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23A-039 (6) WKB * CARPENTRY 91 Pinevale Street Springfield,MA 01151 411525.2914 12/12/14 Chuck Miller Assistant Building Commissioner City of Northampton I request that you grant a modification to waive the requirement for control construction for the project at 56 Maple Street#101 in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. "Mass code chapter 34, sections 606.2 and 606.3 do not require engineering for this project" Respectfully, Bill Butll WKB Carpentry Inc. 91 Pinevale Street Springfield, MA 01151 Fire,Wind &Water Damage 413.525.2914 WKB WKB Carpentry& Restoration Inc. CARPENTRY 21 Schuyler Drive East Longmeadow,MA 01028 413.525,2914 Client: Jon Hite,Executive Director,Tobin Manor Horne: (413)584-4030x211 Property: Regarding: 56 Maple Street Apartment#101 Dave: (413)584-5987 Florence,MA 01062 Operator Info: Operator: GENE Type of Estimate: Date Entered: 11/3/2014 Date Assigned: Price List: MASP7X_NOV 14 Labor Efficiency: Restoration/S emodel Estimate: 56 MAPLE SUPPLEMENT Dear Jon Hite,Executive Director,Tobin-Manor, Thank you for calling WKB Carpentry! The following estimate contains the scope of work for your remodeling project. The project total is$1,002.24.This estimate is valid for 30 days. Please feel free to contact me with any questions or concerns at (413)525-2914. Thank you, Gene Kennedy Project Estimator (413)525 2914 gene@u,kbcarpentry.com Winthrop Green General Adjuster winthrop.green@aig.com<mailto:winthrop-green�Baig_com> 978-887-3678 office phone 978-8825685 cell phone 855-887-9294 Fax Claim No.5632328182 Z-d /Gluadaeo8NM a£1Z117160060 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: In�� S The debris will be transported by: The debris will be received by: � Building permit number: Name of Permit Applicant J' Date Signature of Permit Applicant Main Level ' 25'4" -91911 1417#1— Kitchen O N �o T Living room o - 4'2" '10 Closet 1 6%-31911 f 1. It a` Hall wZ21 � o0 00 8f Yf c� 00 1 T Bedroom o 0 O' Tv 1 - o 11' 9" 15'3" - Main Level 2014-10-24-1420 11/21/2014 Page: 11 I*AIGJ AIG Recap by Category with Depreciation O&P Items RCV Deprec. ACV CABINETRY 3,792.56 297.05 3,495.51 CLEANING 82.53 82.53 GENERAL DEMOLITION 1,167.53 1,167.53 DOORS 45.57 45.57 DRYWALL 394.16 394.16 FLOOR COVERING-CARPET 1,281.55 211.19 1,070.36 FLOOR COVERING-VINYL 579.85 44.22. 535.63 FINISH CARPENTRY/TRIMWORK 521.16 521.16 PLUMBING 426.44 426.44 PAINTING 684.97 69.67 615.30 O&P Items Subtotal 8,976.32 622.13 8,354.19 Non-O&P Items RCV Deprec. ACV GENERAL DEMOLITION 510.00 510.00 ELECTRICAL 1,992.42 697.35 1,295.07 PERMITS AND FEES 84.35 84.35 Non-O&P Items Subtotal 2,586.77 697.35 1,889.42 O&P Items Subtotal 8,976.32 622.13 8,354.19 Material Sales Tax 277.74 27.09 250.65 Overhead 925.40 64.92 860.48 Profit 925.40 64.92 860.48 Total 13,691.63 1,476.41 12,215.22 2014-10-24-1420 11/21/2014 Page: 10 01 WIN I AIG Recap by Room Estimate: 2014-10-24-1420 Area: Main Level Kitchen 5,615.11 48.56% Closet 57.61 0.50% Living room 712.36 6.16% Hall way 616.80 5.33% Bedroom 655.45 5.67% General Conditions. 3,889.25 33.64% Area Subtotal: Main Level 11,546.58 99.86% Labor Minimums Applied 16.51 0.14% Subtotal of Areas 11,563.09 100.00% Total 11,563.09 100.00% 2014-10-24-1420 11/21/2014 Page:9 JALGJ.� MG Recap of Taxes,Overhead and Profit Overhead(10%) Profit(10%) Material Sales Tax Clothing Sales Tax Storage Tax(6.25%) (6.25%) (6.25%) Line Items 925.40 925.40 277.74 0.00 0.00 Total 925.40 925.40 277.74 0.00 0.00 2014-10-24-1420 11/21/2014 Page:8 [ALGJ AIG Summary for Dwelling Line Item Total 11,563.09 Material Sales Tax 277.74 Subtotal 11,840.83 Overhead 925.40 Profit 925.40 Replacement Cost Value $13 691.63 Less Depreciation (1,476.41) Actual Cash Value $12,215.22 Less Deductible (5,000.00) Net Claim $7,215.22 Total Recoverable Depreciation 1,476.41 Net Claim if Depreciation is Recovered $8,691.63 Jerry Green 2014-10-24-1420 11/21/2014 Page:7 IAIGI AIG Grand Total Areas: 1,385.45 SF Walls 463.92 SF Ceiling 1,849.36 SF Walls and Ceiling 464.03 SF Floor 51.56 SY Flooring 172.38 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 177.21 LF Ceil.Perimeter 464.03 Floor Area 509.84 Total Area 1,459.10 Interior Wall Area 864.00 Exterior Wall Area 96.00 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2014-10-24-1420 11/21/2014 Page:6 AIG General Conditions. DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 1. Dumpster load-Approx.20 yards,4 1.00 EA 510.00 0.00 0.00 0.00 510.00 tons of debris 2. General Demolition-per hour 16.00 14R 45.52 0.00 0.00 145.66 873.98 demo with debris to dumpster 37. Electrical(Bid Item) 1.00 EA 0.00 1,992.42 0.00 0.00 1,992.42 Bartholomew electric Invoice 3728 Will require canceled check for hold back payment 38. Detach&Reset Interior door- 3.00 EA 15.19 0.00 0.00 0.00 9.12 54.69 birch-slab only 39. Paint door slab only-2 coats(per 6.00 EA 0.00 25.44 2.24 30.96 185.84 side) 40. Paint bifold door set-slab only-2 2.00 EA 0.00 40.84 1.46 16.64 99.78 coats(per side) 41. Finish Carpenter-per hour 2.00 HR 0.00 62.96 0.00 25.18 151.10 retro fit bi-fold door 42. Painter-per hour 1.50 14R 0.00 68.22 0.00 20.46 122.79 sand prep trim 43. Cleaning Technician-per hour 100 HR 0.00 33.01 0.00 13.20 79.22 post construction cleaning 45. Taxes,insurance,permits&fees 0.01 EA 0.00 8,434.96 0.00 0.00 84.35 (Bid item) Totals: General Conditions. 3.70 261.22 4,154.17 Total:Main Level 277.74 1,847.50 13,671.82 Labor Minimums Applied DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 44. Cleaning labor minimum 1.00 EA 0.00 16.51 0.00 3.30 19.81 Totals: Labor Minimums Applied 0.00 3.30 19.81 Line Item Totals:2014-10-24-1420 277.74 1,850.80 13,691.63 2014-10-24-1420 11/21/2014 Page: 5 I A EIG] AIG 49" 47 g Hallway Hei ht•8188.56 SF Walls 70.81 SF Ceiling 259.37 SF Walls&Ceiling 70.81 SF Floor 7.87 SY Flooring 23.17 LF Floor Perimeter 25.58 LF Ceil.Perimeter Missing Wall-Goes to Floor T 5" X 6'8" Opens into LIVING_ROOM Missing Wall 4'2"X 8' Opens into CLOSET Missing Wall 3'9"X 8' Opens into KITCHEN DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 48. Remove Carpet-Standard grade 70.81 SF 0.25 0.00 0.00 3.54 21.24 24. Carpet-Standard grade 81.43 SF 0.00 2.32 8.04 39.38 236.34 15%waste added for Carpet-Standard grade. 25. R&R Carpet pad 70.81 SF 0.11 0.57 2.04 10.04 60.23 26. R&R Cove base molding-rubber 23.17 LF 0.27 1.92 1.65 10.50 62.90 or vinyl,4"high 29. R&R Drywall per LF-up to T tall 19.25 LF 2.05 6.48 1.43 33.12 198.75 30. Paint the walls-two coats 188.56 SF 0.00 0.78 2.12 29.84 179.04 Totals: Hall way 15.28 126.42 758.50 14'7„� Bedroom Height:8' t way r T 464.32 SF Walls 146.73 SF Ceiling z'1 0111 Bedroom 611.05 SF Walls&Ceiling 146.84 SF Floor _ o0 ^ l 16.32 SY Flooring 58.04 LF Floor Perimeter 1 1 58.04 LF Ceil.Perimeter DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 49. Remove Carpet-Standard grade 146.84 SF 0.25 0.00 0.00 7.34 44.05 13. Carpet-Standard grade 168.87 SF 0.00 2.32 16.68 81.70 490.16 15%waste added for Carpet-Standard grade, 15. R&R Carpet pad 146.84 SF 0.11 0.57 4.22 20.82 124.89 16. R&R Cove base molding-rubber 58.04 LF 0.27 1.92 4.14 26.24 157.49 or vinyl,4"high Totals: Bedroom 25.04 136.10 816.59 2014-10-24-1420 11/21/2014 Page:4 I'A LGJ AIG Ktcl,en Closet Height:8' F-4'6" 73.35 SF Walls 10.42 SF Ceiling T T 83.78 SF Walls&Ceiling 10.42 SF Floor 1. N 4'2" 1 1.16 SY Flooring 9.17 LF Floor Perimeter 9.17 LF Ceil.Perimeter Missing Wall 4'2" X 8' Opens into HALLWAY DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 46. Remove Carpet-Standard grade 10.42 SF 0.25 0.00 0.00 0.52 3.13 34. Carpet-Standard grade 11.99 SF 0.00 2.32 1.18 5.80 34.80 15%waste added for Carpet-Standard grade. 35. R&R Carpet pad 10.42 SF 0.11 0.57 0.30 1.48 8.87 36. R&R Cove base molding-rubber 9.17 LF 0.27 1.92 0.65 4.16 24.90 or vinyl,4"high Totals: Closet 2.13 11.96 71.70 Living room Height:8' 14'7" - 401.22 SF Walls 167.71 SF Ceiling N Living room �_ X68.93 SF Walls&Ceiling 167.71 SF Floor �iosCN 1 7 18.63 SY Flooring 49.75 LF Floor Perimeter 52.17 LF Ceil.Perimeter N ty Missing Wall-Goes to Floor 2'5" X 6'8" Opens into HALLWAY DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 47. Remove Carpet-Standard grade 167.71 SF 0.25 0.00 0.00 8.38 50.31 31. Carpet-Standard grade 192.86 SF 0.00 2.32 19.05 93.30 559.79 15%waste added for Carpet-Standard grade. 32. R&R Carpet pad 167.71 SF 0.11 0.57 4.82 23.78 142.64 33. R&R Cove base molding-rubber 49.75 LF 0.27 1.92 3.55 22.50 135.00 or vinyl,4"high Totals: Living room 27.42 147.96 887.74 2014-10-24-1420 11/21/2014 Page:3 AIG AIG] 2014-10-24-1420 Main Level 10,3" Kitchen Height: 8' 258.00 SF Walls 68.24 SF Ceiling Kitchen 326.24 SF Walls&Ceiling 68.24 SF Floor 7.58 SY Flooring 32.25 LF Floor Perimeter ci sit Ll�3. 32.25 LF Ceil.Perimeter 1'6' Missing Wall Y 9" X 8' Opens into HALLWAY DESCRIPTION QTY RESET REMOVE REPLACE TAX O&P TOTAL 3. Drywall-Labor Minimum 1.00 EA 0.00 269.42 0.00 53.88 323.30 5. Cabinetry-upper(wall)units-High 7.00 LF 0.00 162.17 57.64 238.56 1,431.39 grade 7. R&R Cabinetry-lower(base)units- 9.50 LF 6.83 193.19 96.64 399.36 2,396.20 High grade 8. R&R Countertop-flat laid plastic 12.00 LF 3.93 47.55 27.80 129.12 774.68 laminate-High grade 9. R&R Cabinet panels-side,end,or 18.00 SF 1.77 13.97 8.64 58.40 350.36 back 10. Finish Carpenter-per hour 4.00 HR 0.00 62.96 0.00 50.36 302.20 install cabinets and counter tops 12. Finish Carpentry-General Laborer 4.00 HR 0.00 35.85 0.00 28.68 172.08 -per hour Additional labor to install cabinets 19. R&R Cove base molding-rubber 19.35 LF 0.27 1.92 1.38 8.76 52.51 or vinyl,4"high 20. Floor preparation for resilient 68.24 SF 0.00 0.77 0.81 10.66 64.01 flooring-Heavy 21. R&R Vinyl tile 68.24 SF 1.03 3.24 8.36 59.96 359.71 22. Plumber-per hour 4.00 HR 0.00 106.61 0.00 85.28 511.72 detach and rest plm fixtures 27. Paint the walls-two coats 258.00 SF 0.00 0.78 2.90 40.82 244.96 Totals: Kitchen 204.17 1,163.84 6,983.12 2014-10-24-1420 11/21/2014 Page:2 E'AIG AIG Insured: Florence HA Property: 56 Maple St Tobin Manor Florence Ma Claim Rep.: Jerry Green Business: (978)887-3678 Company: AIG Business: Bos 2310 Alpharetta,GA 30009 Estimator: Jerry Green Business: (978)887-3678 Company: AIG Business: Bos 2310 Alpharetta,GA 30009 Claim Number: 5632328182US Policy Number: Type of Loss: Water Damage Date of Loss: 10/14/2014 Date Received: 10/19/2014 Date Inspected: 10/23/2014 Date Entered: 10/24/2014 2:20 PM Price List: MABO8X_OCT14 Restoration/Service/Remodel Estimate: 2014-10-24-1420 y -Terra s' mc�" VAj eVA cthC C / �>� L v� v, C) � f ; c e— U Vl W Gr L( Tit Commonwealth of Massachusetts Department oaf Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia 'VVbpkere*Compensation Insurance Affidavit: Builders!Contractors/Eleetricians/Plumbers A, &_Iu&iMatioli Please Plint-Ledibly Name(BvsinesslO r0nizaiioiond;vidual):t t/ I /t l'�t'1/V I 1 t!1 G Address: of / j e- U1 /-t- 5 r City/S#ate/Zip: ,�� 4�-L L+-��r;l Phone#:Z� , 5 2- - Z V 6/ Are you an.employer?Check the oppro'priate box: 'Type of projecg(required). 1.�`am a employer with .•4. Q I am a general contractor and I employees(frill and lar:part-time). have hired ilia co contractors 6. New construction 211 1_ama sots proprit~tor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any_capacity. employees and have workers' [No workers'comp.insurance comp.insurance.# 9. ❑$uldmg addition required.] S. [] We are a corporation and its 10.0 Electrical repairs or.additions 3.❑ I ain'a;homeowner doing all work officers have exercised their 11.❑Plumbing_repairs or additions m self: o workers cum right of exemption per MOL Y ' p• 12. Roof repairs insziratice required.]t e. 152,§t(4),.and we have no. employees:,[IJo workers' ' 13:Cj Other comp.insurance required:] `Any applicant flint checks box ft l most.thb fill out the srcaon below showing then workers'compensation;po j;y information.. . t Homeowners wLO.snbinit this ai davit ind'tca�nig thoy'sre doing all work and.dsai hire outsxle contractors mnst'su6m�t a new a idapit tadi Arks such tContractowlltat.c4wk flwtbox mug&Usehed:an.addst 001 omm sWvmg:ihe now o€tE z6u contiacabrs-and stets whedw oroot*.m.cnttitses'bave. emploxeos�.. if dlcsnb�eontra�ctorshavae�nployee�,tbty muskprovida:tbeic:wocicros'samp:yoficy�mndber:.:: ;: . 1.an an Moyer Aat.ls providing.workers compensation imuran a for my employees. Below tJtepoliey tnd oG site Insurance Company Name: a 1'I n• g"6(� t nip ALg /" A.,J Policy#or Self-ins:tic.#:/l we—,�'7&L2Le)sly, 2-0/1 Expiration lbate: a Job Site Address:: c� E��1 Cstij+lState/Zip• /`r' -Yd 'r _ _ Attacfi a copy:of the workers'compensation palzcy decl rhtion page(showing the.policy number and expiration date). Failure to secure Govt rage as required under,Sectiow25A of MoL e. 152--oen iead:to..the impontion+Qf criminal penalties of a fine up to$1,500!00,and/or one-year raprisonment,as well.as civil;penalties in the:form,.of a-STOP.WORK,C;IIfiDER.Viand a line of up to$250.OU a day:.agams the=violator..Be.advised that a copy of this:staiement:may be:forwarded to the'4ffice of investisations of the MA-for insurance-eoveratze verification. " X do hereby certify'uirder Ike pains dud penal of perjury that the information provided shone its true,arid correct. i attne- Date: I 2 ° LC ` FLOther on y. o not write i:7 is area,to coi»p e y city or!sign o�rcial n: Perm it/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son• Phone* 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 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, 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 SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �--arc, License Number uk-)v <P `(7j Addres Expiration Date Signa ure 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 0 No Version 1.7 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 9.2 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 f j L� ��1 - "c Not Applicable El Company Name: ( i —CX 1 [ r2il, I Responsible In Charge of Construction Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 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 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 O 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: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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 ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. %;'ktea Of Proposed Work: / Fk SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ 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 ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑ 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 1St 1 St 2nd 2nd 3rd 3rd 4th 4 m Total Area(sf) Total Proposed New Construction(so Total Height(ft) Total Height ft 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 E) Versionl.7 Commercial Building Permit May 15,2000 � Department use only r-- City of Northampton Status of Permit: 8 204 Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Electric, Plumbing&Gas inspectiNQ hampton, MA 01060 Two Sets of Structural Plans Northampton, NIA ioso _587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION 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 56, l�ql& 51' 7'o 6. rl Ac,vie,Y^ Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: , Name(Print) Current Mailing Address: Signature y Telephone 2.2 AuthorizOL( ent: G✓ K 13 C's rpel&,"y I v,L, 91 1?"'7 U-, / S r Name(Print) Current Mailing Address: Signature _ t- Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building / -7 (a)Building Permit Fee r IG (... 2. Electrical (b)Estimated Total Cost of cz Z Construction from 6 3. Plumbing LIZ.61 q, � Building Permit Fee 4. Mechanical (HVAC) (• ''77 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0633 •APPLICANT/CONTACT PERSON WKB CARPENTRY INC ADDRESSIPHONE 91 PINEVALE ST INDIAN ORCHARD (413)525-2914 PROPERTY LOCATION 56 MAPLE ST MAP 23A PARCEL 039 001 ZONE GB(100)/ 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: REPAIR WATER DAMAGE(CABINETS, SHEETROCK&FLOORING] New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 96193 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9,WWATION 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 Permit DPW Storm Water Management Demolition Delay 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. 56 MAPLE ST-UNIT#101 BP-2015-0633 GIs-#: I COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-039 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-0633 Project# JS-2015-001218 Est.Cost: $11687.00 Fee: $72.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WKB CARPENTRY INC 96193 Lot Size(sq. ft.): 64904.40 Owner: NORTHAMPTON HOUSING AUTHORITY TOBIN MANOR Zoning: GB(100) Applicant: WKB CARPENTRY INC AT: 56 MAPLE ST - UNIT#101 Applicant Address: Phone: Insurance: 91 PINEVALE ST (413) 525-2914 WC INDIAN ORCHARDMA01151 ISSUED ON.•1211212014 0:00:00 TO PERFORM THE FOLLOWING WORK.REPAIR WATER DAMAGE (CABINETS, SHEETROCK & FLOORING) - UNIT 101 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: Date Paid: Amount: Building 12/12/2014 0:00:00 $72.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner