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17C-214 (13) Versionl.7 Commercial Building Permit May 15,2000 SECTI0N�10 STRUCTllRAL' PEER`REUIEIN7(780 CMR 110.11)'- _ , �, Independent Structural Enzineerin2 Structural Peer Review Required Yes......❑ No.. ...❑ I, s as Owner of the subject prope-t\, l7,Pf hereby authorize n-�ll� to act on my behalf, in all matters relati to work authorized by this building permit application. I _ j Signature of Owner D9te 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. ?rint Name l j Signature of Owner/Agent Date SECTibN 12r-CON TR CTIION'SER1%ICES� P, — 10.1 Licensed Construction Not ❑ nSupervisorp: N_ame of License Holder : J A�J � ��� �Applicable C*73-5 ? License Number -7 / i►� /Z-LS -- Expiration Date Address j Signature Telephone i SECTI0N 13 PENSA"T16N 1N5''M CEAT.! DAVIT(M G L 4c,,152,04'2 C(6)) j1N0RKER§jtb' 3�» '�� vii. 3.-xxseW.+rz°'n",��� _s-',i �',i � ?.:• 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...... ❑ o0.t tw-r nTO � r �E (rite of Pcz:fllallilptoil � ' Ejia>>nrhntr(fe _ w c� DEP/S i-MEN-r OP pUlf Dr\IC INSpECT10).'S 212 1\ atn Street ` Municipal Dwiding Northampton, Mass. 01060 «'0M<MIZ'S COiI UCNSWIZON G'�SUR C- A=A%'17- �Vith s pruicipa-I place of busicess/residence at o S 2 Lt � (st1-�t/city/ aic�ap) do hereby ccrtif;, under tic pains and penalties of perjury., ?hal ( I am an employer providing the following worker's comocns-n:Jon cove;Zgc For m), etuplovccs wor�Dng on'this job. n� -f�: - (1asw=ate Con=y) (Peke: r) - (r=:Ipir-,do 4 Dom) ( ) I am a sole proprietor, general C.00 Lor or homeowner (ci cie one) and have hu-la the coop actors listed below who hive the `olloVving workers coDoen-,-;-,6on policies: (Name o.Coat nc,orl (In2ranr Cotnom�/i'oUC, Nlum=cr) - (Name 01 Con(TZ!C10r) (lnsuraoce. Company/Polic)' (Exw:lion Date) (Name of Conrraeto;) (IasZiranc Compan�/Po�c� N,tr�bJ) (E��iroon Datc) (Name of Contractor) gnsuiance Comcaay/Pobcy Numb-s) (L-:�pu-aoon Datc) (n nub Ai;;ocaJ cScC it❑cc�-is to me u�mfo m--n oo pa zuains to ku O I a-m a sole proprietor and bave no one wor4dng for me. ( ) I am.a home oNvner performing all the work myself. NG 1 E:plea be ew've C�-'-t;Je 6emeouver:ubo aaploy perlo W So r.;r.- �--.: 00 c rrpziT wor-k d,.eLL,^z of not more th_o L`ro:=fu in"-Eid tSc bocnoawocr rev do OC OO L11C(S[YJDCj Z It]Ct-.D LT OJC " to he cmployc�uric c ttx RSc�—P=� lica pa(GL152.=1(5)�apptiaL6=by a bomcoogo fw--G=r-m.a pcm�r=y--id—Lbc Icp.1 naau of en a=Zployx under di wor' ,Coexpom.tion AeL f undcrn.and dvs a copy of(hi,mL— a—y b<fo(v nrded w the D-p-,�of I-i—ial.A-6.niY Off-of G�for th. COV xsc serif eaiioo azd U"L l�e to tm `Covcr,&e uodo- onion 23A of MGL 1 52 cna It d rn the ^;oo of c-u i p-1— 00-- at^of a rinc or up to S I X00.00 and/or or up to ooc ymz tnd ra\i)pc rjo;n ttx roan of a,S1op Wort;Ordr and e (tm of 5100.00,day tPM-1 a)'-- For dam. m��u.c only - `� ��5rti.- - 9 I1 C► Pcrm;t Numbcl 3 tit Si�naturt otLianscclpermiuc ce J . Version 1.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION(SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT-TO vO 1._ u,. CONSTRUCTION;CONTROL PURSUANT T0780.,CMR,'116{CONTAINING MORE THAN 35000 C F OF ENCLOSED"SPACE) 9.1 Registered Architect: Not Applicable ❑ THOMAS Co (v LAS S� Name(Registrant): I3(n W E Registration Number i rn y O/ 1 Expiration Date Signature Telephone l0 92 Registered Professional Engineer(s): i i I Name Area of Responsibility I address Registration Number signature Telephone Expiration Date Name Area of Responsibility i Address Registration Number Signature Telephone Expiration Date I Name Area of Responsibility r;ddress Registratlon'Number Signature Telephone Expiration Date I Flame Area of Responsibility I Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor 0113 1(0 Not Applicable ❑ Company Name: i Responsible In Charge of Construction Ad toZc-Ltl S,,,nature Telephone NNW �,Tcrt11a1)iptoll f .61cssnrhrczrtte' —0 i DEPARTME?-T OP DUILDP\)G INSPECTIONS —' 212 Main Strcct ' Municipal Building Northampton, Mass. 01060 Zl'ORICTR'S CONDENSATION »SU 3_ NCE AIT3?)AVIT {Ii ccnscrlperm�tree) %vith a pi-Mcipal place of business/residencc at: (phoney-) (sv�.t/c�h/sia.tclza p) do hereby certify,, under tic paitls and penalties of perjury., hal O I am an employer providing the following worker's colnocosn;on cove 2gc for 1ny elvplovccs Nvor­�Dng on Oils job: (Lni.an= Cora=_m,) (POUc: Nu__mixr) - (Ex do n Due) O I am a sole proprietor, general contractor or homeowner (circie one) and.hzve hired the coauactors bsted below rgbo have the foilo%vinQ worker's coC;)erlSabon policies: (game of Con!mcior) (Inst rant- Coinpanyi-PoUq N1UIIt_­_7) (Expinwjon Dnic) - (Name of Conaaeior) Mssran= Comaavvpobc�, Nu.mcrr) (-Ear—"lion Daic) (Name of Coluraciw) Omstuancc CompanyfPobcy Namkr) (Expimdoo Datc) (Name of Contractor) (Leca am Compzrry[Poliey Numbr) (E%pirtion Darr) (atlaci:d.�icoc�J ricer if ao�iry to cKUC�iaforna�oo pcsta�sin6 to all oom-sGO:'�) O I a.m a sole proprietor and have no one working for me. ( ) I am..a home owner performing all the work myself. NOTE:pl=s >K awzrc the�tijc •bo employ per%oam w r3s seen•^^• ec.,,c-Da c renir work oa a d%,c1 -Z of tux mort thsn L`_roe tmta is a bicb the bort»o-v rc ide or oo the aounca tbern e. o(Leh.ally o0=-d=-d to be catploycs 11 tic.=kcr s co=pdttica Art(GL(52SS I(5)),apptim6on try a homcoanc fcr c lip-or Permit r>:y cvidmtx tic Icgil ctaau of en r_eP loyec uoder dio Workoet Goaxpoczvtioe Ad I uo.dcstaad tba a oopy of thin—1—m+y be f,,nrdod to the Dcgarrmcoa of lnm.ttricl Ao,d6.a 'C'Mi or t�rranCe for Lb, -v--&c YCZC=ioa acrd tlu:t C-ilLrc to socurc hoverase under soetioa 25 A of h(GL 152 on Ic d to the L=r,=itioa of==iwl pea+ - ooasi-< g of a rMc of up to S 1}00.00 and/or kcP-is000=of uP to one year and civil pca:Yio to 6c form ora Slop Woric Order and■ ftm 0(1100.00 a d:y Lpjna t mG For d �use o gy Permit Numbcr r; ?,.tap.,--Lot.' Si�patuzr of Ltansct crmiucc Version 1.7 Commercial Building Permit May 15,2000 . .. ..................__....................... SECTION 10 STRUCTURAL`PEER REVIEW! 7$D CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ -SECTION 11 OWNER AUTHORIZATION TO BECOMPLETED WHEN! OWNERS AGENT OR CONT#2ACTOR APP'L`IES FOR BUILDING PERMIT 1"- ` �aS as Owner of the subject property hereby authorize ` to act on y behalf, in all matters Native to work authorized by7his building permit application. �s Signature o Owner ate I, 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 Name Signature of Owner/Agent Date SECTION 12 -CONSTRUCTION SER1flCES' 0.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone 5 CT10N 13 WORKERS o g'I=TISi�710N INSURANCE AfF1DA1/IT{M,G L c'152, `25C(6)) TIP ti ., 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...... ❑ � 4 Version 1.7 Commercial Building Permit May 15,2000 SEC710N 9 PROF,ESSlONAL DESIGN AND C�3NSTRUCTION SER1li_CES -FOR BUILDINGSAND STRUCTURES SUBJECT t.0 CONSTRUCTIONO,NTROL P1IRSUANT T0:780 CMR,116'{CONTAINING MORE THAN 35'x;000 C f AF 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 Company Name: Not Applicable ❑ Responsible In Charge of Construction Address Signature Telephone IL I 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 ❑ 1 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 arldn #of Parking Spaces Fill: (volume&L.ocation 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 S1�LON fNSliilmt)lfl #�CfSlft'��tO�ECSS i HAN�3, �flA©�� PC CUBIC fEET :FNCi.�S'Ef1 a Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ Exterior Alterations Demolitiow, New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: SECTION S-USE3GROUP..gllcONST#t1 C 3t1!N YPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 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 ❑ I Institutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ 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: C�NIP,LETE ISS ( N F,t G-OZ NG 1MI G©ING4RE[+OOHONS,bA013T1"ONS AAft R'CHAIVGE`IN 11SE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SEC IO1W i_SIII,QV%G,- flAREA . JAL BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION � ;_ 3-3 - Floor Area per Floor(sf) 1n 1st 2nd rh d � 2nd rd 3rd u 4t' Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft---------- y � r 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 01, ANY BUILDING OTHER THAN A ONE OR TWO FAM V SEP 1 6 2003 SECTION� SITE`INfORMATiON _ , 1.1 Prouedy Address: 4� "u,,yilc154" _ x }� eta SECTIOIfI ,P,.RO�PERTYOWNERS} P AUORIZED�GENT 2.1 Owner of Record: , Na (Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION,3} ;ESTIMATEDVONSTRUCTION COSTS .....�. .. . __.u_ . .. . Item Estimated Cost(Dollars)to be OfFiciahU e Only completed by ermit applicant 1. Building (a)l3uildi g PO Irm itfee., 2. Electrical DK-stit'n Total Cost of � �Constr�cbon from b. -. 3. Plumbing $n'�1 �ngPerm�tee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2 + 3 +4+ 5) Check Number., This Section For tl►ff ciao.Use emi 'beBuild N r mate Issued: Signature: Building Commissioner/Inspector of'Buildings Date File#BP-2004-0288 APPLICANT/CONTACT PERSON ANDREW O'BRIEN ADDRESS/PHONE 75 Clayton Rd. (413) 536-2564 PROPERTY LOCATION 99 MAIN ST(REAR) MAP 17C PARCEL 214 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Txpeof Construction: INTERIOR DEMOLITION New Construction Non Structural interior renovations Addition to Existing Accesso1y Structure Building Plans Included: Owner/Statement or License 047357 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9&MATION 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 Stree omnussion Lop Signatur o 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-2004-0288 GIs#: COMMONWEALTH OF MASSACHUSETTS _ �4= CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2004-0288 Project# 35-2004-0429 Est. Cost: $0.00 Fee:$35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ANDREW O'BRIEN 047357 Lot SizeLsg. ft.): 18120.96 Owner. FLORENCE FAMILY ENTERPRISES LLC Zoning: GB Applicant: ANDREW O'BRIEN AT.• 99 MAIN ST (REAR) Applicant Address: Phone: Insurance: 75 Cla3qon Rd. (413) 536-2564 Workers Compensation HOLYOKEMA01040-1543 ISSUED ON:9118103 0.00.00 TO PERFORM THE FOLLOWING WORK.INTERIOR DEMOLITION 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• Receipt No: Date Paid: Check No: Amount: Building 9/18/03 0:00:00 3188 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo