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17A-056 (3) y r i PROF110-SAL q u rII�: +j Iurm 1' -I VUN .iI P I. i DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: tiII 1 BO Rrl .,.v,, I.•:=.rr k u9�2111�41e.1 , wli uuk II f-wm .I ,N�alann`a n:=" u.- ry•nM I�I,a rll>alls ! .N ,V, ^k ,,°I�v_ IIIu �-. I I sllya 111 r I P iws m I aI^r r h...1 a ,I��VI+ II.dll ":` I'w, # I :.Ix�,lh ,r AIL 91a iN allel ,` i DATE OF PLANS � I I PHONE NO. «` ARCHITECT i 1 I�,+a�al��.INN .I�. � �I �.�,I"� ,� a +''� I I plow ,mIW�l+G sl ,Im,r�a�I amlm�Il,kr!�l"kIl v II�4'11II I I I I .._ H q p 1 �I, 7]I �Ili �� III ', -✓I V I.� li' I4.II III III PII SVS ry �'9111 r Pp .• 3 v1.;,. 11 '' ,r11 'wV` 3�u Nt' Ill.a.� I6 EII4 I�1 I�I� �l�i Ii,'ilhl w II^`>G11N 9 .fir 1.,I r 2'r I4 ._I :N Ir rj'r;I V tl 'll , ,. III fll! qly IL,I 1tl^ p.k4 far ^ s �,m d I� 41 ,r. '. o x�ilu._ 'NII �i�lf6 � rlf II „+I x III_.I `Illy III I:: .,I,Ir xI Iti ;u�i; fI IPII I�Ir yIP Ipfjl " _ WF ° ...� _ �� .II.II, .. ''I. .:Ir II I�Ili�d sllllq I�III Y��hi l�r3�l�a1 k Iu uw I' h�V� u' P w Im 7 . r - r reV a kI "rI II II I VN ��I 11�I Y tlll ll I,. I,I V - I I I lu III rI �I lti ',� I{ I I + , a. u7 ul w I I , vt T i.....r 'Its. sIOI JA' ° I i i All material is guara,niteed to be as-s cifiedf and the above work to be performed in accordan'453,ith te:d n s nd sp ifii� cations submitt for awe Iwo antic feted in a substantial workmanlike manner for the sum'of � �'•� VVIIII, " i t Dollars ($ with payments tt�be made as follows. r 51 �K CA "rid 0/ -3, o � + Respectfully submitted IJI Any alteration or deviation from above specifications involving extra costs will be executed only upon written order,and will become an extrd-charge Per over and above the es' Its. All agreements contingent upon strikes, ac- cid ants, r delays and r control. Note—This proposal may be withdrawn by us if not accepted within days. I i ICI rr P wki Iv ��aI�M1I vll II; I I I kr Ilr VI� I r I�4a s vn �dlrr�u s ilw I �k II - �' II -PRO IIII°. " f y yl�lll dl IIH 1^ � Ih y^ I I r. T at? Ye Ip I� � rlo ere . � 0pd ens hereby " t� a sl file work. ��. ayri�t l'1r ill�,1��. ltni d abC Vfe. Signature Date Signature j GAdarrs NC 3818-50 MADE IN USA PROPOSAL ii i OQKKAM p�O . laf wart 11 lnytoll $ 6 f�asarccfTnsctts' m DEPARTMENT OF BUILDD\TG INSPECTIONS c 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMTENSATION INSURANCE 't AVTT l�el-mitice> with a principal place of business/residence at: /, A D 96 6C,k 3+ P1J(rnCe / j . Vt062 (l)honei#) (str�t/city/stafc/rip) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees wori�ing on this job: (Incurana� Corapany) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Poiiu),Numb,-;r) (Expiration Date) .f (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoEc�,Ntunber) (Expiration Date) ( g e of Contractor) (Insurance Compauy/Policy Number) (Expimtion Date) oml theet if m6ocnary to include information pertaining to aE ooafrnciors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself-. NOTE:please be aware that while homoown=who employ perzons to do m iajc+*ac,�suction or repair work on a dwelling of not more thsn throe units in tafiich the homoowner resides oc oa the grounds appurtenant thereto are not gcncr l ooandcred to be employ=under the w orkt'%oompcnu4on Act(GL152,m 1(5)},application by a homeov n r for a Gccase or permit may evidcaoe the legal atanra of an employer under the Wor o t Compemation Aei. I understand thai a oopy of th s ttatemcni atay be forwarded to tho Depwtaxal of IndusLial Aj)cidw&offioe of Insursaoo for tho oovemge v+crificatioa and that failure to aeatrc ooverago under scdion 25A of M43L 152 can lead to the impositioa of criminal Penalties ooasisting of a fine of up to 11,500.00 ardor imprison of up to one year and civil penalties in the form of a Stop Work OrdG and a fort of 3,100.00 a day q7=t ma For departmesral ur a Daly Permit Number gyp} Lot# f: Si gna of Li rmittee 2 Version l.7 Commercial Building Permit May 15,2000 SECTION 10='STRUCTURAL,PEER REVIEW(780 CMR 110.11)i Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 1,11-OWNER AUTHORIZATION'-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 I, IJC�e 1 WY17'1crme i as Owner/Authorized Agent hereby declare that the staternerds and intJrmation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. des Print N me __ /I /?i J--W w-40�� bo� Signa e of Owner g Dat SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Mon+ 07 7&f/ 0 License Number Ll 04. Fl"c r 10A - /.q/0/ /a00-3 Addres _....— - Expirat n Dat Signs re 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....... ❑ No...... ❑ Version].7 Commercial Building Permit May 15,2000 SECTION 9-;PROF,ESSIONAL DESIGN AND CONSTRUCTIOWSERVICES - 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 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 401,7 Not Applicable ❑ Company Name: :Ycsst. M c� Responsible In Charge of ConstruQkion Addr s Signgture Iff:77 Telephone Versionl.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: Public ❑ 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 Special Permit/Variance/Finding e r been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Reg' y of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # the site contain a brook body of water or wetlands? NO DON'T KNOW B. Does Y 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,/here any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 SECTION'4-CONSTRUCTION SERVICES FOR PROJECTS LESS'THAN 35,000 CUB,ICTEET OF ENCLOSED SPACE Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] her [ ] ❑ Accessory Building[ ] Repairs [ t der-ki�Iss SECTIONS -,USE GROUP AND CONSTRUCTION"TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly Io 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 t�FFICE,USE ONLY Floor Area per Floor(sf) St k y F 2nd t 1st sy/ 2nd 3rd "� t Aj »psi th rd 4' 3ya� Total Area (sf) Total Proposed New Construction (sf) � z� Total Height(ft) Total Height ft ------------------- � w Version 1.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street ze Room 100I l va Northampton, MA 01060ets phone 413-587.1240 Fax 413-587.1272 'of/ afie P ans APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTIONJ-'SITE INFORMATION 1.1 Property Address: This sectionJo be completed by office M Map Lot Unit Zone Overlay District< G, Elm St. District CB District SECTION 2'- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: eSSe M& oryvel Name(P int) Current Mailing Address: Signatu Telephone SECTION 3:- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �� (a) Building Permit Fee 2. Electrical (b) Estimated'`Total Cost of Construction from 6 3. Plumbing Building Permit'Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 + 3 +4 + 5) Check Number This Section For 00icial Use Only Building Per it Number. � '!2'�2 �� Date Issued: � Signature: � of Buildin Building Commissioner/Inspector gs Date 123 LAKE ST BP-2002-0503 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-056 CITY OF NORTHAMPTON Lot: -001 Permit: Building Categoa: BUILDING PERMIT Permit# BP-2002.0503 Project# JS-2002-0760 Est.Cost: $2300.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 077410 Lot Size(ss . ft.): 22564.08 Owner: MARDAS JOSEPH Zoning: URB Applicant: Jesse Montgomery AT. 123 LAKE ST Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482 O FLORENCEMA01062 ISSUED ON:1119101 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ROTTEN TRIM AND DECKING & STAIRS 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 si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/9/010:00:00 1 116 $25.00 212 Main Street, Phone(413) 587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo