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32C-142 (16) 0.Z ivar�'T l•• <� A E �Zc3sachncr(tn' _ DEPARTMENT OP DUILDD'\'G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 «'O DUCE R'S C O\/(P)✓N S A TI O N LEI S U A-N CE A 1'1 M A Nr17' ' 0l c=s--JpcTrf7)ttcc) _5 �•' ),( (Phone.) (str�-tJc,ty/nau'zi p) do hereby certify, under the pau'-Ls and penalties of per3ury., O I am an employer providing t1ie following %�,orlcers comoens-zlion cove—.se for my etupl'oyccs Nvorlong on this job: (Lasuisn=Coon=- Y) (PcLicy Nu--airr) --- (r--piruer, Date) O I am a sole proprletor, general contractor or homeowner(circie oee) and have hired the cones actors bsted below wbo h2ve the following worker's coc--ipe.g5a6on policies: ( Namc Oi Co-n.na0r) Gn urzncc Colnoanwt'oi.ic-, ��tumh--:) -- `t_�')l-j", ? 1�:1IC)' - (Name of Coaractor) _ (lnslranc°. ComoaziviPode, Number) (E»ir,Lion Date) (Name of COUMCIOT) (Insuranc Compa )'/PoUcy Mdmbu) (ExaiF36os Date) I (Name of Contractor) (Iasu=c-- ComDzry[Poticy Numbs) - (F-a�Jim6on Date) (eascb Ai oca� �cet ifnoxz��•in ccum ioformi-Zoa pe,tniaing to.L coat-ry s) ( am a sole proprietor and bave no one worming for me- ( ) I am.a home owner performing all the work myself. NOTE:plea be ew•�rt ti-w-I Jo bomcO.,v i w-bo auplay pc7Lc=, eo do r-,;.,�-,..,.,. �r ern r repair work on t d��c1Lg of aot axxt th--m throc'mrJ to-tt r}1 the bomoowver rtardp ar oa lbC t!""""�Z�put•(.0 ^lJ)C'Ca LT oA(;G1C y occ=d=vd Lo be -aVloyva ucx c the c=pc=-+'pa Act(GL152fs 1(5)�rpplintion by a bomcow-a fcr a lica'-Y oc pamit t=y cid—lt:c IePaJ M"'l c of en erployx uo&r dw Wori;.ola Coaspooa.>_i AeL 1 undesz.ad tha a copy or tbu mu—may bo ror�.wrded to tbo Dopartmcat of toda,r-ri.J AccdaotY Otrioo or Uzuc-co Tor tbl 00 Xe c vciCetioo acid Ih_t UL=to too=lcoverase vadcr soetioo 25A of NIGL 151 as lead to the i=PCI-603 of crimi=,pcatllirn ooasirin of a dux crop to S1 500.00 arwor isoaax ri orup to ooc Yf god civil pe..rjo in d.,form ofa Slop Work Order+rid a f1m of S 100.00 a d_y ap.i=mc. For dcp+rtrz."'•�u,c only Pc-rmit Numbc-r Lot ..- C. a-.i�.:.I"i$c:L'r!-C II1u iic.c: •sir-c t ...--- .J Version 1.7 Commercial Building Permit May 15,2000 J.. SEC-TION.i,U STRUGTURA.PEERREU►EW(780 CM(T 110 i t� , _ Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION�11 OWNER AUTHORIZA- -TION:-TO-BEZOMP1:ETEQ'WHEN' OWNERS AGENT.OR CONTRACTORAPPLIE& OR SUILDING`PERMIT t h as Owner of the subject property i hereby authorize! to act on my behalf,in all matters relative to work authorized by this building permit application. I ` Signature of Owner Date I,l ��,Lam_ L Q• L ,.�'�'�LC as Own r/Authorize gent ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge tmd-belief. Signed under the pains and penalties of pe•u!y. , Print Name ture of Owne Agent Date •SECTION 12 CONSTRUCTIANiSERV(CEI 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: {/J 011- License Number } .�1� Il)1 r►Zt'C�l� tS 1 v�/r /7 �1�i 6� Address Expiration Date Sigp6turej Telephone SECTION 13-WORKERS'COMPENSAT(OK INSURANCEAFF(QAVIT(16 L , T52,:§•28C(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 r Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGt�CAND CONSTRIlOTIOISER\/1GE5 EQR BUILQINGS A(iIQS2UCTEtkZESUtECT 1.0. CONSTRUCTION CONTROL PURSUAN TQ,T80 CMR 11fi{CONTR RING MORE THAIt*t ics.OF EACCL©SEDiSPAGE) 9.1 Registered Architect Not Applicable ❑ Name(Registrant): I Registration Number Address j Expiration Date - Signature Telephone 9.2 Registered Professional Engineer(s): ;Name - - Area of Responsibility Address Registration Number � I � Signature Telephone Expiration Date { E Name Area of Responsibility I j i Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility i s ' Address I Registration Number Signature Telephone Expiration Date t i I Name Area of Responsibility Address Registration Number j I Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: I 3 i Responsible In Charge of Construction i r Address 1 Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Deparpnent Lot Size Frontage Setbacks Front ( 1 Side L:' R: - L:— RE=] f Rear -Bu—iWugIei Bldg.Square Footage € % j 1— Open Space Footage % (Lot area minus bldg&paved I parking) #of Parking Spaces Fill: ! j (volume"k 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 Pagej and/or Document#i B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Date Issued: C. Do any signs exist on the property? YES 0 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 Q IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is Apart 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. Version 1.7 Commercial Building Permit May 15,2000 r.. SEOi ION 4�COfJSSI2tTG1ION SERVICES FOfPROJEGTESS1AN 35,000 CUBIGFEET DEENCLQSED SPt/CCE": Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ ,New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description EEnter a brief description here. Of Proposed Work: ( c _'SECTION 5 USE-GROUP AN Q CONS3RUCTIQN�IYPE^ USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly AA ❑ 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 ❑ 1 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: 1 M Mixed Use Specify:i S Special Use 0 Specify: COMPLETE TI 11S SECT tON iF V BU1t�11N Existin G 1[NDERGQI G'FtEf�fOa/A�[( AQLitTtONS A iDfOR PWGE 1N USE �g Use Group. I Proposed Use Group: f Existing Hazard Index 780 CMR 34): ! Proposed Hazard Index 780 CMR 34): i SECTfDN"68IIILDINGEIE1GfANQREA- -? BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 151 1 se - .. nA ' .- 2nd 2 _ 3`d 3rd 4'h i 3 4 th i Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) r " 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? I Outside Flood Zone❑ Municipal ❑ On site disposal system E] Version 1.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room,100 a 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 SECIION� SITB'INFORM�T'ION" =° ry --- Jl-1-Property-Addfes . 3 T secUocLta be cocnpYetetc6Xt€ice_ , Sl i ice. . t�►sfrrct` -_---�� '.'��s °m.---_ �"��"` SECTION 2 'PROPERTY OINNERSF3IPCAUT HOR1ZELi,AGENT 2.1 Owner of Record: Atj dc— z Name(Print) `` v 2 S Current Mailing Address: Nov a.\ Signature I Telephone I U 2.2 Authorized t:�� -Q'-s e /� Name(Print) C Mailing Address: �✓�G""� Signature - Telephone ---SECT ION 3- <ESTIMATED:CbNSTRlJCT10N:COSTS Item Estimated Cost(Dollars)to be ficiaT Use;©nIq; completed by ermit applicant 1. Building j (a�>Budding Perrrmit Fee l i 2. Electrical (b)Estimated TotaL:Cost iif" i Construcfi on. from 6 3. Plumbing # Btiild�ng PenritFee 4. Mechanical(HVAC) s - 5.Fire Protection 6. Total=(1+2+3+4+5) s G� --check Number _ This SOdUci 'For..Offic�al=Use-Only BuI umiaer.. Qafe s. fissued' r _ Signature Building Commissione6lnspectorof Buildings Date t 317 PLEASANT ST BP-2006-0616 GIS#: COMMONWEALTH OF MASSACHUSETTS MU:Block: 32C- 142 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0616 Project# JS-2006-0906 Est.Cost: $1500.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: John Corbett 104000 Lot Size(sq.ft.): 12327.48 Owner: PAQUIN GERARD A Zoniniz: GB Applicant. John Corbett AT. 317 PLEASANT ST Applicant Address: Phone: Insurance: 56 Dimock St (413) 586-8712 LEEDSMA01053 ISSUED ON.121512005 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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 12/5/2005 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo