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17B-027 (2) Q�IV.}f pP. -- � "' E �lc�encllncclta 4 DEPARTMEl,rr OP DUILDP�G INSPECTIONS ` 212 Main Strect " Municipal Buildinf Northampton, ?facs. 01060 �1'OR1Q R'S CONI'GNSATION I-NSURANCE AFFIDAV F \1"Ith a principal place of business/residence at: -— ----— — — (siTcyt/ci ty/st21c,73 P) do hereby certify, under the pains rind penalties of perjury, .ha) ( ) I a-m an employer providing (hc fol!ov.,Hw workcr's comocns,:T)ol: cove:-^e for ins' elnplovees wot ing on this )ob Onnr_C:� (Polio ( ) I am z sole proprietor, general contractor or homeovy-ner (cl cic o: e) a_nd gave hired the contractors l)sied 'below who hzve the folloVlanp orkei's compne aon pe!!c)es: -- (1'"'Imc of Coil::;Cio-) (I(iR1r311CC COIT1Da;l}/PGIIC•� 1�11fI1^=�) l�=':)!:�'iQ' 1�?lC� �r (Na.ne of Cou actor) (Ins-a=ce Comos_o,,•/Po!ic,, Date) (Name of Coalraclor) (InsVranc: Company[Pot;cy NniAx-d -- (TH`piruon Date) -- (N2mc of Cnntiacwr) -- (In llr-alic_- CompaQy/1,011cy Nu1Dix-f) Daic) ( ) I a-M <1 Sole proprietor and have no one working for me ( ) I am a home ov,,ner perfonu-mg all the work myself. NOS:plc-_sc b bo air,toy pciom LO 6D� lcaaxc � -c��c r.,au.•crk v�z u..cl �of ao(moct 11-n L`x ,Diu in u,::ch tix o<oo the�aiy z x ten r tbctn o-x L�=:lly or_::d 1 w t� —';)icy-- Lh_ .uSua=�ti(a Act(GL152__�1(5)},r4v cwjcn try a 6o;ncaavo fe :Les-.: F r•y'd--nee Lc I,S.,IL-'w of e n ploy_und"d-W_kt ,.Coazpocn.tioa AcL I U-6e 1And dvd>c py of thin a7i�my bo foc--a.2veled to tbo De;wrtz><sz:of 1-1u rid Of -of tr--u f°*t covcn gc vailiciioo n,sd th_.t(-i)=to eoaut eovamEc uri&cr scajoo 25 A of MOL I S]c n lmd w the u-,;>�oa of C-Umo.il •... 00,11i5: g of a rim_of up to S 1 500.00 enNCX czx}-n-isoaizwT,of up to ozr_year e�6 i1 pm.hio Ll dK fo�n of°St°P\VC, rich of 5100.00 z d_y cpui:t me For cScp+rtn��l ur`--"`�_ permit Numb Si"Ialltrc of Liccslsc A)crnlitccc • Versionl.7 Commercial Building Permit May 15,2000 LUCTION 10-STRUCTURAL PEER"REVIEW(780 CMR 110.11) idependent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11 2ANER',AUTHORIZATION-TQ BE COMPLETE!) WHEN OWNERS A{�IEA QR CO RAC.f 'APPLIES-FOR SUIL©ING.PERMIT 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. ii Signature of Owner Date -as-9�u /Authorized Agent hereby declare that the statements a-n—d 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. �P<! e I— Si Owner/Agent Date SECTIt)N 12=°CONSTRUCTION,SERVICES , 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �`��1- —� / 1 L�ici_e—n°si�e` lumber � �Vr- es o l l less � � � 1 ' Expiration Date — Si na ure e Telephone SECTION 13 -WORKENS'COMPENSATIONi 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....... ❑ No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION 9,.PR�3FlS51oNAL DESIGN,ANt?: UNS'fRt1C714N SI= 1tICES FdR BUILCtI!!� S AN13 STRUCI'UES" , BJECT'? 0 4N& tUCTI'iN CC1NTRa1.PURSUANT TO 78b CMR 11 ,°(CClNTIINING,MORE THAN 5M©C.F.OF EC1.8SEC SPACE) 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 ell'ii;gnature 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 =ddress Signature Telephone Version 1.7 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: blic ❑ 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 Spaces Fill: volume&Location A. Has a Spe ial 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 # 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 t/ 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: Version 1.7 Commercial Building Permit May 15,2000 SECTION 4--CONSTRI)CTtON SERVICES FOR:PROJECTS LESS THAN 35,000 i CIE" , O ENC SEA PACE, Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] r f• SECTI[QN S. USE GR UP AND GONSTRI;ICTION TYPE In�i'�de�l`� �/G,rl USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑ 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: Mixed Use ❑ Specify: S Special Use ❑ Specify: CC)Ml?IETr THIS'S,IfT1QN IF EXISTING BUtI.DING UN ERGOING;FtENOUATIONS,ADDl1ON5 ANC/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 ` E_ Floor Area per Floor(sf) ` St � 2"d 1st x sK 3rd 2nd h WK." % y th , i 3rd r � 4thr� Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft - �' "" ' Versionl.7 Commercial Building Permit May 15,2000 a of Northampton QQ ding Department ��- 2 2 Main Street Room 100 pEFT OF 815��C;�FCa war� �Iorthampton, MA 01060 ItiOr`it�,. phone 413-587-1240 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 SECTIQN 1-SITE INFORMATION 1"hiS tecf fay , 1.1 Property Address: pl G 1 l k r M;. YSr' s y�i E1tti riff F�... ,r S CT' I -!,.ROP— RTY OWNERSH�PIAU'THQFtIZED AGENT 2 Owner of Record: ame(Print) ent Mailing Address: Signature Telephone 2 2 Authorized Agent: Q a' Na a(Print) Current Mailing Address: Sig Telephone p U. I Item Estimated Cost(Dollars)to be 6fficial Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction fra 6 3. Plumbing BuiIding'Permit Fe" ee, 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) Check Number This Section For Official Use Only Bui1lding Permit Number: Date Issued: Signature: Building Comm iss ioner/1 n spector of Buildings Date File#BP-2001-0083 APPLICANT/CONTACT PERSON CDT CONSTRUCTION ADDRESS/PHONE 158 NORTH MAPLE ST (413)585-8677 PROPERTY LOCATION 395 BRIDGE RD MAP 17B PARCEL 027 ZONE URB 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: MISC INT/EXT REPAIRS TRIM BOARDS HANDRAILS BASEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 003666 3 se of Plans/Plot Plan THE LL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: :Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § —w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Co sion Permit from CB Architecture Committee 2 2"0 Signa Building icial 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. t , rt:� , 395 BRIDGE RD BP-2001-0083 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 17B-027 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0083 Proiect# JS-2001-0131 Est.Cost:$11050.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Group: CDT CONSTRUCTION 003666 Lot Size(sg. ft.): 13372.92 Owner., BASSETT PATRICIA A Zoning.URB Applicant. CDT CONSTRUCTION AT. 395 BRIDGE RD Applicant Address: Phone: Insurance: 158 NORTH MAPLE ST (413) 585-8677 Workers Compensation FLORENCEMA01062 ISSUED ON:7/27/00 0:00:00 TO PERFORM THE FOLLOWINGWORK.•MISC INT/EXT REPAIRS, TRIM BOARDS,HANDRAI LS,BASEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM tHE STREET Inspector of Plumbing Inspector of Wiiing D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Rough Frame: Gas Fire Deuartment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final:p�{ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/27/00 0:00:00 3096 $55.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo