17C-129 (5) 0
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DEPARTMEIrT OP BUILDIh.0 wspzCTIot s —
t 212 Main Street ' Municipal:Budding
Northamptori, Mass. 01060
W0IUCC,It'S COiVTENSATION, GNSURA-NCE AI, IMA�,rij-
. . �censoc7pci•niiirce}- � -
(sir�t/cat}/staticfz�p). (PA. - ...
do hereby cercjf--, under tlic.pzins aad penalties of perJwy, hat
I an employer providing the following comoc;isat;oD, cove arc nor !ny
efnpl'oyces worlong on this job:
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(Insu r-:�c-Corer } ( clic:N tL-zir_r) D21--)
atn a sole proprietor, general conrractor or homeo.wmer(circ?e,oee) o have.hired
the cones actors listed below vvho have the fotloxving worker's ramoe,isnnil`pc!icies_ : `
ali1 rbc—,- 0-:16I1-jf3o III*�0
(Namc of Coac"rac'tor) (bi-7 rZncc Comt)a.a)'iPoUc-,• Nunc_r) (—B—pii;ation Dace)
(Name of Cgarractor) (Ldswanc-- C:ompan)-/PoUcy Numbu) (E.xpir don Daic)
(Name of Contractor) gdai any Commny/Polic.y Number) - IE.xpi:tauon Dais). E
(aaJ.G�:d:ri:;'ocJ> C iraoc�zi 1••to a�cud=iai{oc1•t.a oa pct,_aias to aU coos-..con)
( ) I am a sole proprietor and b.ave no one worming for me-
(. } I am:a home owner performing all the work myseIf
NOTE:plea lx ewsn Je bomco —--bo catpfay P--,-cU rcpz;r uarz 02•d ctLy or
❑ot @OCt Lh--u 'Y'Y L^SYJ in tc�ch tbC borwo,- rT 4,m OC co[bC Qp=43 tqpur1caa=Tbc:T-• cm 0.7C jt7C'.IiY cx%=d=-Cd tO tY
'crployc-.trnc,c ttx w�;��--•'m Ac(G Lt S2.n!CS)j,zPPtit�cra by:6omma�c rcr c G¢�_«perma r`7 cidmcc tl:c
Imoj ct�rc ofa exployx uaderdio WO koe.Coa�n Act.
[ d d A a copy a th;.—I—my b<f---dad to tba Dcgitmcoa or Indutri cf A=d—0ffioa or Iruu.oca rer th.
oove�,,c ve-irctiop rind t]Lt f:ihac to secure'covet-arc—dcr reckon 25A of MOL 152 as fed to the i�p=kica of a im;-I p-at -
ooazir,�33 of a B. crup to S 1}00.00 andfor tsoatnat orup to ooc ye-.r a od cNil pcmhio in d.roan ora Stop Wort Ordc aad.
rim of S 100.00.d_y.punt tree
For dq,�u. cnty
Lot
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Lim-of Lie-2scClpc MII acc Ce r
Versionl.7 Commercial Building Permit May 15,2000
J..
independent Structural Engineering Structural Peer Review Required x Yes � No � .
SEC-T[�L�'>�t OOYiIItfEE�Af�QI�[Ol�"_T4�B�€QIfIfP��f1�WHEI�' -
aTl_uNERS�GEt�T E7fZ�C,O[�TRA-G�QR..4i?�,;�tEF�E�BI:itL�i�EEZN(ITT
I. as Owner of the subject property
hereby authorize W)IA&�t4 � 11/Z4n ll/\C + to
act on my behalf,in all matters relative to work authorized by this building permit application.
�•y � / ..
Date
I• v 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 pgins and penal ties of pe ury.
Print Name '
Signature of OwnedAgent. Date '
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SECTOCQRIRL`iG`l f000- 11�[CrE
10.1 Licensed Construction Supervisor: ++ Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signatuii Telephone
SECTION 13 111iORKERSONXPENSAI 1k1>rC.�� 5 � �2
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.
AIrN
Signed Affidavit Attached Yes No 0
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Version- :7 Commercial Building Permit May 15,2000
sE�no1�s� MW� nas7IZ
9.1 Registered Architect:
Not Applicable D
Name(Registrant):
# Registration Number
Address i
Expiration Date -
I
Signature Telephone
9.2 Registered Professional Engineer(s)
F@a 8f ieS�urSiui
Name iiiy .
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility '
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Address R stration Number _
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility:
Address Registration Number
i
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable❑
I
Company Name:
Responsible In Charge of Construction
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Address
Signature Telephone
Version_ Y.7 Commercial Building Permit May 15,2000
'Existing Proposed Required by Zoning
This column to be filled in by
:e. Building Department
Lot Size
Frontage 1
Setbacks Front •
Side L:= R:= L:= R—i —
Rear
ni g
$Y� Bldg.Square Footage —� %
°s Open Space Footage }� % �_•
(/� re minus bldg&paved i
"✓ .
of Parkin Spaces
Fill: i
volume&Location) ! I
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO 0 DON7 KNOW YES .
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO "0 DONT KNOW YES 0
IF YES: enter Book Pag and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DON7 KNOW. YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
F
C. Do any signs exist on.the property? YES 0 NO -
IF YES, describe size, type and location: f
D. Are there arty proposed changes to or additions of signs intended for the property? YES 0 NO'
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES- Q ' NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
-j
SECR NS7 �JE12aKGE -01� F MCI
I3yf1 0
Interior Alterations ❑ Existing Wall Signs ❑ .bpi nolition❑ Repairs❑ Additions-❑ Accessory Building❑
Exterior Alteration .1Y Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use[3 Other 9L
Brief nescriptign .. Enter a brief description here. �5+-jc- to VN 6P CU✓ic; ADA:
Of Proposed Work. ''-- \\ (c
.SEG�ION U$ RQI������0..-,���('� �FJs� •-�- •,�{�_* .°
USE GROU.P(CheoR as applicable}. CONSTRUCTION TYPE
A Assembly 0 Al .0 A-2 ❑ A-3 ❑ 1'4 ❑ .
_ A-4 ❑ A5 ❑ 113 ❑
sugi. Q: 2A ❑
E Educational Q 2B ( ❑ ,
F Factory,. Q ❑ F-2 ❑. 2C
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ .. 1-3 ❑ 3B ❑ ..
M Mercantile ❑
R Residential R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑.
S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑
U Utility j'❑ Specify.
M Mixed Use Specify:
S Special Use Specify
r '€�� �ETOE�CfSI�Eil} y `t � itrsF fft3 !"� i11S€
Existing Use Group: 1 Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index-780 CMR 34):
rSEGIO &�fliVtfE WAIN
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1st
1st
2`d i 2nd
I 3rd
3rd 1
Total Area(so i Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage bisposai,System:
Public [] Private ❑ Zone� Outside Flood Zone E] Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
City of Northamp .,
Building Departmen ,
212 Main Street `
Room'100' 0
Northampton, MA 01�do _
phone 413-587-1240 Fax 4+,13-587-12-72";-;-
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE;CHANGE THE USE.OR OCCUPANCY OF,.OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
NOW
91 nmm
-"-Prop erty
�fl Nom. `
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SET1�RO T�i
EkeQ11fi[�ER
S IP OtZIZ ;
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2.1 Owner of Record:
TR old 'S6 oe e4
Name(Print). Current Mailing Address:
. ��, , Ike � � C)i� .
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Signature Telephone
2.2 Authorized ent•
Name(Print) l Current Mailing Address:
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' MA 6 UZ
Signature Telephone 2 t
EG to aEStltlVfi TEWCONStiRC[GTCdN Cfl'STS -
Item Estimated Cost(Dollars).to be OfficlaUse Qraf
com`I 'M:6y permiiappli6arlt'
1 t3udding �i)OBuxJdinP�errrrFee
2 Electrical. timafed Tolost or
Ax. 6
3. Plumbing ��,A i ild�nglselmltee
4. Mechanicaf(HVAC)
5.Fire Protection
6. TotaG_(1+2.±3:+4,+5)'� k Number
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File#BP-2006-1065
APPLICANT/CONTACT PERSON WHITNEY TRUCKING INC
ADDRESS/PHONE 576 PINE MEADOW RD NORTHFIELD (413)498-5591
PROPERTY LOCATION 137 HIGH ST
MAP 17C PARCEL 129 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT HANDICAP RAMP AT BLDG M&O
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 091539
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I RMATION 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
i
�av6
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.
BP-2006-1065
GIS# COMMONWEALTH OF MASSACHUSETTS
; 129 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-1065
Project# JS-2006-1573
Est. Cost: $15000.00
Fee: PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WHITNEY TRUCKING INC 091539
Lot Size(sg. ft.): 125452.80 Owner: NORTHAMPTON CITY OF
Zoning:URB Applicant. WHITNEY TRUCKING INC
AT. 137 HIGH ST
Applicant Address: Phone: Insurance:
576 PINE MEADOW RD (413) 498-5591 WC
NORTHFIELDMA01360 ISSUED ON.4/1312006 0.00.00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT HANDICAP RAMP AT BLDG M &
Q
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 4/13/2006 0:00:00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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