25A-107 (23) np� ?�
DEPT OF BUILDING INSPECTIONS
NORTHAMPTON,MA 01060 I
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DEPARiMLNT Of' LNSPP.CI-IONS �{
212 Main Strcet Municipal DmIdinp �t
Northampton, Macs. 01060
WORlCEWS COiZTPENSATION LNSURANCF -1F LI)AM'
—s�
(l i c�a s:,zlperul i ttcC)
\Ith a principal place of bustniesQresldencc at
(sZT�L/ci t�/st aLCf n p)
do hereby cerZily, under the pains acid pcnaRics ofpcqury,
am an employe piovId]Ili' (11° 10��0vv!315; w'Ot�r;Ci'S COr111)CnS,.:;Ct1 COVCt�'�;C i0( III
Jxn�mpluvccs �Lor=��ins; t>n t�lis jl�l>
1 Cic o!lc) aic hLvc hue(]a11 a Sol pODi tOr CCIaJ C-0nGa IOi Or l)Oi Ov+�C (CL
Ule
conuaCo:'S li C be)ow who ila'�'� Ll iCLO't��Z�P_ '�:'Of>:e�S C�LJ .riC ilOil pch,cles
(N.'MIC OCCOOiT,Cl01 0jLs-']Jd[1cc Co ill-Da-2v/Po!jC-" Nwac^r) (LSpi rion Date)
(Name of Cona2clo,) (?nsurancc Com-paj) /Poke- N;Imb_f) (Expirdoa Date)
(Name of Contractor) �Stlf71]C Coma n��/'olic�� i}nm� ) ������i<<�ion Date)
(r-nnc't :.d{:coc�J c'xa S❑a_�--=.r, to c�.'uc��afc��,_i cc r,:.�:.r.r to.li oti�=r_o�)
( ) I aril a sole proprietor and have no otic v"01tinj for me
( ) 7 am a homic oN"ner perfornlin all the. N of k myself
14071=:pl=s<1. eu rr<Ln: v.�)c 1,caro.�:>cr��.{��c .;!cq Ir--c:c to L,.-�.__c�n.rv�:r,�-_•��c rc,:z:: ,•u�i;v: .� ,ellc�g or
rnt nxrc'���L`.-.cc carte in art-c'�11>c brn7r.•�::rcrdn.0 R:t.1- Lc.�,.`_, z�r>_:tcnzr_Lhcro�:c o-_±��:��:1!v ctr::d-c,,t�C'<
Lcc:_•_a ,.c:mn rcr cv,?.zz tlx
I<ga!Haas oC crloyn uodcr d:o�L�ori.cl C'orx,-w�.wm:/.<x_
I
—A——d tL� a cv;�y of Uhl, aiL-1 m.y tx f--nr A-j to t.`,.: ( O;Loa of t-,—for ttw
cove,E c vciftel�oo aid 0> 1 t-ilurc to come wvrra u &-u,ajca 2 S I.cf of e:v.»rvl itiics
axnU:�Z of■ Fu-o(up t4 S I�00.0J ertNcx cr.l-ci:o o(up torn, )L �: r.�Z)tx?uh�a in tr_fcxtn or a Sta,,VJmk O.dc7 and t
(un o(S t o-�QO.d-y .Favi:1 tom_
� Pcnnil itunlb�J
5�(,naUuc of l.i< t rc/Ycniuttcc �'<<'
, 1.
^ Versionl.7 Commercial Building Permit May 15,2000
SECTION O SIRRU U t 4L PEER E�V�EW(78 l CMR�1
Independent Structural Engineering Structural Peer Review Required Yes.......❑ No......❑
SECTION 1l OWNER AUTHORIZATION TO�BECOMPLETED WHEN
OWNERS AGENTORCO'NTRACTOR�iAPPLIESPOR BUILDING PERMIT
Q Q���1/r7 F(t � ) as Owner of the subject propert
hereby authorize to act
my behalf, i ,I matters relative to work authorized by this building permit application.
r
Signa e of-Owner IL I Date
l 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 Name
Signature of Owner/Agent Date
SECTION12 -CONSTRUCTIO,N-SERVICES
71
10.1 Licensed Construction Supervisor: 1 ( Not Applicable ,E�
Name of License Holder : W `�`���J CS 021
License Number
%A S6C
Addres Expiration Date
Signature Telephone
SECTION 13 WORK,PS' CZOMPI=IN ION INSI�RANCE AFFIDAVIT(M.G.L.;c.,152,,§.25C(6)) '
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affids
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
Versionl.7 Commercial Building Permit May 15,2000
SECTION9 OF,ESSIONALbESIGN°SAND' CONSTRUCTION,SER1/ICES ';FOR BUILDINGSANDSRUGTURES SUBJECTTO
CON,SI RUCTIONCON7ROL PURSUANTT0�780 CMR6(CONTAIaNING IIhORE!THAN35,000,COFENCLOSEDSPAG,E)1.'
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 ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
s aAd d ,
Version 1.7 Commercial Building Permit May 15,2000
�7.Water Supply(M.G.L. c.40,§54) 17.1 Flood Zone Information: , 17.3.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
1 - Building Department
Lot Size N�A CvNDv N C-Pory
Frontage I4i D SA ME
Setbacks Front
Side L:� R: L: R:
Rear I
Building Height
ill �C
Bldg. Square Footage
Open Space Footage W %
(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
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 #
B. Does the site contain a brook, body 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:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
T
,`1 �;6 �;^�•K�•s N' '�.:Ly�� r;'�i!c' !j!tiZ!rt.� `Z�J1 �1�'�1 _ti•�1t cs'i ;k7r'j-�. .
Versionl.7 Commercial Building Permit May 15,2000
- ��''a'�S'��a,::�* ,., x•2 '��.,:.&s v�' �'by 'R �r� �a,p ' _
SECT1bN4�CONSTRCIONERVICES°FORkPROJECT� S LESS THAN 35;000
UBICfETflFENCt.OSEDSI' fiCE '` *
n:;,
Interior Alterations Existing Wall Signs -Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
INS -1-L �tJ�t� rpWw►6/1v6>>v 8h?�11� ;
F J�tit S t N 1Uo R WA t.LS • - {� 1C t N &t iM n-m 4p-"v
SECTION 5 USE GROl1P ND'CONS TRtlCTIONTYpE +^� V6 G I.oS};T Lc/sf�,L f2ENov/FTE
. 154THRootw Rte L >� LuI�IlUGZd copL
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly Io A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educ2ti6nal ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional Q 1-1 ❑ 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-UJNDERGOING RENOVATIONS,ADDITIONS ANDIOR"CHANGE-IN"USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION S"BUILDING HEIGHT AND
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf) '
St
V� 9
1
2nd
st h
2nd 3rd
4th
3rd
4th
Total Area(sf) Total Proposed New Construction (sf)
_-----------------------------------
Total Height(ft) I
iW
Total Height ft -------------------- b F `
i z
R
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Versionl:7 Commercial Building Permit May 15,'2000n
% `ty o Northampton
Ildi Department
� p
OFw\VVNG1NS 01 60 din Street
O
,MA
Room 100
Northampton, MA 01060 0
phone 413-587.1240 Fax 413-587-1272 e
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDIN
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
A 4�5
t� 'This sectionto�becomp)eiaed�by�office `
1.1 Property Address:
I� Q Ma
7 O 1��
N0� Y�Ar141 N !�� RA ✓� !� n verla D�strrct .`
T � 1�
f a�0 ElmSt.bistricf CB District x "
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone ,
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
t
SECTi"ON 3 -"ESTIMATED CONSTRUCTION-COSTS,
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building t 3 O O (a) uileling Permit fee
2. Electrical e} O p (b) Estimated Total Cost of
1 Construction from 6 _
3. Plumbing 1 `7 G Buildini;1,Permit Fee
4. Mechanical (HVAC)
5. Fire Protection {f J
6. Total =(1 + 2 + 3 +4.+ 5) P a o ;Check,NUmber
k, e
This.Sec#ionfFoCoffidalaUse<0nl
I3t f'ermtf plumber: Q Date issued-
7777 ,
Signati��r•e �'- ""
iBuilding Commissioner/Inspector of I3 Rdinp Date
355 BRIDGE ST- IA& 113 BP-2001-0633
GIs#: COMMONWEALTH OF MASSACHUSETTS
"Map:Block:25A- 107 CITY OF NORTHAMPTON
Lot: -008
Permit: Building
Cate o :Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0633
Project# JS-2001-1140
Est.Cost:$14000.00
Fee: $190.00 PERMISSION IS HEREB Y GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN PHILLIPS 063607
Lot Size(sa.ft.): 0.00 Owner: OLENDER EDWARD JR&MICHELE P
Zoning URB Applicant. STEPHEN PHILLIPS
AT. 355 BRIDGE ST - 1 A & 1 B
Applicant Address: Phone: Insurance:
P O BOX 566 (413) 586-1969
NORTHAMPTONMA01061 ISSUED ON.1 116101 0:00:00
TO PERFORM THE FOLLOWING WORK.-REFINISH INTERIOR
WALLS,SHEETROCKING,MOVE CLOSET RENOVATE BATH ROOM,ELECTRC & PLUMBING -
UNITS 1A & 1B
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 Occu anc signature-
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/16/010:00:00 MO $190.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo