Loading...
32C-122 (3) to "Fri Ll —' 1.77 73-7757 e 7 f • f f Y }} R i i f6 f Oq k 7'8 _v.. .. _...__ -__ �✓Z.-.�� J f R © f Q„ x %2 ' (.��'.'_L��a:<.,.;;�c� Qn�.ts��;;•2� ... c� ': Lv��•.�,.r�4>a, �,d rt�.c�,;�y �1 16 7'' Gt� � .��"`tr_^.�c:^a .u..d.t�n� � �+-rte!✓� ..../t*a .�r,�,' ayj ; EC G. kL t ovxuo�f fx I-VO t5�w--M3; 2.x6 ----------- se c /--77Z- 2-x -�aa' L 14 "an C4^-Zt�- e qv I)x Pt 3 6 ,50 rrr 1 ► X u�+ -'rxn ✓"1V"�� 4/..p +,fy �' D "^'�-1�-► r1 U �(� �.'X�r �' '°''7/''i�'�7'�Y'" �"+1+1"" «"A'ryJ °' y�,'Y ^'. ' J7't '�Y�'.,�.°.,. a 5 00 v� 9L d,n A y J����y����/� �.+/��,ty y��y�{,{//���/''��']/}/ Ir� y�y)�+/y� j. •����/}rte City of Northampton Buildng Department ' Plan Review 212 Main Street M7 1 MA 01060 , a 4w x 1 _ F ' t ; ( r . S t s e a 3 : . E , a . e7 i 1 E f r 1 p ---------- 4 i ti I -- �.-_ J _ 3 C - z 41 ; - -- ; I i 44' f >_ I 1 -} -- - ------------ i r I City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 1 i 1, S 150A. Address of the work: 2, ,g_ The debris will be transported by: /l/Aq/6 The debris will be received by: Building permit number: Flame of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts Department oflizdustrial Accidents - Office of Investigations 600 Washing-ton Street } Boston, MA 02111 _ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address Aw .4&,::*x <Z *2* City/State/Zip: a�o ,C Phone#: yi3-675-74S 7 Are you an employer? Check the ropriate box: Type of project(required): 1.❑ I am a employer 4. 0 I am a general contractor and I with 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors _ listed on the attached sheet. 7. El Remodeling 2.®'I am a sole proprietor or-partner- ship and have no employees These sub-contractors have g. F Demolition employees and have workers' 9. Building working for me in any capacity. � Q addition [No workers' comp. insurance comp. insurance.$ D. We are a corporation and its 10.F-1 Electrical repairs or additions required.] 3.❑ I a homeowner doing all work officers have exercised their I L Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.� Othezr .nexr.� employees. [No workers'. comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Of use only. Do not write in this area, to be completed by city or town official — —City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL:PEER REVIEW.(780.CMR11 0.11.) Independent Structural Engineering Structural Peer Review Required Yes _ No SECTION 11 -OWNERiAUTHORIZATION,TOIBE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ©V�7/O _,. ___..._,_.._____.. ......... j,as Owner of the subject property hereby authorize'..... •._. . __ ..w _.. w..._.._.: __....__.. . __. _ .... ..... .... ao act on m alf, in all matters re to work authorized by this building permit application. . 201 Signature of Owner Date 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 __ ....w._...... Print Name Signature of er/Agent D e SECTI 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: _ � Not Applicable ❑ _ __. ^...,_ .__ Name of License Holder: License Number Address Expiration Date Signature Telephone SECTION 13 WORKERS.,COMPENSATION INSURANCE AFFIDAVIT(.M G-L. 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. eDr Signed Affidavit Attached Yes k7i No 0 �! Z Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENSLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant) _............_....__ ... _.... .... Registration Number 4 Address Expiration Date i Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility _._._._.. __........ .....>. ._...._..___._.. _.._._w._ _.....___. ...._.___...._ _.___.__, _. .___,._. Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address _._,_.__._ FWstration Number }mm Signature Telephone Expiration Date Name . Area of Responsibility I i Address Registration Number Signature Telephone Expiration Date ..... _._...._.._..___.._._.._._...__.._.._-__._..__ __.__. _..._...._,.._._,. .. Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address__ Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning . This column to 5e filled in by Building Department Lot Size Frontage Setbacks Front Side L:1-0 R."._ L: 2a R.: Rear Z L 1 Building Height Bldg. Square Footage J _. % g Open Space Footage % — (Lot area minus bldg&paved �� __ w parking) #of Parking Spaces —— Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 1F.YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW^0 mmYES 0 IF YES: enter Book Page` and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES C IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issuedw� 4v6 M C. Do any signs exist on the property? YES 0 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 E. Will the construction activity disturb(clearing, grading, exca tion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 _ a CUBIC FEET OF ENCLOSED SPACE- Interior Interior Alterations El Existing Wall Signs E] Demolition El Repairs Repairs u Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. �1'""'" Of Proposed Work. Q SECTION 5-USE GROUP AND`CONSTRUCTION TYPE 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 - ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard El - 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 M Mixed Use F-1 Specify: S Special Use El Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOINGRENOVATIONS,ADDITIONSAND/OR'CHANGE IN USE Existing Use Group _ .._.._.__.__,_,...m_ _._._.________:_._ _ Proposed Use Group. Existing Hazard Index 780 CMR 34). _.____ Proposed Hazard Index 780 CMR 34) '._ SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(so St q. 1 s1 _.. __...... ,__. ... , __.. 2nd 2nd rd 3 3rd ------ _ .__, _. _.__ 4m ; 4t" Total Area(so Total Proposed New Construction(sf) Total Height(ft) __„_...... _. _....... _,._. 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 Outside Flood Zone❑ Municipal +g On site disposal system E] C,.1 Version 1.7 Commercial Building Permit May 15,2000 Departure t use,only City of Northampton statics of Perrnit aJi'J Building Department Curti 1 U t/ Dn"'veway Pernrut JON a � 212 Main Street Sewer/SepticAvartalirllty Room 100 �` Water/UVell Rvarlabtllty Electric,Plumb o �;'apo mpton, MA 01060 Two;Sets of'Structurai Plans Northamp pone 413-587-1240 Fax 413-587-1272 PIoUSite Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1,1 Property Address: This section.to be completed by office Map Lot Unit �wh Zone Overlay District -- - Elm St:District' CS District` SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDI AGENT . 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature c-,-. Telephone 2.2 Authorized Agent: Name(Print) Current Mailing�Address Signature Telephone SECTION 3`-ESTIMATE NSTRU N COSTS Item Estimated Cost(Dollars)to be Official Use.Only completed by ermit applicant 1. Building _ (a)'BuildingPermit Fee 2. Electrical _.., (b)Estimated Total Cost of Construction from- 6 __.._ ..__.._._._._,.. . ... .._ .. 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) _.... . 5. Fire Protection ._. 6. Total=0 +2+3+4+5) 14,6-00. Check Number 3 This Section..For Official Use Only - Buildin g Permit Number Date Issued Si nature: Building Commissioner/Inspector.of Buildings Date File#BP-2015-1265 APPLICANT/CONTACT PERSON EDWARD RICKEY ADDRESS/PHONE P O BOX 62 WILLIAMSBURGO1096(413)695-7059 PROPERTY LOCATION 26 FRUIT ST MAP 32C PARCEL 122 001 ZONE URC(100)/ 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: REPLACE 2 STORY PORCH&STAIRS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 96159 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 Commission 'Permit DPW Storm Water Management in elay Si e o Building fficial 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. 26 FRUIT ST BP-2015-1265 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 122 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2015-1265 Project# JS-2015-002321 Est.Cost: $16500.00 Fee: $99.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: EDWARD RICKEY 96159 Lot Size(sq. ft.): 5401.44 Owner: MOGGIO MARK A&ANN-MARIE Zoning:URC(100)/ Applicant. EDWARD RICKEY AT. 26 FRUIT ST Applicant Address: Phone: Insurance: P O BOX 62 (413N ,<0';--7Q';0 WILLIAMSBURGMA01096 ISSUED ON.611612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 2 STORY PORCH & 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 Occupant Signature: FeeType• Date Paid: Amount: Building 6/16/2015 0:00:00 $99.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner