32C-162 (5) ' f
1rt s%� DEPARTMENT OF BUILDIOG INSPEGI-ioNS
212 Main Street Municipal Building
Northatnptou, It�ass. OlOGO �'�=='�``
NVOIUCER'S COMTENSATION INST RANCE A.IMD,- Vu
Pioneer Contractors/PI Con,. Inc.
(Lic;�ns�lpt;luii tta;}
�vlth a principal place of busines--Jresidence ax:
(G-ni-�t/c i t3/st31eJ�p)
do Ltreby certify, under the pains and penalties of ptl3uiy, tlidt
(h) I am as employer providing the following N porker s colnpens BOB coverage for my
cluployccs working on r_his job:
MpA-Irj" =nua— (Policy Numt c r) (F puaaon D it )
( ) 1 am a sole proprietor; general couractor or homeowoe: (circle oat) and have hires
the conaractors lisied below who have the following worker's comperuauon policies:.
(Na-We of CQULrd-CLDr) (Iusurazcc Compauy/Mic7\1 Numb,-r) (FxTiuuno❑Date,)
(Name of Contractor) (I.asirancc Compan),/Poke) Numb`r) (Lxvu�oon Dart}
(Name of Cou ractor) (Lasu(t Compan),(PoLicy Nuuli,j) (F_,,piranou Dale)
(Name of Contractor) (Lmaur oe Company/Poticy Numb _r) ' (L�pilaaon Dale)
(eaach a.dditiceul shx ifno�uy Co include infocuutioo p:•r_u to nll co�rna-0r�)
( ) I am a sole proprietor and have no one working for me.
( ) I any a home owner performing all the work myself.
NOTE-.please be aware that while homDor,6�who anpl oy p sons to rupp a wobK on a dwcllins of
not morn than thrao umiu in winch db c homes_v .r ncido of oo tb--go�app.r�ubacw att DX ilty ax1aidg cd w t
Cuploym utidcY tba wQeKas aDa}xis as A,A(GL152,rs1(5))�appUcapoo by a homcowDa far_-G=3c oc par-ma ul-ty cvid-x�We
1cyy1 pus ocan amployoc uodartlaa wocl-Xes C:otupcmai AcL
1 uudcrs d d"i%ropy of this;:VA f m m.y bo fcaw"t d w Lbo Dcpaicmrnt o£lr�J Ac a3 a>?Offioo of L r u to x far Chi
c overa�-.e vaificatioa and thu Calure w nac=re cova-rLV uLUScr salioa 25A of hfGL 152 an Iced w tbo Lw xs hoa of cnmm.%t p-uallia
,Qcm:�of a fmc'of up to S 1,SW.00 andloc i-yy of tip in one yczrr Ut d civil pc-nzlGC3 in 6,Room of a Stop W06�ordcz and a
Ana of 5100.00 a day agAiuA m`.
Pcruut N'umb's
_tV6�� r F h1I _-
Signa e of Lice{xJPermautj= e _ _
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize _ _ _ � ����_� 6rA . .. _ to
act on my be II tters relative to work authorized by this building permit application.
S ure of Owner Date
as-ewrm-r/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 uno pains and., na l f p rlury
Print Name
Signature of 9wMr/Agent Date
SECTION 12•CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Q �
License Number
Address Expiration Date
Signatufe Telephone
SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152,§25C(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 No
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
.. ... _.. _. .._ __._.__ _ .___ _ ..._ .... .. Not Applicable ❑
Name(Registrant):
Registration Number
Address
.............._
Expiration Date
Signature Telephone
9.2 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 I Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING f
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 r
Bldg. Square Footage % �
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: ,........... . . _......_. ....__. ___.,._.,w.
(volume&Location)
A. Has a Special Permit/Variance/Finding er been issued for/on the site?
NO DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the RLegitry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book i Page; and/or Document #'
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES NO Q
IF YES, describe size, type and location:
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: ,
E. Will the construction activity disturb(clearing,grading,excavalion, 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.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description Enter a brief description here. -4 37h,Ax� ( � _,h 11v
Of Proposed Work: I VN
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
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 ❑ 213 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:
S Special Use ❑ Specify: ,
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: __ _.... _.. Proposed Use Group:
Existing Hazard Index 780 CMR 34): ,.. Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
2nd 2nd
3rd ' 3rd E
_ .
_.: �.. .__.. .� _. _. . . , ...;
4 4 m
Total Area(sf) Total Proposed New Construction�sf
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L, c.40,§54) T7.1 Flood Zone,Information: F.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ unicipal ❑ On site disposal system El
Version 1.7 Commercial Building Permit May 15,2000
4,
City of Northampton $
Building Department T0' y�
212 Main Street c Abet
Room 100 V"V"UN111�t vlllr>ty
i�orthampton, MA 01060 Twrrets s Wtraot,rt PIS
-phone 413-57-1240 Fax 413-587-12724Plan
� rcrfy
x-
APPLICATION TO CONSTkU &REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Z P1Gu��3y� Map Lot Unit
1�
Zone Overlay.District
St.District; CB Dlstriat
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
��e �. LLj/ tip 7�e�1
Name(Print Current Mailin- Address:
Signature Telephone �/ 3 S _,7 j
2.2 Authorized Agent:
1 1 43'
Name(Print) Current Mailing Address r01061
Ilk
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com feted by ermit applicant
..m..__._
1. Building .� (a)Building Permit Fee
2 Electrical i (b),Estimated Total Cost of
Construction from 6
3. Plumbing I Building Permit'Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 3.J Check Number Q�
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissionerllnspector of Buildings Date
File#BP-2006-0366
APPLICANT/CONTACT PERSON Pioneer Contractors
ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491
PROPERTY LOCATION 223 PLEASANT ST
MAP 32C PARCEL 162 001 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 0 PLO
Typeof Construction: INSULATE SHEETROCK&INSTALL WALK-IN FRIDGE IN REAR STORAGE AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Co sion
Signature o Buil mg 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.
223 PLEASANT ST BP-2006-0366
CIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 32C- 162 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0366
Protect# JS-2006-0534
Est.Cost: $3500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: Pioneer Contractors 017890
Lot Size(sq. ft.): 4268.88 Owner: ST MARTIN PETER A&
Zoning GB Applicant: Pioneer Contractors
AT. 223 PLEASANT ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586-5491 Workers
Compensation
NORTHAM PTONMA01 061 ISSUED ON:101712005 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSULATE, SHEETROCK & INSTALL WALK-IN
FRIDGE IN REAR STORAGE AREA
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 10/7/2005 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo