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17A-132 (2) R E Crri cif 'ioril?amplol) R a35PtcFncclla _ d DEPARTME1,T OP BUILD0\1C INSPPCTIONS — 212 Main Street ' Municipal Building Nrorlhampton, Mass. 01060 N MCER'S CQiYMENSA N INSURA_NCF AFMA«-z' b (li ccusccJpermi lice) \ ith a principal place of business/residence at: ---- (phone') (stTt/ci ty/Slate/Z]p) do hereby certify, under [lie pans and penalties of perjury, ?hat ( ) I am an employer providing the foilowtne worker's colnocnsZ%t;on cove age for Inv eluplovecs woriang on this job. f)V avd� lX G surnc_- Cors=v) (Pout; Nu_mtxr) --- - (t Lpirtion D2te} ( ) I am a sole propretor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following Norker s coEDoen_'.'_aon policies: (Name Oi Con'mm-) (1ri LIM11c: Coinpany/Pouc; Num!�Cr) (_X-PIF-alo t Datc) - (Name of Contractor) -- (Insurance Comoaay/Po!icy Numcrr) (-BpiFailon Date) (Name of Cone-actor) (Insurance Compomy/PoLcy Number) (Expiruoo Date) (Nalne of Contractor) (Lasuranc: Comt mY[POLCY Numbs) (Expiration Date) (mach •A�.�ocal r'_xd ifncc_,:y to-'u6c-f—oa pertnining to,Il ooa7-._.co:�) ( ) I am a sole proprietor and have no one wor4dng for me. ( ) I am.a home owner performing all the work- myself. NOTE:plcx be ewzrc th.•�t Je hcm�w�m who employ pez ona to do e rtp�u.•orx o-3.d-c(li:z of not mot:tlLn(aoe tmi'u in uhieh the borno ,� raido or oa the pouM:r zapucten•n the' LT oX Ec:al1V Ocrs:d Ci to be employes"rick the caa p tics Act(GL152-m I(5)�zpgUja6m by e homco,far:bczr_�a pa-mn rr.y mdcocc the legal rtnIIu of on om,loyer under dro WoNk 'C-Cll tioa AeC I underM od the a aon of thi,ex>.I——Y bo foe-x. d d to tbo Depvrtmcar of 4.dd ,d Ae d..&Offs.of Irrau,<noo for tbn oovcrasc�alrcLOO nad tlu L•iltaC to$came covcragc tasdcr Sccuxion 25A of MOL 152 can Iczd to the imposiiioa of aimiail pcn wcs oomuting of a fiat of tqa to S I X00.00 and/or of up to ooc year nab a�iJ pcn,.hio in LX focus of n Stop Wok Ordcr nod e flm of S 100.00&d-,y tpurtA ttx For dqa rt, _"�u,c only Sigzlalun of Licxstscrll' tiuucc —13 Versionl.7 Commercial Building Permit May 15,2000 ECQN 10 :STRUCTURAL P'fiER'FtEYIEW"(78p"CMR 1t1 " ,idependent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTJON 11.0 0WNER AQTHQRIZATION-10'13E COMPLETED W"E" t?WNERS AGENT(�R,CON"��tAmT APPL19 FC R 9 UfiL0114 P(:RMfiT I, as Owner of the subject property hereby authorize y' 7 7": to act on my beha matters relative td work authorized by t is building permit applic tion. Signa 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 ame ign a of wner/Agent Date SECTF SN 12"-C+E NS M"f t1C'FCON,SE1!VICE5 10.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder: �l e-0 0 License Number Address /J Expiration Date tig'natud Telephone SECTIO_13. OkKEFtS''CC►14lI'I NSATIUN I"NISP RANCEAFF1DAVIT{M,G.L.ti,x.52,§256( 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...... ❑ Versionl.7 Commercial Building Permit May 15,2000 SC�IaN PRIFI�5STCINA i?�SIGN ANQ C�NSTRUC'C1©N;5ERICIGES FUR„BfJILQINGSNn 5TRiGTURES SUBJECT„t1) tSRiIt :tN' GI 'tiEQ.'PUSUAiV'[ iQ 7flN1R 11 °(CONTAINING 'Mt):RE THAN;35, ICo- F. EIt . A1 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 `;nature 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 9dress Signature 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: 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 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 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 1 No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 TI 4,CONS'fR4 I(MORSERVICES FOR PROJECTS:I ESS THAN 35,OOCI ;IC F ;��RNi � 1w1� Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ ❑ Exterior Alterations t/" Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ �, 9 ft Accessory Building[ ] Repairs [ ] 5GTIQN I En ADD CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ 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 ❑ I Institutional ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 01 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: Mixed Use ❑ Specify: S Special Use ❑ Specify: CPMPL ETE 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 s, _• � d r Floor Area per Floor(sf) 1st 2nd y 3 1St 3rd j wa M 2nd 4 t 3rd 4 t x . i r/ j Total Area (sf) Total Proposed New Construction (sf) a ................................... X � Total Height(ft) ' s Total Height ft-------------------- Version 1.7 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 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ;S:ECTION,�.=S1TE.INF©RMATION ' 1.1 Property Address: 4 F u _ /�'"G��•s--- Y / 1 UK✓J.� <��. akr� r k �e�� e� a� '� • �n-'� r SECTION =PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ame(Pr' Current Mailing Address: Sign re Telephone 2.2 Authorized Agent: Name(Print) I Current Mailing Address: Signature Telephone SECTION - ESTIM "CONSTRUCTION COSTS. ;P 1/101. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applica nt 1. Building (a) Building Permit'Fee 2. Electrical (b) Estimated Total Cost,of nstruction'Vor` 6 3. Plumbing Bullding�Permitfde 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 +2 +3 +4+ 5) Check N j,mber This Section For Official Use Only u.ildi,ng Permit Number: Date Issued', S!gnatre: Building Commissioner/lirspec#or,of Buildings Oatra 264 CHESTNUT ST BP-2001-0515 GIS#: COMMONWEALTH OF MASSACHUSETTS Map Block: 17A- 132 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:roofin g BUILDING PERMIT Permit# BP-2001-0515 Project# JS-2001-0893 Est.Cost:$700.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor. License: Use Groin Larry Paquette 100679 Lot Sizes .ft. : 1071 5.76 Owner: TOBIN JAMES T&FLORENCE A Zoning: Applicant: Larry Paquette AT: 264 CHESTNUT ST Applicant Address: Phone: Insurance: 40 East Green Street (413) 527-6375 Workers Compensation EASTHAMPTONMA01027 ISSUED ON:11122100 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADD 6`' PITCH TO FLAT ROOF APPROX 8 X 4 POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Tyne: Receipt No: Date Paid: Check No: Amount: Building 11/22/00 0:00:00 2628 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo