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25C-232 (3) .ice r .� ,,,�1!.1..d. � `'� k V V �� - �/ / i` � f 1 `�, � S, , ,��'� �, �,,`'�,/ .,,,��,, . 1 ; 3 C-WK aVi , S Of I Vo se '4 10-6-0 1,20dir) . } ^r � � ir B 61 6'6 544 ed Ile cL 0 0.-� �'Tcrt[jcilllptoil © DEPARTMENT OP DU1LD0\10 iNSPPCTIOI.'S 212 Main Strect ' Municipal Building Northampton, Mass. 01060 �VOR=R'S CONIPENSAUON MSURA-NCE A AVIT I, S r KU Torn ;i_ (li ocuscc/permi ttcc) kl.,]th a pf-mi cipal place of business/residenc-C at: j6rain�;e/d ^4 0/070 (strc Ci ty/stat.clz�P) do hereby certify, under Ole pains and penalties of pedury, :hat O I un an employer providing die following %vorker's colnpCnsznon cove age "or Illy twplovecs Nvorldng on this job: (Insvr_nc� Coop=v) (Polio: Nt_=j�cr) - (' :-pirzLior Dal--) O I am a sole propncror, general contractor or homeowDer(circle one) and have hired the contractor; (fisted below who I'ave the foilo%ving workers cornetnsation policies: (Namc Oi Con!nc-'07) (In ur3ttcc Coinpany/Pobc-, ?�tuQl_tr) -?:Jtid On 1�11C) (Name of Contractor) (IJISUraD(v Comoaaw?obc), Nunccr) (Lx-DirzLion Date) (Na-Me of Conn-aeto,) (Insurane Compan)•/PoUcy Nwnber) (Expirrioo Date) ('Name of Contractor) (Lasutaa(-- Comcany/Poucy Numb:.r) (Ex-pm ioa Date). (na cb sddi;iocal rSocr if noocur,•to exlud=inform-Lzoc pav'�to all oocrz n) netor and have no one wot-dDg for me. I am a sole prop ( ) I am_.a home owner performing all the work myself. NOTE:picsc be evrzrc the +i`lo bomc0,,,,W'bo c3x9toy pctom w w r• -, = c oo c mp2x woric oo.d.•e1L•-;of ont mote tb_n `sr—j in%a35eh the bom�rcado or oo t2u P_a each zapu�t6es a�-c ox& a11y oeca d=ni to be employes unc e ttx..Q o=pcss±_Icn Act(GL15Z_=l(5)j applim600 by R boa=wocr fv c 6c�'x cr permit rn:y c�idea«L:c legal ctanu of nn a'gloyer under dio Work e.Compomati nx I uoderrt,tnd cb-a oopy of thin mtcmcm oaay t e r.,—,id to tho Dopartmea¢of lnatzziJ Medoati'office or La+ra000 for the ' 00ve"Zc KriCtmioo and th_t U=to scour`eovR�ceder scu oa 25A or MOL 132 en led to the impol^;oo of aiminA peatlti ooaz_i sg or R G x of up to S 1}Oo.00 and/or mwi,r, of up w ooc ycv end aril pcaatia in x form of n Slop W ort Order and s rtm Or S I DOM R d:y Rprnst t� For dryartm�l uae drily �... .. Pcrmjt Numb= - - map.,` Lot•"_ signaacut of Lio=sccJp- -te 1 ti r Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEER REI/IEW(780 CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No....!!�- SECTION hf, •OWNER AUTHORIZATION „TO BE'COMPLETED WHEN OWNERS AGENT OR GONTRACTOR'APPLIES FOR BUILDING"PERMIT , I, -e f---/oZ KW C 9,u/!'J-"-' as Owner of the subject property hereby authorize .S-QI—G H e7 ✓ y pr-y to act on my behalf, in all matters relative to work authorize by this building permit application. Signature of Owner Date I, S-e-1^c?✓tom 'I o r r�i 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. -S� (-f Vic` `Th rr Print Name Signature of Own2r/AgenV Date SECTION 12 -CONSTRUCTION SERNICESE 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Se re✓LA To r 0 7$11 0 G) License Number f S8 d''�C'asun'1 Sfi ��4i.n'E'7elcj 1`)� C'7)c�?C j-3/- c�S Address Expiration Date e,7 J0S1g Signature Telephone S_EiCTION 13 WORKERS° COiVIPEAISATION INSIRANCE AFFIDAVIT{M G t c 352, 25Cj6j) 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....... . No...... ❑ 4 Version 1.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGNAND;CONSTRUCTION SERVICES - FOR°BUILDINGSxNDTRUCTURESISUBJECT TO ' CONSTROCTION CONTROL P.URSUA'NT T0780 CM 1161CCQNTAINlNG MORE THAN.35,(100' F.-`OF ENCLQSED" "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 —in la MA ',der r ►- �-A rt, ioh Not Applicable ❑ Company Name: Se re.y�_c4_ Responsible In Charge of Construction 1 SS Plea Jao j�,­�'eid /47 ©i07>0 Address ___ c Ei 3`l }?Ow Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7.Wa Supply(M.G.L c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa a Disposal System: Public Private ❑ Zone: Outside Flood Zone Municipal A On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by /i/1"? set 60-cks Building Department (9 r If y s;ze. Lot Size Frontage Setbacks Front 30" 3L ZC)Of Side L: R: -Y L: —' R: t? IS' Rear ?A Building Height 2 �/ Bldg.Square Footage % J Open Space Footage % (Lot area minus bldg&paved azldn #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO g DONT KNOW 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 X _ 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 X — IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the properly?YES_ No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 ON= - �iSUCIOII�SE RitOGSHAI 'SOD Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ _ ❑ ❑ Exterior Alteration Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] A . _.-, Accessory Building [ ] Repairs [ l BRIEF DESCRIPTION: SECTION.IS USE GROi A CONS itUCTION E 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 Instittutional ❑ 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: COMPLE-E.- SEM,,ON 3I+atG iLI�IIa1C UI�1DEItGD NG DV OILS ODITIONS,'ANDJOI Cti VGE IiV USE Existing Use Group: Proposed Use Group: S d Y""e Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION:,BUIL-61IN 1-H VIII AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION to Floor Area per Floor(sf) ist 1St 2 nd 2`� 3'a M 4 3 tid 4�' „� s 4thd n N r. Total Area(sf) Total Proposed New Construction (sf) ; Total Height(ft) k L Total Height ft------------- A Versionl.7 Commercial Building Permit May 15,2000 C44 Northampton �-Bdilc ing Department -212 Main Street ✓ t ,',,,Room 100 - Nbrthaknpton, MA 01060 phone,#. 3-58?-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING IS SECT30T11-SiTE¢INiFORMATtON .N ;:. ,; ctoneco pleted 1.1 Property Address: �f W ..:. .�i.. ku.w.� ''ursit§dk 'S'^'F'^✓-=1- ���......�,uu?µ-.Cnm..; .r T, ......., ,._. .. -.hhk'Mk_ �.. SECTION 1w.OaA►IERSFiIiPrAUTt!(�RIZED AGENT, 2.1 Owner of Record: ,6 0 f"r'I a r- � ��i /d �Y l C�l �T Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMA D ONSTAA)71OM COM �.. . Item Estimated Cost(Dollars)to be Offidail Use Only completed by ermit applicant 1. Building 3� a) BbIding Perms=Fee 2. Electrical ]Esb[nad Total Lostof �u�Cii�strdct�ori�fi�m.. 6�Y 3. Plumbing Bmtdmg�Perrn�tf—e x r 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+ 3+4+ 5) 3, ',1 0 f? ChcNBriber- a :This.Seitiop.FAr_>Offcia7 use Onl _ Buildm 9 Perm�t,.Nurx�ber tiatessued Signature: Building.Commissioner%Inspector of:Buildings Date File#BP-2005-0394 APPLICANT/CONTACT PERSON SERENA TORRY ADDRESS/PHONE 158 PLEASANT ST PLAINFIELD (413)634-8088 PROPERTY LOCATION 163 BRIDGE ST MAP 25C PARCEL 232 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out it 0*4 Fee Paid T_ypeof Construction: CONSTRUCt I NEW FIRE ESCAPES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 078904 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. 163 BRIDGE ST BP-2005-0394 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-232 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2005-0394 Project# IS-2005-0525 Est.Cost: $3400.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SERENA TORRY 078904 Lot Size(sq.ft.): 6577.56 Owner: GOLOB BERNARD M Zoning.URB Applicant: SERENA TORRY AT. 163 BRIDGE ST Applicant Address: Phone: Insurance: 158 PLEASANT ST (413) 634-8088 PLAINFIELDMA01070 ISSUED ON.10121104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 NEW FIRE ESCAPES 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 Shmature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 10/21/04 0:00:00 174 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2005-0394 163 BRIDGE ST COMMONWEALTH OF MASSACHUSETTS GIs#: Map-.Block: 25C-232 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) BUILDING PERMIT Category: Permit# BP-2005-0394 Project# IS-2005-0525 Est Cost: $3400.00 PERMISSION IS HEREBY GRANTED TO: Fee: $50.00 Const. Class: Contractor: License:Use Group: SERENA TORRY 078904 Lot Size(sg ft.): 6577.56 Owner: GOLOB BERNARD M Zoning:URB Applicant: SERENA TORRY AT: 163 BRIDGE ST Phone: Insurance: Applicant Address: (413) 634-8088 158 PLEASANT ST PLAINFIELDMA01070 ISSUED ON:10/21/04 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 NEW FIRE ESCAPES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. Underground: Service: Meter: Footings: Rough: House# Foundation: Rough: g Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Insulation: Rough: Oil: Final: Smoke: Final: (� `�_j 14 -� THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIO/�Siimature: Certif sate )f OCCU do Check No: Amount: FeeTyp e: Recei t No: Date Paid: Building 10/21/04 0:00:00 174 $50.00 212 Main Street,Phone(413) 587-1240,Fay::(413)587-1272 Building Conunissioner-Anthony Patillo