSKI
AT. 351 PLEASANT ST
Applicant Address: Phone: Insurance:
39 LAUREL MOUNTAIN RD (413) 665-2106 O
HAYDENVILLEMA01039 ISSUED ON.8116104 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR WATER DAMAGE FRONT OVERHANG
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 Occupangy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 8/16/04 0:00:00 240 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo