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31B-050 :� rI r NNAVONSMK=aAVABA*M BOM WM=MWMMMnry sld �IPIen g 1aSU1S ONIN ---- wN • -5- lea4a SDI L£4 -ova �l �dwS CO ��1ht1SN� F'~ 'aft oust -11WsIV Lin -qo!rft (Mv 47A R. - 'Q9 tie 3vd - TRS loam-—A 6B:ET beet/9I/I8 — - X00/b00( _ 00 CIS' adD r H gm r Cib& ani'CT/TA `V� ,�,-� 1 �: (�'�, �-�. �� - � C \ �� �S ��. n � _. .__._. _,,.._--._ �_..__._. _---�.__._..___ `\/� __ __ i - �, � . ? 3 ,''1 '� � � � C `\J �. R�( L� I ��. � 4 �� I /� v f � � J ., C � �-r. � � f __•-_....._�._._. ___-. t J C,�" KJ iA oO �- 3ic. ) F (riff of �'3cz:tljallt}itoll = A ' E 'tTas got(h rife Its ' _ c� DEPARTME1rT OP BUILDrXG INSPECTION'S 212 Main Strect ' Municipal Building Northampton, Mass. 01060 �VOJUC R'S CONQ'ENSATION GNSURANCE AFIrII AVII' (Ii ccnsu'1 permi ttcc) ith principal plat: of business/residence at: (sa-t~t/c�ty/statc�2�p) do hereby certify, under Uic pains --ad penalties of penury., -.hat ( am an employer providing the following worircr's compcns-ztion cove Mge 'tor illy etuployces work3tlg on'tiiis}ob. C s�v. c �a «6,L) 3 (Crsunn Corer �y) (P0Uc:?:u-ter) --- (::piraor,Due) O I,am a sole proprietor, general contractor or homeow-cer (ci-cie one) amd have hired the cons;actors liste—d below vyho have the i6Uo%'1V nS worker's cocpensa6on policies: (Nam: of Co-n.tmc or) (Insurancc Corrloan)-Pi obc-, ?qumhcr) ClExpl'JL•Oe DnIC) (Name of COntT3Lior) (bisarancz Comoan)vPoUc-v Nuns^r) (Lxpir,1300 Dale) (Name of Courramo;) Clruuranc C.ompany/Pol;c). Nnmbu) (cxoira600 Date) (Name of Cootmctor) (lou=d-- Compztzy[Policy Numbs) (Expisat;ou Dace) (a n,ch Ai„oca.l rS if acct.r•to =foc=i xa oo pcviaiag to'U oo©-_c.o.�) O I am a sole proprietor and bave no one woridog for me. ( ) I am.a home owner perforTning all the work myself. NOTE:pl=-tc be aw-rc Lhe w'l^_lc 6cmcoum,:a.abo cmploy pc.=w di c cc_-,c,00 cr rc zu••oric oo a d%--LL-Z of act mo e th_a 'sr-tars is%ib cb the bocnoowver r=d.=a ca the p-a.+,r zpputten:r:the�,o arc ax C- zUy acc:r:d.-rcd to be cmployc�unCc tix o, s as Act(GLI 52-=1(5)�applia000 by s bomrowvc for:fie .or perme r=y c�46=- he Ic-,l cuau of en eraloyor uodcr dim Workoet Cocapom. Q Act I uo6=-Und th.a>copy of tbi.mtcmem m),b.foe-�ivrded to cho pep•,rtmeoa of 1.&a -vicl Acodms!CrM.or I -ucaoee for tb. eove>�c vviCes -And ttu f--Juze to secure`eovr,s under soczioa 25 A of MGL 152 cxa la.d to the imsitiw of a=ia-i PC—LGcs 000si=,rig of a r:nc of up to S 1 500,00.rtd/oc or up to ooe yev end civil pca jc io 6c form of a Stop Wort Order and a rtm of 5100.00 a day Lpin4 me —------ For dcy.rtaa.•-�u,c only Pcrmit humbcr L.ot Siztut� of LicczLSCCIPcrmittcc -- J ► Versionl.7 Commercial Building Permit May 15,2000 SECTION:10 STRUCTURAL.PEER REVIEW,(780,CMR110.13.)' Independent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION i1- OWNER AUTHORIZATION TO'BE;COMPLETED WHEN OWNERS AGENT:OR CONTRACTOR APPLIESS I=,OR BUILDING:PERMIT as Owner of the subject property hereby authorize ( to act on my behalf, in all matters r tive t authorized by this building permit applic;// ,r��. z nature of 6)0%r Date as Own e /Autf horized A ne D 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. �ci c 6/1-1 17 S 'fL Y Print Name i,%2 Signature of Owner en Date SECTION 12:-CONSTRUCTION.SERVICES . 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : �ui � '� S�� _ ")O C 7 3 License Number /big./o s" Address Expiration Date Signature Telephone SECTION 13-WORKERS,COMPENSAT10N 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....... d---- No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 , SECTION 9= PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -FOR:! FOR BUILDINGS AND.:STRUCTURES SUBJECT TO CONSTRUCTION-CONTROL PURSUANT TD 780 CMR 116(CONTAINING MORE THAN 35,000'C:F`. OF ENCLOSED-'S'PACE) 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 Not Applicable ❑ Compan Name: PCv l <f% /c2 � r 1/ Responsible In Charge of Construction Address Signature Telephone • Versionl.7 Commercial Building Permit May 15,2000 7.Water Sypply(M.G.L.c.40,§54) 17.1 Flood Zone Information: 17.3 Sewage D�'sposal System: Public Private ❑ Zone: Outside Flood Zone � Municipal "n site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This colunm to be filled in by Building Department Lot Size l S O h Frontage t 3 Setbacks Front K ' Side L: �'��R: L,N L: G/r✓(, R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arlan #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding every been issued for/on the site? NO DONT KNOW f YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 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 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: Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PI=ECTS LESS THAN'35,000 CUBIC FEET'OF ENCLOSED SFACE.: Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] 111-01, Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION:! '� i� z�'��� �i✓t rya �� iY S © A SECTION 5-USE GROUP AND CONSTRUCTION TYPE 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 I ❑ 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 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 M, --�USE°ONLYt BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION r� � s, ...� . .._ Floor Area per Floor(sf) ist a 1St l ll/ V 2nd . . s -+ 2"d rd 3 3rd 4�' 4�' Total Area (sf) ( °1 ° 'Z a Total Proposed New Construction (sf) Total Height(ft) a Total Height ft------------------- N y Versionl.7 Commercial Building Permit May 15,2000 _City of Northampton Building Department i 212 Main Street . Room 100 t' orthampton, MA 01060 ; rr_B 1 � r004 N ,' . phone,413-87-1240 Fax 413-587-1272 APPL 6AM, N TO CONSTRUCT,-RIEPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION � 7ussect�on toMbe completed by ofDce 1.1 PrODertv Address: fr , r �� r " Map"" Lot Unit lvh SECriON,2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: co 0 Name Print) Current Mailing Address: ature Telephone 2.2 Authorized Agent: ,. Name(Print) / Current Mailing Address: / L 7 - Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ac) o (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from' 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) 3 Q cx" Check Number This Section For Official Use Only Building Permit Number: , V Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-0803 APPLICANT/CONTACT PERSON Roy Omasta ADDRESS/PHONE 21 North St HATFIELD (413)247-5666 PROPERTY LOCATION 137 KING ST MAP 31B PARCEL 050 001 ZONE HB 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: AUTO PARTS STORE-FRAME WALL&INSTALL 8 X 8 OVERHEAD DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 006763 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFP'IZMATION 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 Stree ommission 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. 137 KING ST BP-2004-0803 GlS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B-050 CITY OF NORTHAMPTON Lot:-001 Permit: Buiidina Category: Non structural interior renovations BUILDING PERMIT Permit# BP-2004-0803 Project# JS-2004-1156 Est.Cost: $3000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use croup: Roy Omasta 006763 Lot Size(sq. ft.): 18513.00 Owner: GOLDBERG BARRY G&ANNETTE E Zoning: HB Applicant: Roy Omasta AT. 137 KING ST Applicant Address: Phone: Insurance: 21 North St (413) 247-5666 Workers Compensation HATFIELDMA01038 ISSUED ON:2120104 0:00:00 TO PERFORM THE FOLLOWING WORK.-FRAME WALL & INSTALL 8 X 8 OVERHEAD DOOR 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: Receipt No: Date Paid: Check No: Amount: Building 2/20/04 0:00:00 12949 $50.00 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo