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32C-166 (24)
U.S. Postal Service CERTIFIED MAILRECEIPT Only; Provided) M Article Sent To: rru Bldg Insp - 32C - 166 p Postage $ L �r 'P a k✓1 ._..- lT) Certified Fee i . . - M Return Receipt Fee p (Endorsement Required) Restricted Delivery Fee 1.', (Endorsement Required) C3 � �C? "r te O Total Postage&Fees C M Name(Please Print Clearly)(to be completed by mailer) John-. -------------- st8S;4Pt1v6resVea"c1 Ave r` � fioo�Ce r MA 01040 —CO PS Form 3800,July 1999 See Reverse for instructions: SENDER: COMPLETE THIS SECTION (• THIS SECTION ON'DEUVERY-, • Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery item 4 if Restricted Delivery is desired. j 7 crZ • Print your name and address on the reverse so that we can return the card to you. C. Signature ❑ • Attach this card to the back of the mailpiece, X Agent or on the front if space permits. 0 Addressee DJs delivery address different from item 1? 0 Yes 1. Article Addressed to: J ( If YES,enter delivery address below: ❑No John Hebert ( I((G_1`Cd JH & JT Inc 108 Cabot St Holyoke, MA 01040 1 Service Type 0 Certified Mail 0 Express Mail 0 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 2. Article Number(Copy from service label) PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789 O P�0 " � 6 �asaacilusctlrs' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT with a principal place of business/residence at: (Z o► c) IQLS 2� (phone#) �6q_gS1,3 (st=Ucity/state/ap) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following workers compensation coverage for my employees worming on this job: ke-AL ftJ N¢AL (Insurance Company) (Policy Number) (Expiration Daze ( ) I am a sale proprietor, general contractor or homeowner (circle one) and have hired «r the contractors listed below who have the following worker's compensation policies: ;. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) ,, (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Inntrance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml sheet ifnaocnary to include informsriou p�-.moo to eu 000imaon) ( ) I am a sole proprietor and have no one wonting for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that vihile homeowners who employ parsons to do mainienaacr,comEructioa or repair wont ou a dwelling of not more than thme units in which the homeowner resides or oo the givands apputtenaat thereto arc not gcocrally oomaknd to be employers under the workti s oomQcas4oa Act(GL152,ss 1(5)�application by a homeowner for a liocnso or permit may evidence the legal ctanra of en employer under the Wockor's Compomation AeL I understand that a oopy of this rtat-11 maybe forte wxW to the Deputmco2 of lndirs Cd Acc idea&Office of Gnursnoe for the coverage vcri&cation and that failure to scout covcrago under soWoa 25A of MGL 152 can lead to the imposition of criminal pemwes ooasisting of a f rc of up to 11,500.00 and/or i np isonnxst of up to one ytw and civil penlWes in dr-form of a Stop Work Ordcr and a firm of 5100.00 a day against tae_ c For dgratn%=ea1 use only Permit Number jai{ Lot# f: Signature of Licrosc e/petmi Date Version 1.7 Commercial Building Permit May 15,2000 SECTION SRUCTRA`�PEER�REVIEV 780 C R10 11 <� 3 , .roa.�3 Independent Structural Engineering Structural Peer Review Required Yes......❑ No.......FIJ( SEGION 1....I ,OWNER AUTHORIZATION 'TO BE COMPLETED �fVFIEN OW�ERS AGENT OR CONTRACTORPPLIES'3OR BUILDING PERMIT ,. , I, Jc as Owner of the subject property hereby authorize !A i P+Lk r to act on my behalf, in all matters relative to work authorized by this building permit application. 3 + Rk�ex� I� PS-02 Signature of Owner Date I, as Owner/Authorized Agent hereby declare that the stat ents 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 2n4 Rd Signature of Owner/Agent Date SECTION 12 CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number 12 old Fe ad no giLL5 12-g749 Addres Expiration Date OV/)/ 02- Signature Telephone SECTION 13 WORKERS' CMPENSATION,INSURANCE AfFIDA1/IT(M.G.L.c.152, 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 o the building permit. Signed Affidavit Attached Yes....... No...... ❑ ` Versionl.7 Commercial Building Permit May 15,2000 SEGTIO(N ROFES510NAL;DESIGN SAND CONSTRUCTIONSER1/IGES FOR BUILDINGS ATID STRt1GTURE$ 11BJ G, JO, 3 A 9� 3 '�r 3 3��4 q�'1g3 -fib' CQN,S,T lJ<CTfN CON fROL PURSt1ANT T07$Q,CMR 16_, C©1V7AININ'G MORE THAN 35,000C F,"v:F ENOSEDSs 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 t0/1 T �/1 Not Applicable ❑ Company Name: eAfRc(k k-J I �► Response le In Charge of Construct' CZ c Jifllq ,l Ls rl,-'56r,- Address ( -6451— gS-13 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 l 7.Water Supply(M.G.L. c.40, § 54) 17.1 Flood Zone Information: 17.3 Sewage Disposal System: l Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING Existing jProposed 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 parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO V1 DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 I7 IF YES, describe size, type and location: D. Are ere any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: Version 1.7 Commercial Building Permit May 15,2000 SECTIONCONSTRUCI'tt)N SER �CESEOR OPf PRO iECTS I: SS TFANS 000 C�iB�C l=E� NCLOSEDM§11'ACE'l�' � 4,n3 M3 pf Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ 1 Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] aaF k A W. " DESC2�P�r ( 5ECT10N S tISE G�tOUP AND CONSRUCTION TYPE �z ay__a rt z. so r� e USE GROUP(Check as applicable) IJ CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi Rh Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile M, 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,'ADDITid.NS ANE)/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6�UIIL Q F1EIGHT AND i41REA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION il Floor Area per Floor(sf) st s � £ s 1st 2nd 3rd nd 2 3rd 4th a 4th yf"' Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft ------------------- `f Version 1.7 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 SITE INFORMATION f ThIS 5 @Ct10 to`be q [! Q. office 1.1 Property Address: a . "1If9 FLeAsigot S7' Nar<t A m PLo § 3 ¢ U'Elm 5t District SECTION 2:-,PROPERTY OWNERSHIP/AUT HORIZED AGEN7 2.1 Owner of Record: Jo b4 �leg�t' � qb •PLe 5,9 'TT , Name(Print) Current Mailing Address: ?,2 8��3 Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION;3 '"EST[M4 ED'CONSTRutfIOi�I C05TS'3 Item Estimated Cost(Dollars)to be Oif �c�al Use OIy completed by ermit applicant _ 1. Building 'I�no+<�n� o, (a)'.Building Permit Fee 2. Electrical ( ) Estlimated Total Cost of' b Con''structioli from. 3. Plumbing Building Permit' -Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) ,°CheckM.tjmber. • .,. ..�"!'h�s...�ec�t�om�`or-Oftic�a� Used"nI Bui ld lh I�`rtllltY Ul 1l BC 3 bate issued 3 3 'Slgnature ' Dh t` .a4 � ,. e Bul1dIPSplrltmissinerdinsp� arf tl > - 196 PLEASANT ST BP-2002-0676 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 166 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2002-0676 Project# JS-2002-1089 Est.Cost: $8600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK G KELLY 128749 Lot Size(sq. £t.): 5401.44 Owner: J H J L 1NC Zoning: CB Applicant: PATRICK G KELLY AT. 196 PLEASANT ST Applicant Address: Phone: Insurance: 12 OLD FEEDING HILLS RD (413) 568-9513 Workers Compensation WESTFIELDMA01085 ISSUED ON:1128102 0:00:00 TOPERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & MASONRY REPAIR 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 Sienature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/28/02 0:00:00 464 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo f 1 r BP-2002.0676 4-1400*0 GIs#. COMMONWEALTH OF MASSACHUSETTS MaD:Block:32C- 166 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2002-0676 Project# JS-2002-1089 Est. Cost: $8600.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK G KELLY 128749 Lot Size(sq.ft.): 5401.44 Owner: J H J L INC Zoning: CB Applicant: PATRICK G KELLY AT. 196 PLEASANT ST Applicant Address: Phone: Insurance: 12 OLD FEEDING HILLS RD (413) 568-9513 Workers Compensation WESTFIELDMA01085 ISSUED ON:1128102 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & MASONRY REPAIR 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/28/02 0:00:00 464 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo