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32C-149 (32) ��lt/J•f pJ, �\ - Fz� Cyif-�) of �,Tcz-fllal)1pfoll t a3a nrhn cIra' W DEPARTMENT OP DUILDP\IG INSPECTIONS _ 212 Main Strcet ' Municipal Building , Northampton, Mass. 01000 WORICEIZ'S COj'UENSATION LiSURA-NCF- AFTIJ)AVIT \r.Ilth a prulicipal place of business/residence at: Ci (s c--Ucity/stazcfzip) 03 J do hereby certify, under th.e p?.ins and penalties of pc Oul-y., --h.?i O I am an employer providing the following- worker's comocnsn on cove 2ge for my eluptovees wor�:ing on'Uns job. (La=---n=Com=v) (Polic:NU--L6^_r) -- C :-pirrt.iorr Dasc) �I,am a sole proprietor, general contractor or homeoviocr (c cle one) app hive hired the conisactors Us-ted below who have the follo�viog worker's compensai'on policies: 0`arllC Of Co,tMC-,Or) (InRJ anU COJIIp1T1}ft'GUC'i N1u-IIl!'C) �t-';�U d]^n Dalc) (Name 01 Coasaczor) (In-suranc—c Compan.vPolicn, Numcrr) Dzse) (Name o(CoJuraetor) (Laswane: ComT=)- PoUcy Nwnb�z.r) (Expimaon Date) (Name of Cona-deior) (Insurance CompanyRoLcy Numtrcr) (Espndoa Darr) (attach adai-0c�J 6cc�iloccc ry to crud_inform,::ioa pcnaioiag to sL ov=m=0n) O I am a sole proprietor and bave no one working for me. ( ) I am.a home owner performing all the work myself. NOTE:plwc be eorxrc theµtitle boco bo caplay pczoax w 13 �• c�=c,�o r renir work oa.d.• of not snort Lb n L-,Z -_—,j is u$ich the bomoo-wc r=do oc oo the aou ,s zpput -lsc: o c ax�o-a12y peer d Teti to be ca00ye-3 under d-..Wk-r's ca=pa=Lz1ica Azt(GLISZs 1(5)).applua0oo by a bomcowoa fcr c 6c-r--.or Perron Inr.y n-rdca«LI:c lc-1 cW. "of ca c ployx uoder dip Worirora Co=p, I;oc Act I uaZoi d dLd a copy of this m.,—may be foc-nud+,d to tlw Dop.,U_od of J-ia ric1 Am"— Offioo of irra.+nvco for the oova-q�c va%Gcxuoo and U%--i L•iltac to soaue`co%-Cn S uadcr saevon 25A of MOL 132 sera Ied to the is os boa of ai aiuw Pea.16- comiAmg or a fiat of up to S 1,500.00-N-imgr-i3oosp of up to otx yvr end ci Vi)PCM h a is tx form of a StoP Work Order end. fin=of S 100.00 a day tpinA me For dc�u, only I crmit NutnbcJ --`? Lot. Signahuc or crmiticc Version 1.7 Commercial Building Permit May 15,2000 SECTION 30 STRUCTURAL PEER 06 IfW,(780 CMR 110 3. Independent Structural Engineering Structural Peer Review Required Yes......❑ No......E SECT ON 11 OWNER AUTHORIZATION. TO'�BE COMPLETED WHEN OWNERS"A ENT, CONTRACTOR APPLIES FOR BUILDING PERMIT e lam- c as Owner of the subject property hereby authorize to act on my behalf, in all m ers relative to work,autho ized by this building permit application. S nature of Owner Date I, Q' _Z , as Owneriorized AgeA hereby d clare that the state nts 6rfd informati n on the fo egoi app ication are t ue and accurate, to y knowledge and belief. Signed under the pains and penalties of perjury. l0�^ Print Name of 5X2 G lgnatur of Owner/Agent to SECTION.12 C, ST- ,CTJ0NS.ERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 0/YI ��D1/2y'T�/$ l,( � e S d 2 License Number Address_ _ /0 3/ Expiration Date -�� �// - 6 G G--2 l O Si nature Telephone SECTION 13 ;WORKERS3 CbMI�ENAVON IN SURANCE S AFFIDAVIT(M 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...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTIQN 9- PRQFESSIONAL DESIGN"AND CONSTRUCTION"SERVICES - FOR,BUILDINGS AND STRUCTURES.S'UBJECT TQ " CONSTRUCT ION"CONTROL PURSUANT O"780 CMR 116(CONTAINING IYfORE THAN.35 000 C. OF"ENCLOSb SPACE 9.1 Registered Architect: Not Applicable 21 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 Not Applicable ❑ Company Name: Responsible in Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L.c.'40,§S4) 7.1 Flood Zone Information: 7.3 Sewagesposal System: Public ❑ Private Ga' 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 arl in ) #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 DONT 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: ` iC t/l&W -� � V- a Versionl.7 Commercial Building Permit May 15,2000 SECTION+4--7=NSTt �SERVIt fS OR R07EC1•S�ESS TITAN 3 ,D00 CUBIC 1FEEC OF ENCLOSED SIPACf - s Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ ❑ ❑ 1 7 Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] l BRIEF DESCRIPTION: femov� - Oor. , fe Ct (; i/eS� ! /Id�1 - ,✓gar: uJ�:�l SECTION 5,USE',GROUP:AN13 CONSTRUCIIOIY?Y�E; USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business Er 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H 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 ❑ S ecify: ' f'c- M Mixed Use © Specify: S Special Use ❑ Specify: r COMPLETE HIS'SECTION. F E S1rIIa1G f3UAQ�17{�DERCOIf1G`?ENOV ONS;ADDII QNS ANDJO.it CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION'6:S1lItDING;"HE GI T ATID 3AREA, BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION " Cam; SE�QNL� Floor Area per Floor 2"d ISt k- 2�d 3� s ? " 3`d — zR � x � naCx b 4 a 4TH e waF - k j fi h9� aW Total Area (sf) Total Proposed New Construction (s A " � w <� Total Height(ft) ig i ;" Total Height ft--------------- r .M•tv� u NIL Versionl.7 Commercial Building Permit May 15,2000 ECi f Northampton " IRi d ng Department 1�AY 2 1 204 I 212 Main Street L—Roo 100 No MA 01060 'ton, " r�rv" PFrore 413^ 87-1 40 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 SITE INF©RMATION 1.1 Property Address: cgtnp! ^bl/oice t2A y�:� /! C�.t' "�-�..40'1 �A IV 0 SEC nON'2-.PROPERTY'OW.NERSHWAUTHORIZED.%1GENT 2.1 Owner of Record: L�-A �� fL /rl iJD ilk- Ll d�/ 0 Name(Print) Current/Mailing Address: Signature Tellfthone 2.2 Authorized Agent: /y- rPrra��� Name(Pant) , ,�� r Current MailingA6dress: -5�70 xrz Signature Telephone SECTION 3-'ESTiN1 AT,ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official"Use Only completed by ermit appli cant 1. Building l,G� (i)Building Permit1Fee" 2. Electrical (b)Estimated Total Cost"of . Constrdetion"from 6 3. Plumbing Building°:Pa'rnnit;Fear_ 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 +4+ 5) Check.Ndmbber O d' Section For OfficiaUse Only:` Bu�ld�n Perris t-Number ljate issued:" g'a Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1168 APPLICANT/CONTACT PERSON THOMAS KORYTOSKI ADDRESS/PHONE 39 LAUREL MOUNTAIN RD HAYDENVILLE (413)665-2106 Q PROPERTY LOCATION 271 PLEASANT ST MAP 32C PARCEL 149 001 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 2Z741 J 50 Typeof Construction: REMOVE NON-BEARING WALL FLOORING&CEILING TILES New Construction Non Structural interior renovations Addition to Existing Accesso1y 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 INFO 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 ommission -s Ls�a©o 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. 271 PLEASANT ST BP-2004-1168 GIS#: COMMONWEALTH OF MASSAC14USETTS Map:Block: 32C- 149 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING UILDING PERMIT Permit# BP-2004-1168 Project# JS-2004-1768 Est. Cost: $2000.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: THOMAS KORYTOSKI 070047 Lot Size(sq. ft.): 10715.76 Owner: MCCARTHY PROPERTIES INC. Zoning: GB Applicant: THOMAS KORYTOSKI AT. 271 PLEASANT ST Applicant Address: Phone: Insurance: 39 LAUREL MOUNTAIN RD (413) 665-2106 (� HAYDENVILLEMA01039 ISSUED ON:5126104 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE NON-BEARING WALL, FLOORING & CEILING TILES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Buildinb Inspector Underground: Service: Meter: Footings: Rough: Rough:�1��f p c, House# Foundation: Driveway Final: Final: Final: fl6 l y �O Rough Frame��'7—/5�d Lf Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation:M 7- 81•Oy-'6( Final: Smoke: FinalV d - 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 5/26)'04 0:00:00 2031 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner- Anthony Patillo Sw �P .: 51r z vow Al 4 } X ANWAR j ME � S t a �- . ,fir EiM Wit 11 AQ a ma'am w< w itsa on r ,x < f > r i 4 ".P to # YL 3N' fd } Oil M-040 { MIN fit mix a Mon zV ow was a Y r 1 } p i Raw +y bt0 VOW } an # * e s ?• Kam T&M df r S :. 'if too FAIR- Mow WIN 5001 VERR S S f L ; e v S mewwwo stx mod t, iy vivo * �4 MR1 nog"a + F w e I VIA e' 271 PLEASANT ST . SP-2004-1168 COMMONWEALTH OF MAS SACHUSETTS �a mk:32C- 149 CITY OF O `.LAMPTON 5 ot.-001 PERSONS CONTRACTING WITH VXRECA TER CONTRACTORS Perrnitt Building DO NOT HAVE ACCESS TO THE GUARANTY FUN'? (MGL C.142A) Cateaon+: BUI L12ING � R1T Pe g# BP-2Ufl4-1168 Project# JS-2 - Est,C,4st-$_2M.00 50.00 PERMISSION IS H .RERY GRANTED 10 +Cons#.Clays: Contractor: License: uLe Q"Ou THOMAS-KORYTOSKI 071 7 Lot SjU(sg,ft), 10A5.76 OW-u: MCCAR1' i��E%QP_9LUL8 INC. P IH � R �� AT 271 FLE&MNT ST Applicant Adder Pane: 39 LAIIAEL M 1 AIN RP (413 HAYDEKIVIl.LEMA01039 ISSUED QN:S/204 tl:ft4U TO PERFORM THE FOLLOWING WORK.-REMOVE NON-BEARING V14 , RING & CEILING TILES POST T IBS 1A VUSUBLE FROM STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building-lospeew Underground: Service: Meter: Footings: Rough: Rough:7/15 House# Foundatlow , Driveway Final: Final: Final: 100 y . Rough Gas: Fire ftartment Fireplace/Chlnmey: Rough: 4f1: Insulation:. ' 7 8/,# Final: o e: Flual: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO F ANY OF ITS RULES AND REGULATIONS. fj e. FeeT : R.ece `t No: L1ate Paid: Cke.Cjk U: # . Building 5/26/04 0:00:00 2031 212 Main Stmet,Phone(413)587-1240,Fax (413)587-1272 Building Commissioner-Anthony Patillo