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32A-255 (14)
Versionl.7 Commercial Building Permit May 15,2000 r SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Star Northampton, Inc. (The Hotel Northampton) as Owner of the subject property Pioneer Contractors hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. 08/14/2006 Signature of Owner Date Pioneer Contractors 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 _ pains and penalties of perjury. Ci Print Nam VIA A (7 I Signatur of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: David A. Claxton 017890 License Number P.O. Box 1145 Northampton, MA. 01061 A 01/19/2008 Address Expiration Date (413) 586-5491 Signature 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 buil ng permit. Signed Affidavit Attached Yes W 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 36,000 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 Expiration Date 9.3 General Contractor Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA. 01061 Address (413) 586-5491 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 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:i_ 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 DON'T KNOW YES C) IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO (D DON'T KNOW 0 YES 0 IF YES: enter Book Page, and/or Document #' B. Does the site contain a brook, body of water or wetlands? NO (D", 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 , Date Issued: C. Do any signs exist on the property? YES eK 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: E. Will the construction activity disturb(clearing, grading,excay6fion, 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. Repair rear entry wall after fire damage Of Proposed Work: 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 ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-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: 1�„` �.. Proposed Use Group: s2.hne.. 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) 15t 1 St 2"° 2nd 3 r 3rd 4tn 4tn Total Area(so Total Proposed New Construction(sf) Total Height(ft) Total Height ft /.v 7.Water S pply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal' System: Public Ef Private ❑ 1 Zone I Outside Flood Zone Municipal On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 Department use only . -City of Northampton Status of Permit 1 Riding Department Curb CdDtiueway Permit 12 Main Street SewerfSeptieAvariability v- Room 100 WaterP`it Avaliab"ility i) N iampton, MA 01060 Two Set :otStructuhal Plans �T phone 443-5$7-1240 Fax 413-587-1272 Plot/Site Plans ,K Other Specify 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 1.1 Property Address: This section to be completed by office 36 King Street Map Lot Unit The Hotel Northampton Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Star Northampton,Inc. © '36 King St., Northampton, MA. 01060 p Name(Print) Current Mailing Address: (413) 587-8100 Signature fF G( L� `� Telephone 2.2 Authorized Aaent: Pioneer Contractors © P.O. Box 1145 Northampton, MA. 01061 0 Name(Print) Current Mailing Address: (413) 586-5491 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $3,500.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of $500.00 Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Vw,07) Check Number Q This Section For Official Use Only Building Permit Number Date Issued Signature: Building'Commissioner/Inspector of Buildings Date I ' File#BP-2007-0178 APPLICANT/CONTACT PERSON Pioneer Contractors ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491 PROPERTY LOCATION 36 KING ST MAP 32A PARCEL 255 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: REPAIR REAR ENTRY WALL FROM FIRE DAMAGE New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included• -- Owner/Statement or License 017890 3 sets of Plans/Plot Plan THXFLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ION PRESENTED: pped 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 M701 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. BP-2007-0178 c- #: COMMONWEALTH OF MASSACHUSETTS y CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:ry: BUILDING PERMIT Permit# BP-2007-0178 Project# JS-2007-000268 Est. Cost: $4000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Pioneer Contractors 017890 Lot Size(sq. ft.): 72614.52 Owner: STAR NORTHAMPTON INC Zoning: CB Applicant: Pioneer Contractors AT. 36 KING ST Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAM PTONMA01 061 ISSUED ON.811612006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR REAR ENTRY WALL FROM FIRE DAMAGE 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 8/16/2006 0:00:00 $50.0011109 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo