36-205 C149 (A-) Pr .7Z) Tt
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.61 antACltnt;(tIS
DEPARTMENT OP DUILDIIG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
ZVOR CElZ'S COiYMENSATION G`1SURANCE AFFMAx I-F
with 2 pr-bicipal place of business/?esideirce at:
(sat/city/staicrz�p ,d1�7 •
do hereby ce ', under Ole pFURS and penalties of e rJ�7, ;-hat
O I am an employer providing the following worker's colnoens:� cove age for my
etuplovecs wor�Jing on•tills job:
(Lnsun�� Conroy) (POUCC: Number) --- (? xpirdoc Dat:).
( am a sole proprietor, general contractor or homeowner (cucie one) and have hired
the contractors listed below wbo have the follollving worker's coopensadon po!icles:
(Insumnc; CotnpanyipoUt,' '.,'umcti�-)
(Name of Contractor) Ras-aranc_- Comvany/Po!.v Number) (Expir bon Date)
(Name'Or actor}'� Onsuranc: Company/PoUc}- Nwnbcr) (E�pirtien Date)
(Natm of Contractor) Ra uran= Comrzay/Pohcy Numbzs) (Expiration Date).
(aa/Ch OC11 43c dao0�-•to infrrm>;on pctaining to all ooccr.".n)
(V) I am a sole proprietor and have no one worming for me.
( ) I am.a home owner performing all the work myself.
NOTE::Lb—' lx aw•1rt chiz:1w-h�L.laL6_e—m-c_o,�m,=I vtio asptay.`pci,=La do c��ra—�L-c�c�_'-.r�ao -r—cam`a-ori,:au J.d,,,--U---Z of
an(maCt a uP '=Aj La\GEcb Lbc bomoo�w r=&=aC oc WG Uou. 2.'�7p(2ISCa'��tb=,.- L oCK CC::k.'aLV oC,r--1�W od{n`c
employ—unc'.c t5c-ocS:cts c=pcsc oa Act(GLl5Z=1(5)),Z_WUabaa by a bomcowoa fcr.bcy.or permn r=y c%46co=(hc
lcgsl mays of m er;)loyor under du Wori•.elr Conrpomation Ad
1 uadcrstaod du(a copy of tbi*mlcmora=Ay be for+.wrded to the Dcpnn oflo&keuid Ac dco&Office of li ur.oce for the
coverage YeiGalioo acrd ttu U%zt to serum covCrx.&C uodu secxica 2 5 A of 1.toL 151 era icad to the=p0siion of aimin..t PCW-Wc
ooaziaig of a fine of up to S 1300.00 andfcc imprjsomeal orup to oat yev end ava pem.Pjo in 6c form of a Stop Work Ordcr Lad a
fin of S 100.00 a day L p wl me
For d,,P.:tmt u,e only
permit Numbcr
1.(�p
Lot", f
Si�tatuyr of Li crmiucc e .J ;:
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10 STRUCT
URAL PEER REVIEW 780 CNIR 110:11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......
SECTION 11 OWNER"AUTHORIZATION T03BE COMPLETED WHEN
OWNERS=AGENT OR CONTRACTOR APPLLES FOR UUlLDING PERMIT
7 7777777777 7,717
as Owner of the subject property
hereby authorize /�[91—SON to act on
my behal , in all matter elative to work authorized by this building permit'a ph tion.
Q mod171011
Signatke,oMner Date
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 Na
7/1)
Signature o D to
SECT"I=.12 -CONSTRUCTIONSERVICES
10.1 Licensed Construction Supervisor: /� Not Applicable ❑
Name of License Holder : /G 0 ?�l4K C751II 2
QLicense Number
2=9 2 eie 6poo I ie, Qr---4ftw4PMU �/�,,
Addres Expiration Date
ignature Telephone
SECTION,13 WORKERS'COMPENSA710N INSURANCE AFFIDAVIT{M GL c 152,�25C(6)) s Z.
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 f the building permit.
Signed Affidavit Attached Yes....... No...... ❑
Version 1.7 Commercial Building Permit May 15,20 00
SECTION 9,._PROFESSIONALiDESIGN AND CONSTRUCTION SERVICES FORSUILDiNGS AND STRUCTURES SUBJECT
CONSTR-UCTION CONTROL PURSUANT T.Q<780 CMR 116{CONTAINING MORE THAN 35;000 C F .OF:ENCLOSED;SPAC
9.1 Registered Architect:
Not Applicable >�Q
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 l
XMISOAl &41ws �`�� Not Applicable ❑
Company Name:
A C*qe— �T }Rwijc ' 0O
Responsible In Charge of Construction
voice
Address
_ g
Signature Telephone
J ,
Versionl.7 Commercial Building Permit May 15,2000
7.Watef Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: /
Public tl Private ❑ 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 5,4� 766 4,,32
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arldn
#of Parking Spaces
Fill:
(volume&Location
A. Has a Special Permit/Variance/Finding ever een issued for/on the site?
NO 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#
J/
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 sighs intended for the property AYES=
No
IF YES, describe size,type and location:
e
Versionl.7 Commercial Building Permit May 15,2000
� *' swk?
s,
SECTION 4 CONSTRUCTION ERVTCES ORPROJECIS fSSTHAN v 00Q ,„
CITRIC FEET�PENCE05EDSPICE _ _ a
Interior AI rations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION:
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, ❑
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:
x CAMP", S QN IF #{t�G#Bl a TI+JG ING"•RENOW i�VS,K Ot)ITIONS A QR�f R fGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTIOff 6 BUILDING HEIGHT AND AREA,
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf) 1st
2nd
1st
ndks
3,d _ 3
4d'
Total Area (sf) Total Proposed New Construction (sf) a
Total Height(ft)
Total Height ft----'-----�--- ��
Version Commercial Buildin ermit 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 REPAID RENQQI�FATE CHANGE HE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER AN A ONE OR TWO FAMILY DWELLING'-
SECTION�1 SITE3NFORMATiON
1.1 Pro a Address: et
S WIN
SEC7ION,,2 PRQPERTY OWiIYERSHIP..%AUTHORIZED AGENT
34
2.1 Owner of Record: /
4 lLC TM R.
Name rint) Current Mailing Address:
5-'5q--4CR(
Signature Telephone
2.2 Authorized Aaent:
Name{P"n Current Mailing Address: 0
Signature Telephone
SECTION<3. .ESTIMATED CONSTRUCTION COSTS,;`,
Item Estimated Cost(Dollars)to be OfFicial-Use Only
completed by ermit applicant
1. Building TO�DC�CJ (a)Buildin.g,Permit Fee
2. Electrical (b)Estimated Total Cost of "
5S0 0.DO �nstruct�on 1666 6
3. Plumbing Budding Perrolt Fee
4. Mechanical (HVAC)
5. Fire Protection -
6. Total = (1 + 2+ 3 +4+ 5) $O y"-d►p Check Number
This Section'For" al Use
Buildrng`Permit,Number _* " � Date Issued:
Signature:
Building Commissioner/Inspector,of Buildings Date
File#BP-2005-0204
APPLICANT/CONTACT PERSON MICHAEL PHILBROOK
ADDRESS/PHONE 242 RESERVOIR RD WESTHAMPTON (413)529-1819
PROPERTY LOCATION 55 WINTERBERRY LANE
MAP 36 PARCEL 205 001 ZONE SR
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: REPLACE WATER DAMAGED INTERIOR FINISHES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051892
3 sets of Plans/Plot Plan
THE�FO LO WING 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 Co ssion
C? /8 a
Signature ot'Building Official T 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.
55 WINTERBERRY LANE BP-2005-0204
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mv:Block:36-205 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-2005-0204
Project# IS-2005-0246
Est.Cost: $80500.00
Fee: $367.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MICHAEL PHILBROOK 051892
Lot Size(sq. ft.): 55756.80 Owner: JOYCE PATRICK J&TERRY A
Zoning SR Applicant: MICHAEL PHILBROOK
AT. 55 WINTERBERRY LANE
Applicant Address: Phone: Insurance:
242 RESERVOIR RD (413) 529-1819
WESTHAMPTON MAO 1027-9613 ISSUED ON:8119104 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE WATER DAMAGED INTERIOR FINISHES
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 Deaartinent Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVO1XD BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Receipt Nc►: Date Paid: Check No: Amount:
Building 8/19/04 0:00:00 1254 $367.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo