32C-164 (13) OR•(lU�f p�,O _
w Q DEPARTMENT OP BUILDFNG INSPECTIONS
212 Alain Strcct ' Municipal Building
Rrorthnmpton, Mass. 01060
WGrUCER'S CONi CPENSA'nON I;lSUR -NCE A=AVIT
{11 cons Pcnnl ttcc)
kvith a prblicipal place of bushoesslresidence at:
(phoney-)
(So-(.tJa ty/SuIc/ap)
do hereby certif);, under Lh.e p?-ins and penalties of perjury, hat
O I am an employer providing die following workcr's comocns-non cove zge for my
etuplovees worming on'Lliis job:
(IanJJ-�m=Comrz-vv) (PoUc-. Nu--zb--r) --- (-x-piraaori D2i-)
O I am a sole proprietor, general contractor or homeower (circle or?e) and have hired
the consactors listed below wi;o have the fobovvine worker's coc:)nsaaon pohcies:
(Nam-, of Con=cwr) (Iris rancc Colnpan)-Pi oUc-, ?tit1B1L<T) (ExpirdU^n. Datc)
(Name of Cootrac ior) (Lnsuranc:. Comoan}'iPoIjc- Hutton) (Ex z6on Date)
(Name of Conrraetor) (Laurance Compan)•/PoUq- Number) (E\pimcion Date)
(Name of Coatractor) (Lasumc-- Compauy/Poucy Numb-:r) (Expiration Dale).
(aair�Ar„oca.l�'scG if oct�ury to inctu�uzfonai'i on pcta.ining w..l!or.�.cocs)
O I am a sole proprietor and Save no one worming for me-
am a owner performing all the work myself.'
NOTE:ple..sc be ew:.ve tb.e�tjjJ bcmeowvcn who employ pc: o=to do =–.:cr00 c rgair Work oe.d..cUmg of
na morn
Lb-- t"-oc—u in wimb the bocnooweer r=do or oa the pmar zppurte –tbeeco LT we C--mUy aec=daui to be
employ--uoCe the..vci its rm�m Acl(GL152,=1(5))aWilcm600 by s boa=--=rcr_lies_cc permit r=y cN-ideoee the
Ic-PJ et=u of to eszployx uode dw Woric•oe.Coc Vp .,Lion Ant
l and---d tba a oopy of thiw aarcmau may bo forword+d to tbo pcgortmooa orJomrtriaJ A.&.&OEG.or lr�rot tb. '
oovcnsc vviCcstioa o_�d t}t_t L•iltac to tcau,:bovcttsc under suction 15A of hiOL f 51 an tczd to the i ,�itioo of crimioz!pca+ltics
ooavxin of a GM of up to 51}00.00 arWor or up to ooc ycv znd aviJ pcmLf.'ca is 6c form or Stop Wort Order and■
run of stoo.00 a a--y apin:a
For
Pcrm.Jt Nuinbcl r.
�( 1.�P.,_ Lot "
' iws bmX of Li«=nsccrnctrnjucc `USEe J
Version 1.7 Commercial Building Permit May 15,2000
.............__................
SECTION10 STRUCTURAL PEER REVIEW x(780 CMR 110 lIj
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......
SECTION 11, „OWNER AUTHORIZATION TO Z E COMPLETED WHEN
,OWNERS AGENT OR COTITRACTOR APPLLE5�FOR BUILDINGPERMIT ,
l as Owner of the subject property
hereby authorize to act on
my behalf, in all utters rel ive to work authorized by this building permit application.
n �
igna ure of Owner Date
I, 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
Signature of Owner/Agent Date
SECT10N.12 -,'CO NSTRUCTION"SERVICES
10.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
SECTION 13 WORKERS'C " c 152! 25" C (
..
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
SECTfQN 9 R,ROFES51ONAL DESIGN AND CONSTRUCTION SERVICES FQR,BUILDfNGS AND STRUCTURES SUBJECT;TO
r �,,
CQNST;RUCTIOP(CONTROL'PURSUANT TD 780'CMR,116'(CONTAININ'G MORE THAN 35;000 F, OF ENGLOSEQ`SPACE)
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
Company Name: Not Applicable
Responsible In Charge of Construction
Address
Signature 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 ❑ 1 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
SAME
Side L:211-ft: 1435.,26 L: R:
Rear
Building Height 2 V f-0 PLY 10 04 S/4 M�.
�k
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arkin
#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 q(6/9' Page 141 and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO y 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 Y/ 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 V"
IF YES, describe size, type and location:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4 f�NS gXON`SERVI XO1t�VR03ECVV,` STNAN,35,0 0�
CUBIC FEET OEBNCLOSED SP1Cl: '
Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing
❑ ❑
Exterior Alterations TDemolitionO New Signs [ ] Change of Use [ ] Other [ ]
❑ tt Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION: (1A l�o -$ S>,h �/`
,
SECTION 5--USE G O&/CND CONSTRUCTION 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 ❑ 2A ❑
E Educational ❑ 2B ❑
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 ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE TF1IS SECTION IF EXLS7ING BUILDING UNZ�ERGflIN6 RENOV�4TIONS,` DDI�Ifl1VS ANDOR CHANGE,IN";tJSE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION SBUILDING rHEIGHT AND JAREA
t,l
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
if.L
Floor Area per Floor(sf) 1st .
lst
2"d
2nd rd
3 s �-
3rd —
m
4"' 4 r
t,
Total Area (sf) Total Proposed New Construction(sf) °
Total Height(ft) > ..
Total Height ft---------------- ;
t
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
SECTION 1 S1TJ JNFQRMATION
.
ssectwn enpletec�b ,effice"
1.1 Property Address. 3 ' 4 r
/(:y
I'�V � "! I `� ��(��� � a. a i tea. +.• Y"�� ,r.�`" �" �
SECTION T; PROPERTY'OWNERSHIP,JAUTHORTZEU'AGEtTa "
2.1 Owner of Record: PM Q
Lr_- A) 8 �( /y�-
Name(Print) Current Mailing Address:
(-{13 ) 2-0 °° /9 / (?
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 4 .ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit applicant
1. Building �� (a)Building Permits e
EStlmated s
2. Electrical �(h� Total Cost of
�w Construction from,.6
3. Plumbing MP A '49,1 'Prm�t ee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1+ 2+ 3+4+ 5) Number
This-5" diiFor:Offcia7zUseOnl
Building Permit=Number
date IssUed.
Signature:
Building:Commissioner/Inspector;of ad,lidings Date
185 PLEASANT sT BP-2005-0144
GIs#: COMMONWEALTH OF MASSACHUSETTS
�k:32C- 164 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-2005-0144
Project# JS-2005-0158
Est. Cost: $3500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 18992.16 Owner: CHONG JAE HUN& DUCK SOON
zoning: CB Applicant: CHONG JAE HUN & DUCK SOON
AT. 185 PLEASANT ST
Applicant Address: Phone: Insurance:
185 PLEASANT ST UNIT D (413) 250-1353 ()
NORTHAMPTONMA01060 ISSUED ON.8110104 0:00:00
TO PERFORM THE FOLLOWING WORK.SHINGLE ROOF OVER 1 LAYER
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 Shmature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 8/10/04 0:00:00 109 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo