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32C-288 (4) i ---- 2-0 Crii� IIf �a�-fljal)1}�fon R E _ — RqI aJ l Rch nr II I's' �{ Way _ .�• - - ; �_ DEPARTMENT OP BUILDDN.G INSPECT101.'S 212 Train Strcet ' Municipal Duidding Northampton, Mass. 01060 «'ORCER'S CO'NMENSATTON. MSURA-`CF AFFII A� rlj- ' Q i ccnsxlpcTmI(tcc) 7 ScsctT�i S 7 &a z, (phone:') ;y/3 _i, 7 do hereby certify, under thc.ppim aad penalties of pcgury, ha.i ( ) I am an employer providing the following A,orkcr's comocns::;o, cove�gt 'or my etuployees wor�Jing on uiis job` (Lasu_ran=Coc=-.c-) (Polio: Nu_mbcr) --- F--,-p Dais.) O I am a sole proor;etor, general contractor or homeowner(ci cie one) and have hired the cone actors listed below who hive the fo� nw icies-ov t L (i+t1IDC Of C0^'^Ci0') (Insuranc. CoinpaSl)-Pi c)6Ci N'uIILC:) (I'xpli-a",on Date)' (Name of Concaaor) (1nsrfa.ncc Comma}•/PoUc—, Nuraccr) (Lzoirtion Date) (Name of Cottnaelo,) (lasuranec Company/PoUq- Nwnbcr) (Exairadon Date) I (Name of Contractor) (Losuranc—c Comoany/Policy Number) - (Ea�irdaoa Datc)- (ans.cb:ddi�ol3!ESoC ifncc�-s..�-ca a�duc�iafo=� oo P=12a nips to (r am a sole proprietor and bave no one wort ng for me. ( ) I am.z home owner pp erfonni.tig all the work myself. NOTE:plcsc lx cvnrc th.. .t )c bomcouvcn wbo caaplay p-zoni to Sa r. =- -c b c rcpau .orK oo a d. _U_g of aot wort th n tr ro t^tar in 11sji-h the bomoo wet traic}o a oa the me zppu�y l ty.,c r ooc G.-.ay oeez.&�c to be employes unfc the u z�_ .., Am(GLI 52-=1(5)�nWUca.iou by a bomcoa=fv l fig_or puma r=y c%idco=tl:c Icgal luau of ea-=Pioyx under dro Wolkofr Compomatioa Ael_ 1 undo l"d th.a a copy of thi.mtcmaai m y bo rocv.crded to tbo Dopan Orind+atrid A.64.A'OfSoe or 4iul•oae for d- °ova's`v aira'oa a td I!t i L•.—to soatrc tcovero.se tmdcr soczioo 25A of?,IGL 152 cio Icd to the i ,�aioa of eiminst pcnxlti ooava i Z of a tine orup to S1 500.00 aaldror orup to oat yr=end a%it pmahio is do form or Slop Work Ordct and a fim of 5100.00.day apticra m,- - u.e only Pc=t Number Lot K rcm, Lkcc ._.._ __ _j !< Version 1.7 Commercial Building Permit May 15,2000 SECTION.10=5�RUGTURAL•PEEFtREV1EW(780 C—c 011 Independent Structural Engineering Structural Peer Review Required Yes No Q SECTION-11 -OWNER AUTHORIZATION,'-TO-BE COMPLETED:WHEN' OWNERS.AGEN.T.OR CONTRACTORAPPLIES FOR:µBU14DINGPERMI.T I I, 1 as Owner of the subject property i hereby authorize! 'to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, c CJC 1 Z 5 r (L) [q S f ,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. Si ned under the pains and penalties of perju�r)y., Print Name S c �' 11�f11 q 'J tj Signature of Owner/Agent Dat4 SEGUON 12-`CONSTRUCTION SERVICES. 10.1 Licensed Construction Supervisor: 1 Not Applicable�j❑ rA Name of License Holder: License Number i -�- So tO-li s7' T%57`4a- PkDToti IMC� oelo d � � ` ����� ago 9 Add s l Expiration Date Signature Telephone cTSECTION 13-WORKERS COMP ENSATIOU INSURANCE A=FA 52 : 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 0 No Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-P.,RQFESSiONAl:DESIGN AND_CONST—RUCTIM SERVICES EOl Wif:DINGS ANQS UGG ES 1 lEGT O CONSTRUCTION CONTROL PURSUANT 7Q_780,CMR 116(CON7AI,NING ,M©RE THAN 35,OOIk Cl OE ENCEOSE�SPCE) 9.1 Registered Architect - Not Applicable ❑ Name(Registrant): Registration Number l Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): R Name Area of Responsibility Address Registration Number Signature i Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility I # , Address Registration Number t Signature Telephone Expiration Date I Name Area of Responsibility i Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable❑ Company Name: l i Responsible In Charge of Construction r j Address I k I Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 ,.`.. . . Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i Frontage Setbacks Front �J Side L:' R: L:= R:= Rear I -Buildingg Heigif-"— Bldg.Square Footage % ' Open Space Footage (Lot area minus bldg&paved F-11 3 f #of Parking Spaces Fill: (volume"k.Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT 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 0 DONT KNOW 0 YES Q 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 0 NO Q IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. A Versionl.7 Commercial Building Permit May 15,2000 SECTION 4 CO14STRCTC-TLON SERVCCEW-FO PRO.II GTS I=ESS fHP bl 35,000 :"` CUBIC--FEEi"OE ENPLOSED SRCE" _ 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. _ Of Proposed Work: ; PGt i y- U SECTION 5 USE GR©UP ANQ COKSTFZIJG'EIONTYRE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly AA ❑ A-2 ❑ A-3 ❑ 1A ❑ __ _ ❑ Ate. ❑ A-5 ❑ 1 B ❑ B Business -- ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 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 F71 Specify: I M Mixed Use 0 Specify:; M S Special Use E Specify: GOIv1PLEFETb11S;SEGT[OI TF E�CISTINO BU1LD[GtG 1I�dE12GQ1f�G°REt�fC1/AT[Ol?IS; ICIDffiOltlS Af�thf,OR CEfiANGE 11V USE ,._._. . _ _ _ r t Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): I SECTIOTF G BUILDING Ell GH FAf�tD io kZFJt BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) St i 5 151 1 2nd ; •"% a 2nd 3 ro i 3 rd 4th 3 4�' Total Area(sf) 1 Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ 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 Q _.U_ N Y C� MC��ISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY b�l11ELL11�- ;'J L JUL 2 - G `207 -SECTION SfIEINFORMAiTION' ' `' ° _ ���;' is{sectron.�to6e comp ed�x�ffce.� --"-Property-A ddres yy � } 1 5 r i s sa _1 i s SECTION 2v PROPERTY�OViIhIERSH lP/AfITHORIZEI;IAGENT 2.1 Owner of Record: ye j-o h 10- i bcr h / � Cvi %r¢s►,s' ST N�To�✓ Name(Print) Current Mailing Address: 5�9 h I Signature Telephone J 2.2 Authorized Age nt: _ p r [� 7— d � EG.a�D 5 ! SO�t �I 7/ t� i�o vi Name(Print) Current Mailing Address: el y � Signature Telephone oc � -SECTON,.3-ESTtMATED:CONSTRUGTI'ONCOSTS. . Item Estimated Cost(Dollars)to be Official Use>fl* completed by ermit applicant 1. Building (a}Building Rertnit.Fee s y 2. Electrical i timated"Total"Cost of a I "Construction from 6 ` 3_ Plumbing ' ! Buildmg.!?ermitFee I , 4. Mechanical(HVAC) L 5.Fire Protection 6. Total=0 +2+3+4+5) check Number This Section Fde�OfficialUse Only Bu11d4ng Permif Numbed Qafe Issued Signature: Building Commissionerllnspector."of Buildings Date File#BP-2008-0002 APPLICANT/CONTACT PERSON CHARLES GROWHOSKI ADDRESS/PHONE 57 SOUTH ST EASTHAMPTON (413)527-5857 PROPERTY LOCATION 126 WILLIAMS ST MAP 32C PARCEL 288 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 1,�­Bgilding Permit Filled out ee Paid r�'Zf) — e Typeof Construction: Porch Repair New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052458 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 Commission 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. File#BP-2008-0002 '1 APPLICANT/CONTACT PERSON CHARLES GROWHOSKI ADDRESS/PHONE 57 SOUTH ST EASTHAMPTON (413)527-5857 PROPERTY LOCATION 126 WILLIAMS ST MAP 32C PARCEL 288 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: Porch Repair New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052458 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Commission 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-2008-0002 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Cate orV: BUILDING PERMIT Permit# BP-2008-0002 Project# JS-2008-000004 Est. Cost: $300.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHARLES GROWHOSKI 052458 Lot Size(sq.ft.): 9 19 1.16 Owner: BIMBANE FLORIAN M&VERONICA Zoning:URC Applicant: CHARLES GROWHOSKI AT: 126 WILLIAMS ST Applicant Address: Phone: Insurance: 57 SOUTH ST (413)527-5857 EASTHAMPTONMA01027 ISSUED ON.71312007 0:00:00 TO PERFORM THE FOLLOWING WORK.-Porch 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: FeeTVpe: Date Paid: Amount: Building 7/3/2007 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 1 126 WILLIAMS ST BP-2008-0002 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-288 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2008-0002 Project# JS-2008-000004 Est. Cost: $300.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CHARLES GROWHOSKI 052458 Lot Size(sq. ft.): 9191.16 Owner: BIMBANE FLORIAN M&VERONICA Zoning: URC Applicant: CHARLES GROWHOSKI AT- 126 WILLIAMS ST Applicant Address: Phone: Insurance: 57 SOUTH ST (413) 527-5857 EASTHAMPTONMA01027 ISSUED ON:71312007 0:00:00 TO PERFORM THE FOLLOWING WORK:Porch 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: Qx S"-7.0 7 THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL NS. Certificate of Occu anc Si nature: FeeType• Date Paid: Amount: Building 7/3/2007 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo