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32C-140 (41)
/- F 6 5T I Of �iL?L"fllctl]1}If011 _ — __ �: E �t:�snchnsclte' - DEPARTMEITT OP DUILDDIG INSPPCTIOI,'S — 212 Main Street ' Municipal Building Northampton, Afass. 01060 `firOIUCC IZ'S CO\OENSATION, MSURAINCF AI7FMA� IT (lccnscx7perm�ttcc) ; (su-�a/ci ty/slalcrz�p) do hereby terrify, under Lhc.pains and penalties of pcguf-y, _hat ( ) I am an employer providing the following N�'orkcr's comnens::don cove—, for my eluplovecs worljng on Lhis job: (I>Lnu-nom Corer sv) (Folic:?;ur} -- (r:-pir oor,Date} ( ) I am a sole proprietor, general contractor or homeowner(ci cie one) aDd have hired the coon-actors listed below who have the folloWU' g worker's compensation policies: (`amc of Con'nao-) (IRRSt3nl;:. COIr]p1r]}"rPGUC-i ?','L1n1'_rC) -- (Expird(ini'. Da1C)' (Name of CooG-amor) -- (InSUIZUCC. Comoanv/Pol.ie; Numcrr) (Ex ir,:tion Date) (Name of Coanamo,) Qasurana Compan)-/POL-q- NLunbu) (Exairaen Date) I CNamc of(;ont clor) (Insuraac--Comt:any/PoUcy Numbzr) - (E��uation Datc)'. (anacb_ddit:ors!L�CQ trOoOGZ.i'y[D Q1CLiGl LaformA ioo pcnaicing to..0 oo=mcon) i } I am a sole proprietor and have no one worlong for me. ( ) I am.a home owner perfori-nma all t-be.work myself. NOTE:plea be twat,th::�t .1c bomcrnavcr�.rho clay pczoos to bo r-.;..=,.,.,, o=.—ur o cr rcpxir work on.d---U---C of oaf mote it>:�L'.7o tafr is u�ic�Lbe bocnoo�wcr reu¢e�oc oa�hc p-ounct�z�put7 tyCxto c.r ax hex..:-ally o_�crd-resi to be calployc7 und'e the.. :Carr-- tica Act(GLI S2ss i(S)) r..pplicx6on by a bomeo-=far a 6C=r--=or penoit rr_y CNI&DCC Ibe legal ctaau of ea exployx under tbo Wolf-o!a C �A� - I uodczst,ad dmd a copy of thu�,my be fcrw—ded to the Dcpertmcat of I.&Lr-r J A—dca&Office o(trz -ow for the oove>�c reif atioa=td t1t t Liltzc to sccluc)Covm&� ion 21A of 1,(GL 152 on tad to the impos!ioa oreimical pcaiWC3 oomitatg or a riac of up to S 1,500.00 xnNo<b=P-„0=3C=orup to one yczr cad Civil pcwPjo is fx form of a Stop Wort ordQ read. f1w of 5100.00 d_y rpj=t3 �, For dr�run-,•j u,c only --•----- 1 (�--�-- PcTmlt Numbc-r — 1 pact tun of t c rmi um —C�Fe Versionl.7 Commercial Building Permit May 15,2000 SECTION',10=5TRUCTURAL P>=ER REUIEIN'(780'CMR 1.x011) _ 71 Independent Structural Engineering Structural Peer Review Required Yes No SECTION•11 DWNER�At1THORIZAT1ON O 'T 'BECOMPLETEQ;:WHEN OWNERS AGENT OR CONTRACTOR APPLmI&FORBuiu&4:j"PERMIT' i !, as Owner of the subject property hereby authorize! to act on my behalf,in ail matters relative to work authorized by this building permit application. i Signature of Owner Date 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. Signed under the pains and penalties of perjury. Print Name 33, I Signature of Owner/Agent Date SECTIQWA CONS. I,ft"CT101�SERVICES, 10.1 Licensed Construction Supervisor: Not Applicable ❑ y� jCS Y7 Name of License Holder:!1 1�r''�'/'3 X��Yr�S t`'� � �©� License Number f % L,�✓;,�N %� . 1<14 Addres Expiration Date nature Telephone ENSATN'tNSSECTION 13 WORKERS'COMP tDM L.c:1;52,;§,24C(6)) --- ---------- Workers Compensation Insurance affidavit must be completed and submitted with this application:Failure-to-provide this amdaviiwiii result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ® No 0 r Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SER1fICES-EOR"BUI,LDINGS AND STR2UCTILIRES UBJECT7.0 CONSTRUCTION CONTROL PURSUANT TO 78o=CMR-1161CONTAINING MORE THAN 35;000 C.F.OF`ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable' Name(Registrant): ? Registration Number 1 Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date ' I t i WI Name Area of Responsibility j Address Registration Number Signature Telephone i Expiration Date Name Area of Responsibility Address (Registration Number Signature Telephone Expiration Date I Name Area of Responsibility j 1 Address Registration Number Signature Telephone expiration Gate 9.3 General Contractor Not Applicable❑ Company Name: Responsible In Charge q Construction Address � Sig ture Telephone j R Versionl.7 Commercial Building Permit May 15,2000 ,JARYz�1+ Tp11Z0`V) 1T QR i Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L:' I R:' L:) i R:-= Rear { -Buildmg Height Bldg.Square Footage % Open Space Footage , % (Lot area minus bldg&paved azldn ) #of Parking Spaces Fill: 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: j IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 j IF YES: enter Book Page' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 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 0 - IF YES, describe size, type and location: j 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: J 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 ` NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r Version 1.7 Commercial Building Permit May 15,2000 SECTION =.CONSTRUGT1011 SERUIGESOFPROJECTSESS Tt AN X5;000 CUBIC FEETO.F.'ENCLI3SE SPADE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief description �En er a brief description here. Of Proposed Work: yw T 'SECTION 5=kUSE�QRQURAsFI GDNS U tQl+a YPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ _ ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ 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 ❑ U Utility ❑ Specify M Mixed Use Specify.I S Special Use ❑ Specify. COMPLETE"CEilS SECTIO_F F-XISTJNG$UILD[NG U 1L?Ela2G4 l G 1 f�O�ATfC)MS,AabMbf4S.Ai�lD10RaCGt�+IGE'IN USE _, Existing Use Group: l Proposed Use Group: I r Existing Hazard Index 780 CMR 34):1 Proposed Hazard Index 780 CMR 34): SECTO1�'IiBTIILD1tGlEaGl AI�QIREA,. BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION I, - t Floor Area per Floor(sf) ist 1 St ' w I 2ndl rd 3 r 3 i + t 4u, 4 I Total Area(sf) Total Proposed New Conte struction(s f) Total Height(ft) Total Height ft 1 I 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone i ; Outside Flood Zone❑ Municipal ❑ On site disposal system❑ �x? y'1.e. Versionl.7 Commercial Building Permit May 15,2000 � - ,, City of Northampton � ! Building Department 212 Main Street Room;100 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 �EGI10�1 SITE'tNFORMATIOtaC:_^ A ecyton�tg°beconp`1efed"t,jraoffiaz - '� - - 1-P�e,`r-I'SOVEC3 � :' Sr 'ry ..1XtF u2:'>. 1 5 4 ✓�� (N/-t'.le�✓ —J ^s. - A ', t x� ,x%�.;e,s�:z+s.x.:s:x��ac 4 � ..-sx�.?,`:�-�"'.....c.,�i€•sd c � SEC-7—n 2 PROPERTY 01tVN1~RSI31PfACfTHORIZE©RGENT° 2.1 Owner of Record: Name(Print) Current klajffingAddress: Signature Telephone C ' 2.2 Authorized Agent: Name(Print)LIS ,� ��?{'7 c,�,�.- � Current Mailing Address: 0, Signature Telephone 1—,2 j -'-SEC.T.I0FF.3=.:ESTtMATED4CONST CTION COSTS Item Estimated Cost(Dollars)lobe t)tc�at Use{3rJIY com feted b permit applicant . 1. Building S—GG i .(a `Buildlhg P"Fee- 2. Electrical (.bj;Estimated Total Cost of � ; _ ( °Const�i�on from. 6• � �; 3. Plumbing- 4. Mechanical(HVAC) l i 5.Fire Prolection M, 6. Total-0 +2+3+4 5) CfeckNumber 4tO �._ I s-Section FerciaF°Use-On rvsued: ij Signature: <- _•-' � Building Commissionedlnspecfor.`.nf Date $uildings .l4Y �1 i t File#BP-2006-1137 APPLICANT/CONTACT PERSON THOMAS KORYTOSKI ADDRESS/PHONE 359 BARDWELL ST BELCHERTOWN (413)250-8095 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 Building Permit Filled out Fee Paid Typeof Construction: UNIT#8 -REPLACE SKYLIGHT&WINDOW New Construction Non Structural interior renovations Addition to Existiniz Accessory Structure Building Plans Included: Owner/Statement or License 070047 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INATION 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 Co ion - �� 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 351 PLEASANT ST BP-2006-1137 GIs#: COMMONWEALTH OF MASSACHUSETTS :Block:32C I40 .-F. ` CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT g or V Permit# BP-2006-1137 Project# JS-2006-1685 Est.Cost: $5000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS KORYTOSKI 070047 Lot Size(sq.ft.): 0.00 Owner: HAMPSHIRE PROPERTY MANAGEMENT Zoning: GB Applicant: THOMAS KORYTOSKI AT. 351 PLEASANT ST Applicant Address: Phone: Insurance: 359 BARDWELL ST (413) 250-8095 O BELCH ERTOWNMA01 007 ISSUED ON:51212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-UNIT#8 - REPLACE SKYLIGHT &WINDOW 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 5/2/2006 0:00:00 $50.00593 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo