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17C-184 (5) vvfF1 LA ,ar -• .0 m z C t4 1- a r i0 a oQ'�tw-r PTO A `E C�iT of irr#ll�llt}�tolt _ 'aZasa Itch ncrtlIs* = DEPARTME?,T OP I3urLDr)\C [NspECT10Ns 212 Alain Street ' Municipal Building, NTOrthampton, Mass. 01060 WOR14•R'S COMPENSATION MSURANCE AIMAVJ-J' (li c�->LUSJpertni tttx) pr tcipal place of business/residence at: (sit/c�ty/azlf-lb P) do hereby certify, under dic paint and penalties of perjury, :hat O I am an employer providing ate following workcr's colnocnsZuor, coven-c for lny etnplovecs wor ong on`L11's job: (In)Fdr-_n=Cofazz v) (Policy N"u-m e-T) --- (r;-pirtior, ('lam a sole proprietor, general contractor or i cie one) and have hired the consa(nors Gs e—d- below wbo have the following worker's com—oensadon policies: (Name Of Contmao-). (Insuranc .Colnpa,�}ri'OGc; �tllIIllY,) (r?;)li7 0? Date) (Name of COntT3CZ0-0 Rrls-draDc-- Comoaavi?o!ic-v Numccr) (EkDir iron Date) Cr'ame of Connaeta:) (lasZcrdne: C.ompan}•/Pobicy Numb i) (ExpirafJoa Date) (Name of Contractor) (L uran(-- Company/PoLcy Numt•r) (E��ir�tion Date) 71am ir oc —ry in mc!ud;informiboo percaioing to L sole proprietor and have no one working for me. ( ) I am.a home owner performing all the work myself. NOTE:plcz}c be ncrzrc t'14 wt1 jJ bomcauvm.tb ctyploy P—aw to da m..„- repair work oo.d—J.1. of not rnoct t s n t`sw tau is u3ir�the bomoowocs rmda or oo the p-ouodr zppur�thceo z c ox Caae zlty oeexid=cd to be cmploy—unCa ttx-=kcrh . "on Act(GL152-=I(5)�applinboo by n boMcoo-oc for.bc.r-x-or permit rr_y n-rd==the Iegil rtaau orm eezPloyx un tho Woricol.Coczrpeozal Act l uodcitxad d�a of this mlcmo¢ma be f �vva.6Y�� lh1 f_iltae�smart:� oewnrded to tbo pcgertmeoa of InmtSriel Aocdoat�I OtTioo of(rr�r•oev for th. � •erase under soRion 25 A of),(GL 152 ca Icsd to the i ,�o: oa orai ai w pco l cs 0—ir-i%of a Gne r to S 1300.00"'No'�yq�o(up to ace-yev e_nd a%il pmntio in 6c form of a Stop Wort Order nod a fiao of 5100.00 dif cpian tt�c - For dryattaa�al use Drily Permit Number Map-" l.+Vt 4 Y Si Wre of Li�is<xlPcrmictcc e Versionl.7 Commercial Building Permit May 15,2000 ,4 r a i s, fir- SECTION 10 STRUCTURALPEEI2 REVIEW(780 AMR 110 11) P E -- - . .. r., Independent Structural Engineering Structural Peer Review Required Yes......0 No......0 %EC �Tfl BE COMPLETED WHEN GENT ORCONT#tACTOR APPLIES fOft BUILDING.PERMIT , as Owner of the subject property hereby authorize kA- to act on my ehalf, in all matters relative to work authorized by this building permit application. k Signature of Owner Date as Owner/Authorized Agent hereby declare th t the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pa' s and penalties of perjury. Print Name Signature of Owner/Agent Da 5ECTIQN 12:-CONSTRI�CT�QN SERVICES' 10.1 Licensed Construction Supervisor: Not Applicable 0 r Name of License Holder :1X2 M �C- � 1 ,G C-,t) 0-7 1 License Number A ess ExpiraKon Da e igna e Tele one SECTION 13 WORKERS'�OMPENSATION INSbRANCE AFfIDAVIT{MG L c 152,,E 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 Version 1.7 Commercial Building Permit May 15,2000 SECTION 9 PROF L DESIGNF IND,CONSTRUCTION SERVICES FOR BUILDINGS 'ND STRUCTURES SUBJECT TO V CONSTRUCTfON CONTROL PURSUANT T,O 780,'CMR;116{Cn"NTAiN1NG M90RE-THAN 35;000 C f',,AF:ENCLOSED,SPACE) 9.1 Registered Architect: Not Applicable D 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 - %(_UP<m kc Not Applicable ❑ Company Name: Responsible In e of Construction �I Ad ss �1 Z� I Si ure ALIephone 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 colurnn 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 arldn #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES,date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT 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— No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 St-�7iry+4- NC01ERICES RQ_E 7HANi7 aGO CS�Irt� ip1fE � R Interior-Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ ❑ ❑ Exteri AYr ., emoli ' -New Signs [ ] Change of Use [ ] Other [ ] ry Buyiding [ J Repairs �� ] BRIEF DC'7l SECTIOrl S .USE GROUjQ ANL�gCONS1<'RUC'i�ON TYKE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ 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 Hi h Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage jo S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: CCMPI.ECf'TH �5E7IQlT�KISTI1�tG �3�1G IiIDLRiCtltiiG R1JlOA3It1!NS� flI3TONS ADS©Ri4NGE IN"USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SfCTION:6'BUILDINGQGtI7 pND.AREA n BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION L� w - Floor Area per Floor(sf) ist « — L in MJ fl 4 X 3 � 2nd ` r � 3rd — 4th Total Area (sf) Total Proposed New Construction (sf) � x , 5k Total Height(ft) Total Height ft---------- ',. Versionl.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 :$ECTIO.III�]. �ITIF�3NFORMATiON 1.1 PrODerty Address: S ±LTION2 ENT"'u' 2.1 Owner of Record: WO Name(Print) u nt Mailing Address: v ? Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTIONS .ESTIMATIfD COIVSTftUCTION C',oSTS ' r Item Estimated Cost(Dollars)to be OfficialUse�Qnly completed by rmit applicant 1. Building (a)Swld�ng.Perit m Fee n 2. Electrical Estrrtaa Total Cost of �� Af a ..�.- Gonsiruct�ora=firom. 6 3. PlumbingBxulc�ng°Rertn�tFee 4. Mechanical(HVAC) 5. Fire Protection 1 0 6. Total = (1 + 2+ 3+4+ 5) y Z/✓f =°" Clti`iNu` dt . . d This:Sec#ion FAr=Official tTse flnl Buildin Perm��ltilrtlber �,� �. �� `O ate Issued Signatures Building•°C ommissionerJInspector of:Buildings' Date File#BP-2004-0742 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: APTS 2&4-SHEETROCK KITCHEN,BATH,INSULATION&FIREBLOCKING 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 FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 Co sion Z ove- 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. 53 &55 CHESTNUT ST BP-2004-0742 GIS#: COMMONWEALTH OF MASSACHUSETTS M lock: 17C- 184 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0742 Project# JS-2004-1072 Est.Cost: $4400.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM PICHETTE 071053 Lot Size(sq, ft.): 9016.92 Owner: BOULEY ERIC S&MICHELLE Zoning:URB Applicant: WILLIAM PICHETTE Applicant Address: Phone: Insurance: P O BOX 454 (413) 628-4787 ASHFIELDMA01330 ISSUED ON.1113104 0:00.00 TO PERFORM THE FOLLOWING WORK.APTS 2 & 4 - SHEETROCK, KITCHEN, BATH, INSULATION & FIREBLOCKING `" 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:`,, a r y`-,Rough- House# Foundation: / 4.1 priveway Final: Final: Final: e2 Rough Frame: Gas: Fire Department Fi-eplac ./C lair:,;;: Rough: Oil: Insulation: Final: Smoke: Final:-4 -I)V'4 O r CERT1CATE OF OCCUPANCY FOR'. 4 ONLY THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. r Certificate of Occupancy Si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 1/13/04 0:00:00 311038 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo s r � z t s r AT j 76 MIT vo% 30 VMS TV 'V vv Amen 4 Y rt 'ti, ,c. y > -.. "s � r 3n Mom,r .cb y; d w t"Y NP u ,. `• r n � Als r 11 PIR l r Y`C &3 ""a" To w to Oft kit ATM QQ S, s, 3 1, Y # t p ' 3 b WE was fizz got - - Pr i` xfi 'rI IN, 53 &55 CHESTNUT ST BP-2004-0742 GIS#: COMMONWEALTH OF MASS_ :CHUSETTS Map:Block: 17C- 184 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0742 Project# JS-2004-1072 Est. Cost: $4400.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin WILLIAM PICHETTE 071053 Lot Size(sq. ft.): 9016.92 Owner: BOULEY ERIC S&MICHEL;LE Zoning,:URB Applicant: WILLIAM PICHETTE WSJ. �a (X Jj Applicant Address: Phone: Insurance: P 0 BOX 454 _ _(413) 628-4787 ASHFIELDMA01330 ISSUED ON:1113104 0:00:00 TO PERFORM THE FOLLOWING WORIf:APTS 2 & 4 - SHEETROCK, KTi-CHEN, BATH, INSULATION & FIREBLOCKING 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:q -d,,�-`06e4Final: Rough Frame: J,�C Gas: Fire Department Fireplac,+/C1.:�r .;3 Ro ugh: Oil: Insu:ation: V = Final: Smoke: Final:O/� THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy S. nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 1/13/04 0:00:00 311038 $100.00 212 Main Street,Phone(413)587-1240,Fax: (40)587-1272 Building Commissioner-Anthony Patillo