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17C-184 (4) r° �c3 u 0 �� — A f L1It-7 0f 'To tfjarilpfoil _ — Ejl a l I A Ctl nc.(I I a' d DEPARTMENT OP BUILD N,C INSPPC710NS _ 212 Train Strcct ' Municipal Building Northampton, Mass. 01060 WORlCj-_, It'S COMTENSA' ION, GetSURANCF AF MA�rIT 0 M-D x Pcrmjttcc) L��1'� ...�:��. t�►�L tom;.' -(rnonci=) <v�� �d�, do hereby certify, under Lhc pa,_ins and penalties of perjury, :hat O I am an employer providing the Following %�,orkcr s comocnsadon covem,c 'or lny emplovecs worldng on Lhis job: (La=-.o(= CoEi=:,) (Polic:Nt mb-cr) (T_:-pirtior,Dai^_) ( ) I am a sole proprietor, general contractor or homeowner(ci:cie or2e) aDd have hired the cone actors fisted below who have the following workes cooptn_,anon policies: (I`iamc of Cone ncror) (Insuranc: Colnoan)vt'obc; Nu-m*rC) gate) ~- (Name of Cootramor) -- (lrls-ara.ncc Comoa.nwPoiie; `um6cr) (-B»tf-alon Date) (Name of Coumclo,) (Insluanc; Compaoy/PoUq- Nwnbcr) (Exp r.:tioo Datc) I I (Name of Coataactor) ()_I]SUrHIIc-c CompZ-GyRolicy Numbs) (Expirtion Datc) (anach:G.ii� s'x�iraco�zil to¢wu�iafort��oc pctta.iaiti6 to'L oo�r-._C.o:s) ?. ( I am a sole proprietor and have no one world_ng for me. ( ) I am.a home owner perforrnina all ff. the work myse . NOTE:plesc be ew-uc tt,+.,.{ to homco,-O n bo cmplcy p-z tv 63 mi ccs e o Cr rrnir•rock on c d"�=o of tu,t mete t�a L' _tcai,,is Nli cb the bocnoowucr rrsic�ea oc oo t}x Qoun zppurtea tbera�c ox Goy zlly oc-crd=rd Le be cmploy=unfit tbc..o ic{a --'m Aa(GLI�2ss l(S)),zp9li=.6.b7 a homcowva fw c uc _or pump r=y cndczcc tf:c Icgaln,n,,oraacsployxoodcrdtoWoik .C..q.it Act L uadc4� —f mt—ovy be forwocded to the pcgnr,mr I orladusr;J noadc�OLLoe of(rsa+r�000 f--the cova-,-c v tae to saxlrc boverase tndcr socmioa 25 A-f 2.(GL 151 cin Ic d to the=*outioa of auawal pcaaib,= eocair.iag 5oo.00 and/or orup to ooc yc_,end ci it pasm'ua in t5c Corm or Stop Work Ordc and. fit,of S 10me For do mr=z-1 u+ ol y permit Number :z C.i i.�ti.IiX:i'J f-c I 1 IL U cr- L.OL n .... .J 3=• Versiont.7 Commercial Building Permit May 15,2000 SECTION 10-5F2t 1G1IfRALaPEERREVIEI(V;{78QCMI�ITO [ ) Independent Structural Engineering Structural e R ructural Peer Review Required Yes Q No SECTION 11'=OWNER AUTHORIZATION,-TO BE.GOMPLETED WHEN OWNERS.AGENT OR C T CT A'7 IES FOR BUILDING`RERMIT h i as Owner of the subject property i hereby authorize' to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declare a statemen nd 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. I Print Name f Signature of Owner/Agent Date •SECTfON'12. .CONSTRUCTION SERVICES: 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: W 1i i.rt - �� 0 �Jb5, , License Number Address Expiration bate Signa re Telephone SECTION 13-WORKERS'COMPENSATION;INSURANCE'AFFIDAVIT(M 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 Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIQNAL DESIGN[ANDONSIRUGTIOI SERVICES FOR BUILDINGS AI�D,STRUGTEIRES"SIIIEG EZO CONSTRUCTION CONT�tOt PURSUANT 7078Q GMR 1'1fi(COBFTAINING. MORE TF1AN.35;OOQ G:F.OE'EN[GL©SED SPRCE) 9.1 Registered Architect Not Applicable ❑ Name(Registrant): { Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): { 3 t Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number r I Signature Telephone Expiration Date 3 � Name Area of Responsibility Address Registration Number ! Signature Telephone Expiration Date I ! i Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor cis iiA� w� ci� 'T 1 — Not Applicable ❑ Company Name: I +i.3. 1 t-, "� r iCUti'C Responsible In Charge of Construction r j E Address Signs re ' _.-Telephone Version 1.7 Commercial Building Permit May 15,2000 m rf,. Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front ! 1 � r-- �--', ;---, Side L:' , R:'�---� L. R�J =_� Rear -Bw"rdm`g Heig-fii— i ; I,—j Bldg.Square Footage Open Space Footage % �- (Lot area minus bldg&paved 1 3—� DaTidne) #of Parking Spaces Fill: ' volume&Location) A. Has a Special Permi#/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 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 Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO � DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 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 ` NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SEDTION,4�,�,CONSTRIJC—T1ON SERVICES:4FORiPRou- ECT ES THA�f 35#000 CUBIC FEEi`OENC�OSED SPADE 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 description here. �?,EMC�1G Ps-t- 2 a 2£'pA�►R.1�U ��.f'tr"�► , Of Proposed Work: w�L { 'SECTION 5 USE-GROUP�AND CONSTRW ON YPE� USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ( ❑ 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: I M Mixed Use Specify.I f S Special Use Specify COMPLETE THIS SECTfOI iF,FbCIST1Nf�BUILQtI*1G U7EGQII�G RKIOa�AONS;AaQFffONS AC�fF31OR 0E#QNGE tN USE . _ EqT--.. ... . _._._._�._ �...< Existing Use Group: 1 Proposed Use Group: Existing Hazard Index 780 CMR 34):1 E Proposed Hazard Index 780 CMR 34): i SEC FION`G81]1LIIINGNEIG�TAND_-94REA..; ; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION s Floor Area per Floor(sf) St 1 st 2nd i 2nd i 3rd 3`d i 0 t 4s' ! i I Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) � E Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone i Outside Flood Zone C] Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Pennit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 x3 _ APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECtION SITEINFORMi4fON" -' 1 1 PropertyAddres k s Tltts ectrorrtabscornpfeied� ffice__ - - � . iSECTION 2. PROPERTY pity NERSHIPIACITHq K OREEY AGENT �' IZ _ 2.1 Owner of Record: j R Name(Print) Current Mailing Address: Signature '� Telephone 2.2 Authorized Apent: [ i i Name(Print) Current Mailing Address: I Signature Telephone :'SECTION_3. ESTIMATED°CONSTRUCTION:-COSTS Item Estimated Cost(Dollars)to be `: OfficPat Use7,Only, completed b permit applicant . D 1. Building (a)=Building'Perrmit:Fee F c � 2. Electrical _ tal Cost oBOG , ho f r -"Co ConstFUCtion#rom_'fi 3. Plumbing ' BuildingP,eiinitFee 4. Mechanical(HVAC) 5.Fire Protection 6. Total:=(t+2+3+4+5) % !. ✓' G -Check_Number All ' Chis Section-For iieliWse Onl . "Bualdrng errnl umber;; " Dafe r Signatures 6uilding Commissioner hiispecforofiBuildings Date r File#BP-2006-0857 APPLICANT/CONTACT PERSON WILLIAM PICHETTE ADDRESS/PHONE P O BOX 454 ASHFIELD (413) 628-4787 PROPERTY LOCATION 53 -55 CHESTNUT ST MAP 17C PARCEL 184 001 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: REMOVE PLA TER REPAIR FRAMING,DRYWALL,KITCH CABINETS,FIRE BLOCK&INSULATE New Construction Non Structural interior renovations Addition to Existing - Accessory Structure Building Plans Included• Owner/Statement or License 071053 3 sets of Plans/Plot Plan THE FCjkLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 C ssion 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. ��� ��''x' � ���� � � � �& t � a � � ��a ax �, ,� � � ., � ��� C � ' s��Y��a � � ��d ,�s�r ?g - � � ,.rig � ,. �n't �� � _ ,�. ., �� � 5 r +,� �� Y � s ����'�� ns �* �� ,�; �`� ��� fit,•'_.:,, t. i .. �` � , nom, -,:,. s �< ��„�s`. �` ' e �€ �Ns �� ��"�'�w Yt �� v F� � ? 4.. �� �� k �µ�� ����� � fl�� � �±e=.'5'asst ��"-�'� .,. ��:� F � �,� � ��* „� y � g.s rx ��? �< ; s ,�, �k ,�,r � :< � � �` � � �� � � �� � , � .. .. k .; a �:, a _. � � ,�� N, _.-� �.. __ ... ,: «.; ... _ �; ��. ,, � F . �{�� }+.��` F F ;,� - .. 1 �. e � E �� � 6� �F �� � ¢ �� .� P �h.` p �` 3�V�' � t '- F r 3,y n d s �..�` ': ``��, M s 53 -55 , .0857 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 184 CITY OF NORTHAMPTON Lot:-001 Permit: Buil!± Category: B. ILDING PERMIT, Permit# BP-2006-0857 Proiect# JS-2006-1313 Est.Cost:$4600.00 t Fee: $50.00 PERM ON IS HERL4BY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM PICHETTE 071053 Lot Size(sg_ft.): 9016.92 Owner: BOULEY ERIC S&MICHELLE Zoning:URB Applicant: WILLIAM PICHETTE A T: F3-.55 CHESTNUT ST Applicant Address: Phone: Insurance: P O BOX 454 _ (413) 628-4787 ASHFIELDMA01330 ISSUED ON.31212 0.00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE PLASTER, REPAIR FRAMING, DRYWALL, KITCH CABINETS, FIRE BLOCK & INSULATE 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 ?i' �' �'( House# Foundation: Driveway Final: Final:/ a".25- Final:/6 v —c G, ��to .Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: /( jB •.1O-a 6, THIS PERMIT MAY BE REVOKED BY THE CI OF NORTHAMPTON UPON VIOLAT N OF ANY OF ITS RULES AND REGUL NS. �,, ; Certificate of Occupancy si nature: FeeType: Date Paid: Amount: Building 3/2/2006 0:00:00 $50.001929 212 Main Street,Phone(413)587-1240,Fa::: (413)587-1272 Building Commissioner-Anthony Patillo y P