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0� ARCHIMETRICS New Tenant Space Proposed Plan
DESIGN STUDIO
28 N. MAPLE STREET 28 North Maple Street
FLORENCE, MA 01062 Date October 9.2007
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PH 413-582-9100 Al .1
FAx 413-582-9101 Project No. 07087 Scale 1/8"= 1'-0"
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ARCHIMETRICS New Tenant Space Proposed Plan
DESIGN STUDIO
a 0 28 N. MAPLE STREET 28 North Maple Street
FLORENCE, MA 01062 Date October 9.2007
_
PETER LAPOINTE, ARCHITECT , Drawn by PEL
PH 413-582-9100 A1 .1
FAX 413-582-9101 Project No. 07087 Scale 1/8"= 1'-0"
10/9/2007 11:45:50 AM
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
`�M s�•yw www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLuibly
Name (Business/Organization/Individual): e- ,A
Address: (D t'> Lc> �w'� ►�l
City/State/ZiP\N0_ k*k-Q 6J'1 Phone.#: 5 1 -::?-1
Are you an employer?Check the appropriate box: Type of project(required):
1.El am a employer with 4. 7 I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling
ship and have no employees These sub-contractors have g. E]Demolition
working for me in any capacity. employees and have workers'
9. E]Building addition
[No workers' comp,insurance comp. insurance.:
required.] 5. � We are a corporation and its IG.❑Electrical repairs or additions
3.F-1 officers have exercised their I am a homeowner doing all work 11.0 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
employees. [No workers' 13.❑Other
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 a new 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 thg-na' d p nalties o perjury that the information provided above is true and correct
���
Signature: Date: _
Phone#: 1 Z
Jr-
Official 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 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Version 1.7 Commercial Building Permit May 15,2000
SECTION 70==SRUGTURAL PEER REViENf(ZSQ CMR L101�
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 14'-'OWNERAUTHORRAT.ION "_TO BE-COIMETED WHEN
r
OWNERS AGENT OR'CONTR4C TOR>APP.LIES.FOR BUICDTNG°PERIIl11T
^'x as Owner of the subject property
hereby authorize' l „ �to
act on my behalf,in all matters relative to work authorized by this building permit application.
i
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 Rains and penalties of pedury. -—
r �
Print Name
i
Signature of Owner/Agent Date
.=SEGTfON.t2, iGOHSTRU'CIC0;1s1 SER�CES ,-:
10.1 Licensed Construction Supervisor. Not Applicable 0
Name of License Holder
License Number
4
lj o c� �,v Y-e- ` o w f Z
Expiration Date
Address
Signature Telephone
SECTION 13-WORKERS'CONtPENS%1TfON:-NSURA'NCE At=FIDAV-F(M G L c.'152�§25C(6)jt
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
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y
Version 1.7 Commercial Building Permit May 15,2000
City of Northampton
_—Building Department
I` L
r 12 Main Street _
i Room,100
__•
N rt ampton, MA 01060
J i, OCT ' 9 pf e 41 ,$7-1240 Fax 413-587-1272
APPIp sAg?ION.TOtQQ)RSTR"j1 T,RE AIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
N "'i '' C1i0E0 OTHER THAN A ONE OR TWO FAMILY DWELLING
,_SEC219-N'-i SITE-INFORMATION)__�'
---- -'H Protierly-Addres � �� °�Tft�s�ecfi`ocxto�secomyp`Tefe"'Sbya�"ice_
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—,.SECTION:—Z— PROPERTY OVMERSHIPIAUT-HORIZED AGENT y
2.1 Owner of Record:
Name(Print) L k+64.,X0'1 Current Mailing Address:
1 7
Signature Telephone — 20 2(32-
Authorized Agent:
I a: 1 L . /u� i.a C, I-e��- V�► �l �
Name(Print) Current Mailing Address:
Signature Telephone q
-SECTI01+:3-ESTIMA'TED CONSTRUCTION-COSTS
Item Estimated Cost(Dollars)to be Official,Usefi)ralq
completed b permit applicant ='
1. Building 2 Bwfding Permit Fee
( J 1 '
2. Electrical (b) Co structiori fromos6t'of
3. Plumbing uilding"PermifFee
4. Mechanical(HVAC) I
5. Fire Protection I ✓� I l
6. Total=0 +2+3+4+5) 42 tO Check Number ^
This Section`'Fflr.Official Use Onl
Building Permit;Number - Date ;,
]�s d=
r
Signature:
Date
Building Commissioner/lnspecfor of Buildings
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-GONSTRITC-'LION SWMgES f t�PROJEC�S LESS THAN 35,000
C.UB,I,C O.F„ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[I Change of Use❑ Other❑
Brief Description' 'Enter a brief description here. 1
Of Proposed Work:i [Y -�} ° W `� 5
.>`
i
SECTION 5-'USE�GROUP-AN01 CC~NSTRUC 01 �1 PE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly Awl ❑ A-2 ❑ A-3 ❑ 1A ❑
— A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 28 ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 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 Specify:I
S Special Use Specify:
r 1
COMPLETE`o SS1iCTID1*�fiF CISTINGBU1LDf JG 1lNDEE G011 G-REN C)VATf01VS;AQDIT(ONS`ANDtORcCH NGE1N USE
Existing Use Group: 1 Proposed Use Group:
Existing Hazard Index 780 CMR 34):? i Proposed Hazard Index 780 CMR 34): 1
SECTION"6 BUILfi)ING;kiE1GHT,=ANDREA . ._s
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1 St
St
2 yf
2nd; , ...
3rd 3m i
4th
4m
Total Area(sf) i Total Proposed New Construction(sf)
i t W .
r gab ss, � , m
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 (] On site disposal system[]
Version 1.7 Commercial Building Permit May 15,2000
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
I °
Frontage
Setbacks Front
i
Side L: R.'
Rear i
Bldg.Square Footage % I ;
Open Space Footage r- %
(Lot area minus bldg&paved
parldng)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES 0
IF YES: enter Book j Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 0
IF YES, describe size, type and location: i
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
SECTION .9-PROFESSIONAL DESIGN:AND CONSTRIICTIQN SERVICES-FQR BUILDINGS AI D STRUCTU15 E UBJECTTO
_ .
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN,35,000°•C.F:OE ENCLOSED=SPACE)
9.1 Registered Architect
j
Not Applicable ❑
Name(Registrant):
i Registration Number
i
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
i
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
E
Signature Telephone Expiration Date
i
Name Area of Responsibility
Address Registration Number
� i 1
Signature Telephone Expiration Date
9.3 General Contractor
i Not Applicable ❑
Company Name:
I tPPZ� ( I
' E
Responsible In Charge of Construction
d:� `tvcclJ✓C _ L(JP� ,`ila�.y� dam! A
Address
-71 7 '
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Signature Telephone
File#BP-2008-0381
APPLICANT/CONTACT PERSON ERIC PAYNE
ADDRESS/PHONE 100 LAUREL HILL RD WESTHAMPTON (413) 529-7175
PROPERTY LOCATION 28 NORTH MAPLE ST
MAP 17C PARCEL 229 001 ZONE SI
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: CONSTRUCT PARTITION WALLS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 086442
3 sets of Plans/Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS.APPLICATION BASED ON
INFTION PRESENTED:
ed 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 -We'll Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street mmission
-y
ZCo
Signature of Buildi g Officia 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-2008-0381
GIs#: COMMONWEALTH OF MASSACHUSETTS
i T CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:_ BUILDING PERMIT
Permit# BP-2008-0381
Project# JS-2008-000555
Est. Cost: $3500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group_ ERIC PAYNE 086442
Lot Size(sq. ft.): 16422.12 Owner: ROSS HERBERT EB III&ROBERT P
Zoning: ST Applicant: ERIC PAYNE
AT. 28 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
100 LAUREL HILL RD (413) 529-7175
WESTHAMPTONMA01027 ISSUED ON:10/11120070:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT PARTITION WALLS
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: Date Paid: Amount:
Building 10/11/2007 0:00:00 $50.00465
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo