17C-226 (2) February 24, 2006
City of Northampton Building Inspectors
Attn: Building Commissioner Anthony Patillo
212 Main Street
Northampton, MA
RE: 12 North Maple Street
Building Permit#BP-2006-0393
Dear Commissioner Patillo:
I am writing to have the contractor of record changed on Building Permit#BP-2006-
0393, Project#JS2006-0573 from Frank Sienkiewicz to Galvin and Sons, Masonry&
Construction.
I appreciate your prompt attention to this matter.
iLruly
Frank Sienkiewicz
Cc: Todd Sienkiewicz, Galvin and Sons, Masonry& Construction.
12 NORTH MAPLE ST BP-2006-0393
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-226 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Cate¢oL, : BUILDING PERMIT
Permit# BP-2006-0393
Project# JS-2006-0573
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: FRANK SIENKIEWICZ 009034
Lot Size(sq. ft.): 3615.48 Owner: SIENKIEWICZ TODD J&LAURIE J
Zoning: GB Applicant: FRANK SIENKIEWICZ
_AT. 12 NORTH_ MAPLE ST
Applicant Address: Phone: Insurance:
26 FAIRFIELD AVE (413) 584-1952
FLORENCEMA01062 ISSUED ON:1011212005 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR FOUNDATION
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: k Inaf
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Of
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 10/12/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
ii
��� �, 5
12 NORTH MAPLE ST BP-2006-0393
GIs#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 17C-226 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0393
Project# JS-2006-0573
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PATRICK GALVIN
Lot Size(sq. ft.): 3615.48 Owner: SIENKIEWICZ TODD J&LAURIE J
Zoning: GB Applicant: PATRICK GALVIN
AT. 12 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
31 EAST ST (413) 586-6146
HADLEYMA01035 ISSUED ON:1011212005 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR FOUNDATION
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 10/12/2005 0:00:00 $25.001673
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
¢�tv.IfPT N..
(rite 0f Port 11 alllp 011 _
A E �ix3aRchntc(Ia' _—
DEPAR TIM E 14T OP BUILDING INSPECTION'S
212 Alain Strcet ' Municipal Building
Northampton, Tfass. 01060
WORIC ,IZ'S COi•TI'ENSA-MN, MSURA�CE AF=AVIT "
pi ccnscxJpc7m;ttcc)
(phone:')
(sa�t/c�ty/stalcf p p)
do hereby certify, under Lhe pains god penalties of perjury, hai
O I am an employer providing the iollowine %i,orkers colnnens-nJo, cover-age for my
emplovecs woriong on this job`
j -
(In --n= Comrany) CPotic: Nu--.rr) -- (c:-pirraor, D2i--)
( ) I am a sole proprietor, general contractor or homeowner (ciucie one) and have hired
the cones actors bsted below vybo hLave the foll0�'linQ worker's coi pe s2don ao!!cies:
(N+amc Oi Conractor) (Inwrancr- Compm)'N1�obc-, Nlu h---) (Expim".-Or' Dito
(Name of Conaamor) — (Inslrzncc Coman-,,NPo!ie \tlncfr) (E.\Dl—,.don Date)
(Name of Coamclor) (Lair-neo Company/PoUcy NumbJ) (Expirs000 Dale)
(Name of Contractor) (Insu=c-^ Company/PoUcy Numb:r) - (Expiration Dace).
(aaxb--&ik-:o=J tug if noocury w o:tcur�infortn,.aoo pataiaiag to.tl oc�r-.t-n:3) i
l:
O I am a sole proprietor and have no one worhdng for me.
( ) I am.a home owDer performing all the work myself.
NOTE:picu be acrirt of urt to boa=,,cn Hbo cc play pcTOm to da -• ,, o cr rtpzc work on a d%%--U—,-E of
ant more th-n � o t=Aj in xt-b a the bocmo+a'ncr r dpt,or oo the QouacS z,�putteas�tbeco LT ax ccaeaay 0.�6=Td to be
—plor—1, c t5c.�ui�{; �m!w(GL152n t(5)�=WUc rion by a boa=oaxr fm c lica_or p:rnut rz-y c%4&m=tl`c
Ir¢I rtnau of as c=ployer under dio Worr_o!.C,,,pomatian AeL
[uodcstand rhrt a Dopy of thu aarrmcE oaay ba for�rurded to rbo Dcpertmmi of Ind.arriJ ncodcat3'Offioo of trxvr•ow for tbe
co—&c vtrircmioo and amt L-iltzc to scaut tovcrr gc tmdcz s.cctioo 15A of MOL 151 can led a the im os:6oa of cimin3t pc 16cs
oomitmg of a fmc of up to S 1}OO.00 TWor imprboam=of up to ooc ytar cad ci%it pmaYjo in tx form of a$wp Wort Ordcr aad a
fian of 51 Moo a d:y&pinTi m,--
For u�only
permit Number --
1,dap.: Lot "
Sip-tum of Limns=/permiucc
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) -
Independent Structural Engineering Structural Peer Review Required Yes Q No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Si t �li�K 1( V %1 Z— as Owner of the subject property
r � c
hereby authorize �i/g/ C l ��Es2s�K[r Lr C L to
act on my behalf,in all matters relative to work authorized by this building permit application.
j
Signature of Owng Date
FA/�-�/� �✓ /C- / � � �/Z--- 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 hepains and Dinnalties of erl
Print Na e
Signature of Caesar/Agent Date
SECTIOPI't2-CONSTRUCTION SERVICES
10.1 Licensed Construction S�uuDervisor: Not Applicable ❑
Name of License Holder:-! '`� / LZ I a6 / a,�
License Number
Address Expiration Date
Signa Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(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
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):
Registration Number
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
Signature Telephone Expiration Date
Name Area of Responsibility
i
Address Registration Number
Signature Telephone Expiration Date
s
Name Area of Responsibility
1
Address Registration Number
Signature Telephone I Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
c
Responsible In Charge of Construction
FAi
Addre
Signature Telephone
1
r �
Versionl.7 Commercial Building Permit May 15,2000
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
1
Frontage
Setbacks Front
Side L:''—f R:= L:= R:=
Rear
Bat mg Height
Bldg.Square Footage
Open Space Footage
(Lot area minus bldg&paved
narking)
#of Parking Spaces
Fill: '
a
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 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 Page; and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO A*— DONT KNOW 0 YES
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 0
IF YES, describe size, type and location:
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 4-CONSTRUCTION SERVICES-FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
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: I?Efjgi2 of i—vvfv�A-i lO n� .
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 [K -- 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H Hi h 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:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS-AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT-AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
St
151 I
1
2nd 3
2nd+
3rd i 3rd I i k` rw rs
th
4th i 4
Total Area(so Total Proposed New Construction(sf) _
r
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❑
r ,
Version 1.7 Commercial Building Permit May 15,2000
VJ
f
(� Ci I f rthampton
�✓ � ui epartment
OCT 1 'JJ
21 in Street
Roo 100 .
DEP OF Bl 0'"c INs piliigmpto MA 01060 " -
NoR' R �a Fax 413-587-1272
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
S'ECIION I SIT INFORMATION-
--- 1 1-property Addres : �` ' -mss sectronto�e copCetedjcofice
M �. �_ .� ,. �,.> »�,.ti �r
1 ``,, ee __ at X sUAit
zg
�.EIt��Deafricl� �> ��B:D+stncT>a �-
SECTION 2 PROPERTY OWNERSIHIKAUTHORIZED AGENT
2.1 Owner of Record:
!W>pt,tLAILZI(- Kl c'Z... i / _, F6, Ah41AJ Si , LC_1424�X&L.::
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature a Telephone
SEC,hON-3--'ESTIMATED CONSTRUC IOR COSTS—•.
Item Estimated Cost(Dollars)to be Ofificial Use0h!
completed by ermit applicant 1
1. Building (aj"Building"Permit Fee
2. Electrical Estimated Total Cost of
� '='Construction from:ai
3. Plumbing i ;Bitld►ng apermitFee
4. Mechanical(HVAC)
5. Fire Protection L
6. Total=(1 +2+3+4+5) Check.Number
_This Section°For"'0 i6ia1Use Onl Buildmn Permlt Nt�inbeG °;Date
ed-
Signature:
Building Commissioner Hnspector of Buildings Date
File#BP-2006-0393
APPLICANT/CONTACT PERSON FRANK SIENKIEWICZ
ADDRESS/PHONE 26 FAIRFIELD AVE FLORENCE (413)584-1952
PROPERTY LOCATION 12 NORTH MAPLE ST
MAP 17C PARCEL 226 001 ZONE GB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 46 ZJ
Typeof Construction: REPAIR FOUNDATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 009034
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOJtMATION 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 sion
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.
r
12 NORTH MAPLE ST BP-2006-0393
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-226 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category: BUILDING PERMIT
Permit# BP-2006-0393
Project# JS-2006-0573
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: FRANK SIENKIEWICZ 009034
Lot Size(sq.ft.): 3615.48 Owner: SIENKIEWICZ TODD J&LAURIE J
Zoning: GB Applicant: FRANK SIENKIEWICZ
AT. 12 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
26 FAIRFIELD AVE (413) 584-1952
FLORENCEMA01062 ISSUED ON:1011212005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR FOUNDATION
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 Sienature:
FeeType: Date Paid: Amount:
Building 10/12/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
/vcri LA Loon£p A-T (2zl fi -- Gtic,01- of f t - CA(147
BP-2006-0393
12 NORTH MAPLE ST
COMMONWEALTH OF MASSACHUSETTS
GIs NORTH
Map:Block: 17C-226 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
BUILDING PERMIT
Category:
Permit# BP-2006-0393
Project# JS-2006-0573
Est. Cost:
Fee:Cost: PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group. PATRICK GALVIN
Lot Size(sq. ft.): 3615.48 Owner. SIENKIEWICZ TODD J&LAURIE J
Zoning: GB Applicant: PATRICK GALVIN
AT. 12 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
31 EAST ST (413).586-6146
HADLEYMA01035 ISSUED ON:1 0/12/2005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR FOUNDATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector
Inspector of Plumbing Inspector of Wiring D.P.W. Bu g p
Underground: Service: Meter:
Footings:
g
Rough:
Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas:
Fire Department Fireplace/Chimney:
Insulation:
Rough: Oil:
Final:
Smoke: Final: 0Y 5 aV G�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. �}
Certificate of
Occu anc - Si nature:
Feel e: Date Paid: Amount:
Building 10/12/2005 0:00:00 $25.001673
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
ow