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17C-005 W . 00 Note:This drawing is an artistic f Designed:6/21/06 interpretation ofthe general appearance of Ny°+q'•' r� Printed:6/21/06 the design.It is not meant to be an exact rendition. 621OeObO.kit Drawjng#: 1 r {- I I ff 'or I o ❑❑ ❑❑ ®® ® ® ® o � � r Note:This drawing is an artistic i• r" Designed:6/21/06 `( g interpretation of the general appearance of @y,''--�, Printed:6/21/06 the design.It is not meant to be an exact rendition. ; 6210cObO.kit Drawing 4:1 s I we. x l I i g Note:This drawing is an artistic <"'' %%°f"?° Desi ned:6121106 .. interpretation of the general appearance of �y'^•��y Printed:b121106 the design.It is not meant to be an exact ? e Y=> rendition. KQ vI 66 i to 53-L; - 4 83"'' � 40" "I 25" I W 33R-REF ° 0 0 c � A V W A r 0) W O t W V J ----------------------------- N 2�77 SB3 BF W3b30 _ _ 6 N,. fl\ MW 3 OOD J3621 DT 61 31 All dimensions size designations given are :a'? � This is an original design and must not be Designed:6/21/06 subject to verification on job site and °$ ,w(# released or copied unless applicable fee has Printed:6/21/06 .. adjustment to fit job conditions. 4.,`s been paid or job order placed. 6210eObO.kit JFp5 ID rawing W.1 tc� )at f� RCrno ve �pfiMf�9✓5.�v r Q oo rof QdU i. �Esr, "� �ffv�fury� C a° � S _ � r O�1ttnJrpTO r.. (� \ Gc3.a �. (rii-�) of '001:#1ja1l1P101I - �tcstachncc(Is ' i o DEPnRTME14T OP f3UIL0INC INSPeCT101.'S — 212 Main Strcet ' Municipal Building Northampton, Mass. 01060 WOREER'S COiY[PENSA_TON G' SURANCF AFFMAN!1-1' (licCl� Pcrmittcc) -- P!��;-af-h>3�i-se-s-s/r-c�H�-t ��__�� i��- Ic�.E'E�+s L Die- c9 o .631 "6c9(., 1 (Smc- city/sZalcrap) do hereby certify, under Lhc pains and penalties of perjury:, hal ( ) I am an employer providing the followine �Y,orkcr's comocnsador, covemSc for im eluplovees working on this job` (l an Corer av) (Polic: Nu- r) --- (z ,piratior,D21^_) ge) I am a sole proprietor, gener�LhC or homeowner (ci cie one) and have hired the cones actors GSted below v o o%" lnQ workers co CDenSa6on policies: (i+SII)C Oi CO ' Ci0') (II1Rlranc-c Coinoa,-1}'/POUc'i I IUMQ-C:) �_?:)IiJl30 DIIC) -- (Name of Coo(ractor) _- (Lnsurancc ComoanvlPo!ie'; \lumber) (EkDrulon Date) (Name O(COMaClo,) (La ura acz Comparey/PoL-cy Nainb�r) (Exp'Lm ioo Date) I (Name of Contractor) (Insurance Comozny/policy Numbcl) - (Expiration Dale). (aa1Ch:.d6;:ocal escC'ifnoccz�l-to c,e'.uu iaCormi�oo pertaining to.1J oo=m on) am a sole and have no one wori,3ng for me. ( ) I am.a home owner performing all the work myself. NOTE:ple_sc be cwye tfiL,4_L-jo 6cmcowvcra Mbo employ pezoa:to da a,3 kl,-,••,•,• a rcpzir work oa d..ct--Z of as most'h-' L`____-is u-'-Cb the bcn»ooiwcr raicle«10 1b.-Qouarr�z;xpuflccn_r1 tb,co c r ooe hex-iny oc,=,dcsrd to be employes Uc?--theµaiC=--oc tioa Act(GL152�a 1(5)�appli=Eaa by a homcoaor1 fcr e lic=x or permil r=y c idcnec the IcgIJ rtaau of as a Ployer under dto Worlcola CorapoonaLioa Act 1 undo%.ad tha a copy orthi,—I—aaay bo focw dad to d—Deport=—!of I.&Lrrid A=do.'OIM—of 4rau.00a for thv ooveT rvireslioa zM a"G.ilurc to t4Cu c)eovc try scuioa 25 A of Lint 152 can lad to the impoiiiioa of ai=ms!pcu-LWco ooaM=38 of a rise of tip to S 1,500.00■rNo,vxz;y uooz -yt of up to ooc yev end a%tJ pm.hia Lo 6e form ora stop Work order tod a Gm 0CS100.00 a q,.y apuast me ----•----- \ For dcPrlm—"t uae only _. Pt.rmit Humbcr '(N.7 P: Versionl.7 Commercial Building Permit May 15,2000 SECTION 10=5TRU _Tf1RALpEER RE1/IEW( 80 CIVIF211011} Independent Structural Engineering Structural Peer Review Required Yes No 4 SECTION 11 OWNER=AUTHORIZAT.ION-TO-BE�COMPLETED-WHEN OWNERS.ACENT.OR CONTRACTORAPP.IIES-FOR bUILDIN(J`PERMIT I I,as Owner of the subject property i hereby authorize I Ito act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I I j 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 pe_Idury. { Print Name I Signature of Owner/Agent Date SECTtON,12:=CONSTRUCTI0 N SER\/ICES.; 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:I �iq �— Ct �A zn S Lt y "- License Number i-73 1 _1461VO-el'4 Die Address 01 Expiration Date Signature Telephone SECTION 13 WORKERS'COMPENSATION INSUFZANC_-AFFtDAVII`{M G L.;C:152°:.§.251(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 0 r r j Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGNF AND CONSTRUGGt01!�SERVICES-FQR BUILbING�AND 9-T,,RU-&6RE5 IJB:IEGt'EO CONSTRUCTION CONTROL PURSUANT?0,780 CMR 116{CQNTAINING Nf RE TFJAI�k;isio C.F.OF E�CCLOSED SPQGE) 9.1 Registered Architect Not Applicable ❑ s I Name(Registrant): Registration Number I Address Expiration Date r Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility i Address Registration Number j Signature Telephone Expiration Date 1 Name Area of Responsibility j Address € Registration Number I 1 Signature Telephone Expiration Date i � I Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility j i Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor I Not Applicable ❑ Company Name: i e Responsible In Charge of Construction Address { { Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size i Frontage �- Setbacks Front =—� Side L ! R:< I L:I i R:= Rear ; i_� Bui`Idm-g Hei Bldg. Square Footage 1— Open Space Footage �_ % (Lot area minus bldg&paved arldn ) #of Parking Spaces Fill: 1 i volume&Location) `t A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book 1 Page�� and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES Q 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 f IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: j 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 0 NO M IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r Version 1.7 Commercial Building Permit May 15,2000 i„ SECTION 4-CO ISTRUC-TLON SERVICES:FORPRO.[ECT :ESS 1NANr35�00.Q k �. CUBLC•FEET'OEENC�OSED�SR�CCE' '` 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 esc 'rpti�onhere. ,� s Of Proposed Work:1 L T �y'� ""41L I - SECTION 5 USE GROUP ANQ CONS7RUGTI4NF�YPE 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 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify:s I M Mixed Use ❑ Specify:` I S Special Use Specify: 3 COMPLETE THIS SECTIONIF EXISTINCrBUILDII`IG UNIIERGQIIG RENCIUAt`[E71�CS,AQD1T10N5ALVDfQR G�fANGE:IN USE _� _ _w .u. Existing Use Group ! Proposed Use Group: f Existing Hazard Index 780 CMR 34): i Proposed Hazard Index 780 CMR 34): i SECTION"6'BI11LU1NG�IEiGHTANDr74RIJi;. =' - iF' BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION � 1 Floor Area per Floor(sf) 18[ 1st! - 2 i nd nd 2 - rd 3rd 3 E I 4"' z i 4w Total Area(sf) Total Proposed New Construction(so 1 Total Height(ft) I Total Height ft E 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone ! Outside Flood Zonen Municipal qg On site disposal system❑ f � Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room'100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 Pfa APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY 01,, VI CIS ANIY ggtJl iN OTHER THAN A ONE OR TWO FAMILY DWELLING e SEGZIO�1 i.;SITEINEORMI�' fON >. ., . -"-Property-4ddres p� Tltrsectroc tfie caranfefed i lot n " q -.+.-ar..zG�...,.5..,...r..v:.:' i ,�Y`'. SEGTI DW PROPERT O1lVNERSHIPIAIJTHOR1ZEDrACENT 4 « r 2.1 Owner of Record: i r Name(Print) Current Mailing Address: l 41 eog Signature / Telephone Y/5 _ 2.2 Authorized Age t. f i i Name(Print) Current Mailing Address: Signature Telephone --SECTION 3.--_ESTIMgTED.GONSTRUGTCOAt COSTS Item Estimated Cost(Dollars)to be Imclajl zu se Clraly completed by ermit applicant 1. Building Q b O (aj Building'Per(niffee i. 2. Electrical f o) s d I °ConstrudUbti from-`6 . 3. Plumbing I 13uildting P,errrniFee i 4. Mechanical(HVAC) i 5.Fire Protection 6. ToW=(1+2+3+4+5) Check Number Q tiis-Sectlon Fdt-Oft i6FUse Only ,<Bulldmg I'ermi�l�"�mber'• Date _ issued= r Signature: Building<Commissioner/Inspecforo#:Buildings Date File#BP-2007-0060 APPLICANT/CONTACT PERSON PAUL H WINTERS ADDRESS/PHONE 1731 MEMORIAL DR CHICOPEE (413)531-0861 PROPERTY LOCATION 30 LAKE ST-UNIT#4 MAP 17C PARCEL 005 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid Typeof Construction: REMODEL UNIT 4 KITCHEN&BATH New Construction Non Structural interior renovations Addition to Existine Accesso1y Structure Building Plans Included: Owner/Statement or License 043408 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 F'nclosed 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 q7(to S4tgnature 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. r BP-2007-0060 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2007-0060 Project# JS-2007-0095 Est. Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PAUL H WINTERS 043408 Lot Size(sq. ft.): 12327.48 Owner: LIEBERT DIANE E Zoning_URB Applicant: PAUL H WINTERS AT. 30 LAKE ST - UNIT #4 Applicant Address: Phone: Insurance: 1731 MEMORIAL DR (413) 531-0861 CHICOPEEMA01020 ISSUED ON.712012006 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL UNIT 4 KITCHEN & BATH 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 7/20/2006 0:00:00 $50.001098 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo C,cf� 6a--C L-ALA r�CL— PAT N a (o BP-2007-0060 30 LAKE ST-UNIT#4 COMMONWEALTH OF MASSACHUSETTS GIS#: Map-.Block: 17C-005 CITY OF NORTHAMPTON Lot: -001 Permit: Building BUILDING PERMIT Category: Permit# BP-2007-0060 Project# JS-2007-000095 Est.Cost: $10000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Contractor: License: Const. Class: 043408 Use Group: PAUL H WINTERS Lot Size(sa.ft.): 12327.48 Owner: LIEBERT DIANE E Zoning:URB Applicant: PAUL H WINTERS AT: 30 LAKE ST - UNIT #4 Phone: Insurance: Applicant Address: (413) 531-0861 1731 MEMORIAL DR CHICOPEEMA01020 ISSUED ON:712012006 0.00.00 TO PERFORM THE FOLLOWING WORK.-REMODEL UNIT 4 KITCHEN & BATH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. Underground: Service: k12% "Oi - Meter: g Footings: kVRough: Ho use# Foundation: Rough: -` �� 7/7j,/ L� Driveway Final: aj Final:6- .-p6FinaY: ff�.?�/�10 � Rough Frame: 01(- 01 f 02Id6 S�TAh/ Fire Department Fireplace/Chimney: Gas: Insulation: Rough: Oil: Final: ©JC 08/ '�0 6 Lo N I t Final: Smoke: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF TI'S RULES AND REGULATIONS. Certificate of Occupancy_ �.�- Si nature: Feel e: Date Paid: Amount: Building 7/20/2006 0:00:00 $50.001098 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo