32A-162 (2) Version L7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) ,{,+/''"�'�)
Independent Structural Engineering Structural Peer Review Required Yes No �.,!
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
1>1b _._.
hereby authorize _ y Z"V L� to
act on my be If ma ters l ative to work authorized by this building permit application.
Signature of Caw er q Hate
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 th ains and penalties o, f pen
iw(� _........�
Print Name
Signature of 2 er,'Agent Date
SECTION 12-CONSTRUCTIA SERVICES
10.1 Licensed Construction Supervisor: Not Applicable
)I
Name of License Holder: ' k� ht lyfil ' m _
License Number
olle ---- Expiration Elate
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)j
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
Ver,,ion].7 Commercial Building Permit Nhy 15, 2+:00
r—
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 ENCLOSED SPACE) i
9.1 Registered Architect.
Not Applicable Q
Name(RegistranO
Reg siration Number
Adc:ess
Expirat.on Date
i Signature
9.2 Registered Professional Engineers):
ti 1�s �,� e L i st?C.i ctn '
Name Area of Responsibility
Add s5' - - Registrat,on Number
signature Telephone Expiration ate
Name �_..._9_�._ \ �`�Y�k-��� �. C._• Area of ResponCsibility
��`t
Address Registration Number
- 336 � a�
l Telephone I Expiratior, ate I
Area of Responsibili'y —
i Address Registration Number —
SignatureM _ -- _-- Telephone �— Expiration Date
Name Area of Responsibility
Address _ Registration Number �—
Signature :elephane Expiration Date
9.3 General Contractor
...._.....
Not App icabie
ioirpany Nacre;
Responsible in Carre of Construction.
Addrsss
Signature __.._......._...Telephone
Version.1.7 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 ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant) _ .
�J� Registration Number
Address Avg, 7016
'►— yr�' ',a6 Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name � Area of Responsibility
Address Registration Number
Signature Telephone Expiration Data
Name Area of Responsibility��
Address Registration Number
Signature - Telephone Expiration Date
I Name Area of Responsibility
i
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name.
Responsible In Charge of Construction
Address
Signature Telephone
Version 1.7 Commercial Building Permit May 15.2000
SECTION 9-PROFESSIONAL.DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO ED SPACE)
9.1 Registered Architect:
Not Applicable 0
Registration Number
Exp€rations bate
Signature Telephone
9.2 Registered Professional Engineers}.
Name ' ' - ' 46t pns�ly
l
A ass /t-t— R istration Number
+y8 iatU E7ir3lratiCN1Ltate
�„ Area ssf Re sponsibility
Address I?eglistretion Number
Signature _ Telephone Expiration Date
Name Area of Responsibility
Registration Number
Signature _ Telephone Expiration gate
Name _ Area of Responsibility
Address Registration Number
5igriaWre Telephone Expiration Crate
9.3 General Contmetor
_ Not Applicable 0
Company Name:
Responsible In Charge of Construction
Address
S gnature _ Telephone
Versionl.7 Commercial Building Permit May 15,?tint)
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size S"°G, s3? G�c 5-'?3
Frontage 2co .F�- 2Go ��-
Setbacks Front .�
Side 1..: 3° R: IUC> L:3 o R:
Rear 3 Z 3 Z-
Building Height
Bldg.square Footage 2S Z % Z
Open Space Footage ",ii
(Lot area ininus bidg&paved
parking)
#of Parking Spaces l4 l
O
Fill: 6
volume&Location}
A. Has a Special.Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW ( YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'/KNOW Or 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 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES KX NO
IF YES, describe size, type and location: /V' x Z0, &A S f-Xq f�c" i e
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: NEW S 00 f h,-- 25 514 tack
t 4 N./ 1 4+ 1 e lo+ A'i SOAK O Q
E. Will the construction activity disturb(clearing,grading,exca4ation,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.
Versioni.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 3amolition Repairs❑ Additions Accessory Building[]
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rooting❑ Change of Use Other
Brief Description Enter a brief description here,
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 Z A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ is ❑
B Business ❑ 2A ❑
E Educational ❑ 2B
F Factory ❑ F-1 ❑ F-2 ❑ 2C
H High Hazard ❑ 3A
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38
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 I I Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: R') Proposed Use Group: Ar I
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34)•
SECTION 6 BUILDING HEIGHT AND AREA I
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
st z
2 nd 5—y 2" 0/(v
3fd
3rd
4
Total Area(sf) Z- 5—/ Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water;upply(M.G.L.c.40, 54) 7.1 Flood Zone information:
7.3 Sewage Disposal System:
Public 0 Zone Outside Flood Zone g Municipal [j On site disposal systemC3 N Private I
Versionl,l Commercial Building Permit May 15,2000
f" >. Department use only
City of Northampton Status of Permit:
AUG 2 a �Q�S Building Department Curb CutfDriveway Permit
j Li ' 212 Main Street Sewer/Septic Availability
_ Room 100 WaterAVeli Availability
Elect ic. F,u e actions
Nurtr ,I <,:: , c a Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site 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
This section to be completed by office
1.1 Property Address:
3 ?H'J"�o f 57 Map3' Lot /6 Unit
Matte-�yt !��'►� !v (5110 0 d Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: N 1_A t_ ,4� �VAM 1 V`U c,T
Name(Print) `�'� L� Curren Mailing Address:
o
Signature Telephone
2.2 Authorized A t:
Name(Pri
V,1 L � w�N — Current Mailing Address:
Signature ._�._ Telephone i
SECTION 3-ESTIMAT CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted b ermit a ,;cant
1. Building i -� ` - `'"` (a)Building Permit Fee
2. Electrical i (b)Estimated Total Cost of
Construction from 6
3. Plumbing - Building Permit Fee
4. Mechanical(HVAC) c�
5. Fire Protection ' ' `
6. Total=(1 +2+3+4+5) - - 1 t- Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature: - '��
�. -
Building Commissionerllnspector of Build!ngs Date
File#BP-2016-0240
APPLICANT/CONTACT PERSON D A SULLIVAN&SONS INC
ADDRESS/PHONE 82 NORTH ST NORTHAMPTON01060(413)584-0310
PROPERTY LOCATION 33 HAWLEY ST
MAP 32A PARCEL 162 001 ZONE CB
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: INTERIOR DEMOLITION
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building,Plans Included:
Owner/Statement or License 53667
3 sets of Plans/Plot Plan
THE FO LOWING 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 Commission Permit DPW Storm Water Management
Demolition Delay
X= /Z,4J 612slit
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.
33 HAWLEY ST BP-2016-0240
GfS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 162 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INTERIOR DEMOLITION BUILDING PERMIT
Permit# BP-2016-0240
Project# JS-2016-000284
Est. Cost:
Fee: $200.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: D A SULLIVAN & SONS INC 53667
Lot Size(sd ft.): 20211.84 Owner: Northampton Community Arts Trust
Zoning: CB Applicant. D A SULLIVAN & SONS INC
AT: 33 HAWLEY ST
Applicant Address: Phone: Insurance:
82 NORTH ST (413) 584-0310 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON:812612015 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 Occupant Signature:
FeeType: Date Paid: Amount:
Building 8/26/2015 0:00:00 $200.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner