17C-229 (16) � `1 � ��
s �.�,,
��� �� � ��
�� �
� z __— i
� �
`�-°
�1� M�Pt� S( SiO�
9 �
♦
Q�T�
(�ii�) Of Portliai)IPfor) _ _-
AyJ E 3i aasnr{int:r(la' - _
DEPARTMEN7 OP DUILWXG fNSPPCT1ONS
212 Alain Street Municipal 13MIding
Northampton, Mass. 010GO
W0I CCIZ'S C 0 1 VIP E N S A 710 N GNSURANCE AI'IrLl7A'Tj' '
(saw tJci(y/sZa 1 r 12-j P)
do hereby cerdf--, under dic.pain.s and penalties of perjury, =.hat
( ) I am an eriaployer providing the Following %porker's comoensa60, cove age for Ins
e11jjAoVCCs wor!ong an tllis job:
r
(Lasur--az=Con=y) (Polio:Nu--Ujxr) (r:-pirz or,Dzlc) "
( ) I am a sole proprietor, general contractor or homeovemer(ci c;e one) and have hired
Lhe conuactors listed below vybo h2ve the following worker's c,0oDtnSadon policies:
lr+'Sill: Oi C0:1r:^Ci0") (IRs!rancc Coinpa )-Pi oUC-i Numh--:) -- (-1-x)ma On Da tC)„
- (Name of CORO"aQOr) -- (Lnsar7nce Como nawPolie `tumor) (C:»irafon Due)
(Name of Coaa-aclo,) (Insulancz- CoMr=)-fPot;Cy Numb,-J) (Expim6oR Datc) 4
(Name of Contractor) (1nSU=Cti CompanyfPOUCY Number) - (Expiration Dart:) .
(atl�.cb.:"dd zoczl s' +d if a« si^•to a c!u,3::iaforr .perta.iaios to.11 oc¢r-_=.,)
( I am a sole proprietor and have no one woridng for me. '
( ) I am..a home owner perforTru.ng all the work myself.
NOTE:plea be ew"ue tt`•,-Ljc bc,,o, ors.vbo aapioy pc-cooz to do m meter==.—.:c,ao c rtpair work oa of
ant morn th:a t'so-_tmr'o is a bacfj the bcxnoo+wer r tza4�or oo the ou.o z?puflca:u=tb,:w c.•c ax Cca=z2y occr;dzrcd to Lc
srploy--unCc Lb- . :oa=p=. oa Aa(GL!k-=t(5)�rpptinboa try a bo=o-=for c Gc -�or permil r=y cvrdca«tEc
Iegu ctaau of en e=zployx under dso Wo kie,C.ompoma!q Act,
[aaadass�a6 tha a oopy of thii=-i-�m.y bo foc•�to ibo Dcpazszacoa of Ioc6atricl Aar&.jY Off o0 of lruu—for lb-
aOVa7:b^c vaifieaioa&M tru L•d=to saauc under socsioa 2 S A of MOL 132 na 1a d to the i—,ositioo of eimiall peril,=
ooa ring of a tine of up W S 1,500.00 and/or jr� or up W ooc year Lod ci%i1 pcnah a is rSc form of a Stop Wori;Order Lad a
rim of SIOo.00.d_y apima tnc
For d,,�u,c only
Permit Number
Si turc.of 'fc —�� ivtap9—_ Lot" '
t....- ...--
Version 1.7 Commercial Building Permit May 15,2000
J°
SECTION 1,0.-SRUC'EURAL PEER R,EVIEIl11'(Z80 CMR 1101t
:. .. v..._.. _,_
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 11=OWNER AUTHORIZATION-TO BE COMPLETED'WHEN
OWNERS•AGENT OR'CONTRACTORAPPLIES FOR'<BUILDIMOG`PERMIT
I, VC b t I tl /`�G ti i�?°1 __ as Owner of the subject property
hereby authorize �� to
act on my behalf, n all matters relative work authorized by this building permit application.
Signature bt Owner Date
i
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.
s I
Print Name
i
t
Signature of Owner/Agent Date
•SECT1ON'12.-:CONSTRUCTI0 N SERUfCES,_
10.1 Licensed Construction Supervisor: Not Applicable ❑
L
Name of License Holder:
License Number
Address Expiration Dale
Signature
Telephone
1 ��
P /
SECTION 13-WORKERS'COMPENSATION INSUFZMCE AFFIDAVIT,(M:G.L::c°152x;:,§,25gf6)}
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
r
l
Versionl.7 Commercial Building Permit May 15,2000
SEQTION.9-PROFESSIONAL.DESIGk-AND d'duSTRUCT[Qiv1SERi�1GES ti]Ri3UiL"ui�►�,Ss it7 s►Ru?GTfi ES;;113.1cvT i�
CONSTRUCTION CONTROL URSUANT TQ�TC'UR-171 {CO�FTAINING MORE TFJAN 35,OO C F AE ENCLOSE�SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address 4
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
iI
Signature Telephone Expiration Date
F I t
# i i
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
t I
Name Area of Responsibility
i
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
i ( f
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Eq S r r y ET C.> ' _! Not Applicable❑
Company Name:
Responsible In Charge of Construction
Address
!I �' c
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
""A" 9Ii x]YQ
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage '
Setbacks Front �� 1
Side L: t R:177j L:L—J R:= i
Rear
Bldg. Square Footage i i (�— 1 % r--
J
Open Space Footage %
(Lot area minus bldg&paved
arldn )
#of Parking Spaces
Fill: ' j if
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 0 YES 0
IF YES: enter Book i Pagej and/or Document#s
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 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 Q NO Q
IF YES, describe size, type and location: j
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 0 ` NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
SE'CTIUN#4-C0ffSTRl'TCTIWSERVICES fOf PROJECT ESS THAN 35�OQ0
CUBIGEEE"I=ENCLOSED SPACE
Interior Alterations Z Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description !Enter a brief description here.
Of Proposed Work: 1 ,^ l 0"\' [ t I ,Y\, !N reRI 0(L W STOAk v All j
-SECTION 5-�USE-GRQUP AND CONSTRUG'�7QN;T�PE °
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A 71 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1g Q.- -----
B Business 2A ❑
E Educational ❑ 2B I ❑
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 ❑ 513 ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
t
S Special Use ❑ Specify:
t
COMPLETE THIS SECTIONw1F EXIST1NGrBU1LD[RfG UNDERGDII�IG REI�(QVATEOfvS ADOtTIONS ABfQIQk�CEf#1N E1IV USE
Existing Use Group: Proposed Use Group: i !
Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34): i
;SEC-T.ION`6'BUILDING":FIEIGkIf'i=AND�.Al2E?4."
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
St
1st ` ! r s
^�
1
Ind
2nd i
3
rd' 3m I i
4th
4t'
Total Area(so {- 1. Total Pro used New Construction(so 4-
Total Height(ft) I
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❑
Versionl.7 Commercial Buildin Permit May 15,2000
City of NOiihBmpLo '
Building Department
212 Main Street 5
Room'100
Northampton, MA 01060
r.
phone 413-587-1240 Fax 413-587-1272 P>fl
d
- c
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
g x 4 `This SeGttO,n,to}6e:cornp`Ceted�'y c
coI e c
--- -1 t Property Adffres
1 \ 'SY ' L
7 Rig
-IfflEffinf_
,_SECTION Zo PROPERTY QWNERSHIP/ACiTHORIZE6?�6i NT ~'
2.1 Owner of Record.:.
r y
Name(Print) Current Mailing Address:
Signature U ✓ �} L Telephone
2.2 Authorized Agent:
HILL 17 14
Name(Print) Current Mailing Address:
X15 X2 `' 1 -]
Signature Telephone
SE CM,10N.3 EST.IMATEM0 `STRUGT101 COSTS_
Item Estimated Cost(Dollars)to be Offcial Use{3ra1 •
completed by ermit applicant
1. Building (� �',� �a}Buttdmg'PermitFise°' 4 �
2. Electrical by-Estimated'Total Cost of,
j 17 (" Construction from.'6 s
3. Plumbing i I ButI di i.ng P.ermrt Fee
4. Mechanical(HVAC) I ;
5.Fire Protection
L)
6. Total=0 +2+3+4+5) f� f� Gheck.Number
w :- This sdtt-n,ForOfficfai"Use Onl
- -
Bwldmg Permit�l�um`ber�= ' . �Dafe "
lssued'
r
Signature:
Building:Commissioner%Inspector of.Buildings Date
File#BP-2007-0663
APPLICANT/CONTACT PERSON ERIC PAYNE
ADDRESS/PHONE 100 LAUREL HILL RD WESTHAMPTON (413)529-7175
PROPERTY LOCATION 28 NORTH MAPLE ST-UNIT 3
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 oyrT
Typeof Construction: INSTALL(2)PARTITION WALLS&CEILING
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 069050
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
L.-'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 Prof 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
d'_ 2 46 y 6
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.
28 NORTH MAPLE ST-UNIT 3 BP-2007-0663
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 17C-229 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Non structural interior renovations BUILDING PERMIT
Permit# BP-2007-0663
Project# JS-2007-001007
Est. Cost: $8000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ERIC PAYNE 069050
Lot Size(sq. ft.): 16422.12 Owner: ROSS HERBERT EB III&ROBERT P
Zoning: SI Applicant: ERIC PAYNE
AT. 28 NORTH MAPLE ST - UNIT 3
Applicant Address: Phone: Insurance:
100 LAUREL HILL RD (413) 529-7175
WESTHAMPTONMA01027 ISSUED ON:1212612006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL (2) PARTITION WALLS & CEILING
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 12/26/2006 0:00:00 $50.001244
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo