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- Versionl.7 Commercial Building Permit May 15,2000
SECTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No.....
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
NAC14 ,;&)m 1 J K5�V, �Aam ,pjLlSlYIeS(; MaMQ as Owner of the subject property
hereby authorize `� n r `V ���� �S ��C i�& �uA to act on
my behalf, in all matters rel ive to work authorized by this buil ing permit ap lication.
% v 9 4
Signature of Owner Date
I, I�1v1�A 1 �.1�► C`it VV y-%G�IA —BLtl tAe as Owner/ u ed A�en
hereby declare that the statements and i ormation n the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
IG� c� audV'P-C.0
Print ame
•ryv,. o
Signature of Owner/Agent ate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
ddress Expiration Date
. ' 63227
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 building permit.
Signed Affidavit Attached Yes....... t / 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 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable "�
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone 7
92 Registered Professional Engineer(s):
Name rea of Responsibility
Address Registration Number
Signature Telephople 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
Addres Registration Number
ignature Telephone Expiration Date
9.3 General Contractor
r � - 16w ew-S hC Not Applicable 0
Company me:
14, arwg
Responsible In Charge of Construction
4,6 S S+ �Y c�vv1 n fern M �,
Add ess
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
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 ❑
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:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Snx s
ume&Location
ol
A. Has a Special Permit/Variance/Findin ever been 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 #
brook body B. Does the site contain a y 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
IF YES, describe size, type and location: �� S'�('� Sally C' �'�N
D. Are ere any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
MF
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 Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
�� CR FT2' hJ: NS ONE tge�h'op oa W
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 Hi Eh Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential 10 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 All wclf -iv be done wlff�iri -eyes-hncj Lu ldly) 420*0- r
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf) St
1st 2nd
2nd 3rd
4th
3rd
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft--------------------
r '
Version 1.7 Commercial Building Permit May 15,2000
orthampton S us of
Jj CU ¢`CUtID / s a� P ry�3
li I department
2, ain Street Sewer/Se
M 100 a er`/We
Nartha' pt n, MA 01060 T Sets o c
i
phone 413 .$7.12 0 Fax 413-587.1272 P tSite P �
APPL N 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
Map Lot Unit
Zone Overlay,District
Elm St District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: K AhCyf1 mur n t-BUS1►e% Ma>' ,ef-
Monfessm i
Name(Print) Current Mailing Address:
1:3-- 5b6- A53i;
Signature Telephone
2.2 Authorized Agent:
Name( r t) Current Mailing Address:
Signature U Telephone
SECTION 3- ESTIMATED CONSTRUCTION'COSTS �.'" DfflG� fEFF
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building /6 4. -- (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) b "� Check Number
This Section For Official Use Only
Building Permit Number: 0 3 -N3 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2003-0143
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St (413) 586-8287
PROPERTY LOCATION 51 BATES ST
MAP 25A PARCEL 046 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 3 S'
Typeof Construction: INSTALL INTERIOR DOOR W/HEADER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 060378
3 sets of Plans/Plot Plan
THE F LLOWING 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 Commis
8 Q 8 10�
Signature of Building Official Dat
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.
. t
BP-2003-0143
GIS#: COMMONWEALTH OF MASSACHUSETTS
* CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0143
Project# JS-2003-0275
Est. Cost: $1028.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 060378
Lot Size(sq. ft.): 46 17 3.60 Owner: NORTHAMPTON MONTESSORI SOCIETY
Zoning: GI Applicant: Wright Builders
AT. 51 BATES ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:818102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL INTERIOR DOOR W/HEADER
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 Occupant Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/8/02 0:00:00 13558 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
51 BATES ST BP-2003-0143
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0143
Project# JS-2003-0275
Est. Cost: $1028.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 060378
Lot Size(sq. ft.): 46 17 3.60 Owner: NORTHAMPTON MONTESSORI SOCIETY
Zoning: GI Applicant: Wright Builders
AT: 51 BATES ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:818102 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL INTERIOR DOOR W/HEADER
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: 1/1
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 0 i� �—
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc si nature: I'
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/8/02 0:00:00 13558 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo