17C-229 (17) R E
-RI csanchnrclla' -
w DEPARiME1,T OP BUILDDIG INSPECTION'S '-
212 Main Strcct ' T'lunicipal DLIdding
Northampton, Mass. 01060
WORIC R'S CO'NMENSATTON 1_'i`iSURA-NCF AFFMAr -.'Tj. .
—. (ii ccvs.^rl�cnn�ttcc)
(phone-!)
—- (sa�tic�ty/stalclzip)
do hereby certify, under the p2;nt and penalties of penury., �_llal
O I am an employer providing dic folloNvine %�,onccr's comocns-nUo, cove m for lny
eluplovccs wor-brig on ulis job:
(I�sur-�� Conp:mv) (Pclic;Nu.�r) (F_.:pirlior,D21^.}
O I am a sole proprietor, general contractor or homeowner(curie one) and have hired
the conuactors listed below who have the follo%viog worker's comaenudon po!!cies:
(Name Ot Con=C-Lo-) Unsumnc; Cotnoii)-iPobc; NIum:cr) �_?:)liJt•Qi! 1�:11C)
(Name of Contractor) Ojisura.nec. Comoanv/Polim Number) (Ex-DL' ilon Dale)
(Name of Com-ac w,) (Tnsura.nc: Company/PoUq- N;tmbj) (Eaai adoo Dale)
I
(Name of Contractor) (Lasuranc-- Comcai y/Policy Numbs) - (Expira60n Date).
(atuch:dli�oc�,!L'xG ifaooci,�•co mc?u�iarorw�aoo prrca.iaiag to.L oo�--_c.o:�)
O I am a sole proprietor and have no one working for me.
( ) I am-a home owner performing all the work myself.
NOTE:pie be twzm q-, .trJctbca3�0u�cjm v bo—aaVtay Pcn,=to JJ r• cc� c. a r repair
aot aiccC tb:a U-soc imr'J III wh3cb the�x+iUW�^'�r'Q1ye�of oa d.ti �..)27pUj-t, tb,,,L n-X(,,
arXPloyca U tic o=p=:.- oa Aa(GLI k.=1(5)�rpptitapaa by a bou=ow=fct c
lcg7.1 ct.aau of as c2210yec uadcr dto W.-k ec C.00spom�Ad ..
I und—raad tba a oopy of t5is=U-M—1 may bo to tbo Dcpaccmr=t or 1-6—id Accdcs&0110,
covcrxFc vaiGalica and 11Lt L-Jum to sea rc covcnt�tndd=ctioa 2 3 A of 1,(GL 152 cla lad to the i ,�2ic.
oo=,zL=g of a Gae crop to S i,5oo.00 arl yor a�ri orup to oac yr3r end civ t pea,hia io LSc form of a St
fin,--)0(5 100.00+day tga.init Mr_
use only
permjt Number
][a l,; Lot ° —
Si�na(un of
,j Lt,, Mt
Version 1.7 Commercial Building Permit May 15,2000
SECTION 1.0 SS RiJCTURAf. E E REVIEW(Z8U CMR 11a
Y. ..
Independent Structural Engineering Structural Peer Review Required Yes Q No 0
SECTION It-OWNER-AUTHORIZATION 'TO-,BE'COMPLETED-.WHEN
OWNERS AGENT.OR CONTRAGTORAPPLIES,FOR BuiLD1T[G'pERJV1IT
as Owner of the subject property
hereby authorize to
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
f
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 ains and,penalties of pedury.
Szm y us
Print Names ,
Signature of OA&e Date
SECTION 12..-CONSTRUCTION;SERUtCES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
S , a X360
License Number
'ZoI (� ZA /G Z
Address Expiration Date
1
Signature Telephone,
SECTION 1 3-WORKE RS'COMPENSATION!INSURANCE"AFFIDAVIT(M G.L."c:152,'§,Z C(6))
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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Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL:pESid'*AND CO NSTRlj6T[OI�SEPVICES FOR BUILDINGS AND STRUCTURES UBJECT'[O
CONSTRUCTION CONTROL PURSUANT T0;780 CMR`tii CONTAINING MORE THAh135,O9. C F:OE ENCLOSEDD=SFAGE)
9.1 Registered Architect:
Not Applicable ❑
I
c
Name(Registrant):
Registration Number
Address
Expiration Date
i
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
i 3 i
Name Area of Responsibility
E
Address Registration Number
I j
Signature Telephone Expiration Date
i
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
i r
i
Address Registration Number
I j
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
� 3
f
Responsible In Charge of Construction
r j
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Address
I
Signature Telephone
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 !
Frontage I
Setbacks Front
Side L:' I R:= L: f R:L�
Rear �—
-ButTdmg Heigglif
Bldg.Square Footage i [— % 1—j
Open Space Footage % i
i I I
(Lot area minus bldg&paved ` 3
arldn )
#of Parking Spaces
Fill: ' I
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES Q
x
IF YES, date issued: j
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ? Page; E 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 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 0 NO
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 ` NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
N�
Versionl.7 Commercial Building Permit May 15,2000
SECT GOS7 Rl7C'CLO@t SERVICES FOM-PRO.iEf'GSESS THi4N 35,OQ0
CUBIGFEET OF ENCtSE)3-SCCE.'
Interior Alterations ❑ 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:
_'SECTION 5-"USE GROUP AND�CONSTRUCTION..3~lt
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly AA ❑ A-2 ❑ A-3 ❑ 1g , 0
_ __ A-4 13 A-5 ❑ _
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 2C 0
H High Hazard ❑ 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 Specify:l
S Special Use Specify.,
F
COMPLETE THIS SECTION tF E7CI3TING=BU1LD[NG UNQE12GQlNG RENOa/ATlQ1VS,ADDI1 tO1VS IN17f01?C[Fi4NGE tN USE
1
Existing Use Group. Proposed Use Group: ` --
Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34): I
SECTION`6BUILUING liEtG�l F ANF1 AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION I °s
(
Floor Area per Floor(sf)
1st t O U 1st
2nd i
�—
2nd i
3rd I t
rd
.3
4th i ! 4w i I
Total Area(so 1 Gj�o Lw U Total Proposed New Construction(sf)
t I,
Total Height(ft) 77F € F �
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 [3 On site disposal system[:]
Versionl.7 Commercial Building Permit May 15,2000
• City of Northampton
,$ullding Department =
1' 212 Main Street
Room,100 t_
(�(� Northampton, MA 01060
r pint A 41,3-587-1240 Fax 413-587-1272
APPLtCATION,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 TNEORMATION '
Tats sectran tobe compTefe -v Ift e�
p ll[a Lot �lJntt
't"l—tr�'lxi�(J�' I V`rl�• I��n� -D ec�a�`'Dr�rt° ��-���.
} iGG 7
m5t District �T VNE'.C6 Disfnct y
SECTION 2M PROPERTY OWNERSHIP/Al7THORIZED;AGENT z
2.1 Owner of Record:
Name(Print) j C L tWSI Current Mailing Address:
� i3
Signature ` ` Telephone
2.2 Authorized Agent:
r `v v 1Gt LSO i u21 Y. 9 ItA �Id✓> IN i 1
Name(Print) Current Mailing Address: b Z 1
1 !A4-16
Signature Telephone
--SECTION 3-_ESTIMATED CONSTRUCTlomCOSTS.
Item Estimated Cost(Dollars)to be OfHciaLUse C3nly
completed by ermit applicant -
1. Building O (a)Building'Perinit_Fee
L_710 2. Electrical i I (b)Estimated Total Cost of
] - `Constrri.iction`from;.G '
3. Plumbing Budding Permit`Fee_
4. Mechanical(HVAC) A.
5.Fire Protection '
6. Total=0 +2+3+4+5)
-Check Number
This Section For'Offrcial Use Ohl Y,
;V Buddtrig Permif Number° Dafe
7S Sue
i1:
Signature:
Building Commissioner%Inspector of Buildings Date
P
File#BP-2005-1178
APPLICANT/CONTACT PERSON TIM STOKES
ADDRESS/PHONE 20 TURKEY HILL RD WESTHAMPTON (413) 587-9470
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 NON-BEARING PARTITION WALLS FOR STORAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 083602
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THLS APPLICATION BASED ON
INFO,AMATION 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 Co ssion
_ zcog
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.
I Mill
2 rOP,TH BP-2005-1178
Gls#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1178
Project# JS-2005-1587
Est. Cost: $2000.00
Fee: $50.00 PERMISSION IS IIEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: TIM STOKES 083602
Lot Size(sq. ft.): 16422.12 Owner: TREASURE TOWNS LLC
Zoning: Sl Applicant: TIM STOKES
AT: 28 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
20 TURKEY HILL RD (413) 587-9470
WESTHAMPTONMA01027 ISSUED ON.
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT NON-BEARING PARTITION WALLS
FOR STORAGE
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 SiLFnature•
FeeType• Date Paid: Amount:
Building 6/1/05 0:00:00 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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28 NORTH MAPLE ST BP-2005-1178
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-229 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category. BUILDING PERMIT
Permit# BP-2005-1178
Project# JS-2005-1587
Est. Cost: $2000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TIM STOKES 083602
Lot Size(sq. ft.): 16422.12 Owner: TREASURE TOWNS LLC
AT: 28 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
20 TURKEY HILL RD (413) 587-9470
WESTHAMPTONMA01027 ISSUED ON:
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT NON-BEARING PARTITION WALLS
FOR STORAGE
•
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: u ;►�� 4�C_��f Rough: House# Foundation:
/ Driveway Final:
Final: f►{ /,' Final: ` j,�
U'°�`' Rough Frame:
Gas: Fire Department Fireplace/Chimney:
nougr►:►t" �+., a o,� Insulation:
� Smoke: Final:
Final: 2°En+l )At Gks Af+p
314No'Pf otc
THIS PERMIT MAY BE REVOKED BY THE C TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. _ *�►
Certificate Of Occugancy Si nature:
FeeType: Date Paid: Amount:
Building 6/1/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo