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E 3taasnrhntrtIts' _
d DEPARTMEt,rr OP BUILDrNG INSPECTION'S
212 Train Strect ' Municipal Duilding
Northampton, 1Tass. 01060
«tOR.U--- It'S COMTENSA710N, GISURANCE Al, AAtiTj' .
(Betas permlttcc)
(phone.,!)
(sv-cct/city/slalcrz�p)
do hereby certify, under the paint --ad penalties of penury, ",ha
O I am an employer providing the followine \�,Ori,cr's comoensn ion cove ra^t for lny
elupl'ovees wor�Dng on Lies job:
an5vr_0=Comr, c)•) (Polio; (r:-pirtior,Dam^_)
O I am a sole proprietor, general contractor or homeowner(ci.Icie one) and have hired
the coouactors listed below evbo hive the following worker's compen-sp-don po!!cies:
(i+flrll: Oi Contracto-) (Insuranc Coinoa,1)•Piobc: NtuJ11=`=y) (--' zu-0 Ditc)`
(N.one of Coolzamor) (Insua.nc;• Comoanv/Potic-,, Noumea) (Ex-DI.Mtion Date)
(Name of CoaEmclo,) (Lasu-anc-_ Compaoy Polio)• Nwnbu) (Expimtion Date)
I
(name of Contractor) (L surance Comcauy/PoLiey Number) - k—Expirdtioa Darn).
(ac icb:Ai,-:ocsj rbcCi ifnaci–sue,,•w a�c'uc�iaro�-a+a oa pcYtaiai,ag w.L
I am a sole proprietor and have no one worj6og for me.
I am-a home owner P erfon *m'g all the%York myself.
NOTE:plesc be cw ut ty,. wj,je boc o�von uto cmplay p,= o=w do ,,-•,• cc—=: ,,o c rcpau work on a d,•,1L.z or
apt most tb_o `rye L-Ii'j is u-btieh the boo-w raid,..oc oc the Uoc L �n i,puit CcxaUy oc=.d.avd w be
employes untie the-�.0=p= .*;o y q=(GLI k,ss 1(S)1 npptin on by a bomeoax rer a lies.or per=r=y d idmrx the
lcpJ mt w of ea er,loyx Yoder dso work e,co¢: _Ljoa Aee_
I yndQrtand dux a copy of thin mlLmmx oaay ba for�nud.ed to tbo Dopartmrnr of InrSirricl Aoodcat�Offioo of 4r�+rs000 for th.
eov-6,c vcrirclioo artd tlut L•iltac to sccurt)Covcr s,under section 25A of MOL 111 can Irsd to the p oa of aiminzl pea 16=
oomiztisg of a of trip to S 1 SOO.00 K>dor min-iypamc�Drop to aoc yur rod a.i]pcmhio is Cx corm ors Stop Worti Or'dc sad a
fire of S
Foe&� i u.c only
✓ pcTmrt Number
,4 P. —_ Lot rt
Si uric of Li =yscclpermittcc
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10, PEER'REVIEW(7 8Q CMR 11011 _
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11'-OWNER AUTHORIZATION.TO-BE-COMPLETED--.WHEN'"
OWNERS AGENT OR CONTRACTOR APPLIES.FOR BUILDING`PERMIT
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
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 vain and penalties of pedurv.
Print Name
}
Signature of Owner/Agent Date
-SECTION 12=CONSTRUGTION"SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
:y I
Name of License Holder:� �-
Ucense Number
Address i -� Expiration Date
i
Signatur Telephone
L
SECTION i3'-WORKERS'COMPENSATION 1NSU1tpCNCEAFFIDAVIT,(NI.G.L-' 152x:
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
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN:AND CC}N3TRUCT[6N~SERfl10ES FRBUIEDtNGSAND S2UGTC1tx2ESSfIECfO
CONSTRUCTION CONTROL PURSUANT'-T-
TO 780 CMR`71fi t;CQNTAINING MORE THAN35,000 C:F:OE ENCLOSED SPACE)
9.1 Registered Architect:
1 Not Applicable ❑
- I
Name(Registrant):
Registration Number
1
Address
Expiration Date
Signature Telephone .
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
i
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
a
Name Area of Responsibility
C �
Address Registration Number
Signature Telephone (Expiration Date
Name Area of Responsibility
Address Registration Number
} i
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
r
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
BAR (?P�ZQ: T'( ••
Existing Proposed Required by Zoning
U This column to be filled in by
Building Department
Lot Size
t (
i i t
I
Frontage
Setbacks Front
-��;
Side L:�?� R:�� L:E I R: 4
i
Rear i
-Building Heiff
Bldg. Square Footage % r— -
Open Space Footage
F
(Lot area minus bldg&paved 7-71 I
parking)
#of Parking Spaces I i
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 00\ DONT KNOW YES 0
IF YES, date issued:
t,AF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Pagel and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
CCDo any signs exist on the property? YES NO
IF YES, describe size, type and location: j APP 3 5 G 1.� O&Z 1yC>oTtA -4,106,01' I3��►DIA�
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: j N
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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-COVSTRIfiC'LLdN SERVCCES FORaPROJEC7S,`I=ESSTHQN 35_,OOQ-' .
6umr-FEET OE ENCCOSEQ SPhCCE'
Interior Alterations® Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Ctaqqe pf Use❑ Other(0
Brief Description Enter a brief description here. C vir s P,�r R Pc P, m t`' C E 2i of, OF
Of Proposed Work 0 9,,v'TUA�', ADD �0 DCOR Etr7(:ASS iNicD aXIS-riNc- i3cit-o NG- Fi~e
i �r,AL-� ADO srA)Pw�4Y UNDEP, 'j>0Rctt To E r.�T�R C��-i-A� j
-SECTION 5=USE GROUP ANQ CONSTRUCTJQC
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A,1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business -- ❑ 2A ❑
E Educational
2B ' ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
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:1 hno5eo M, t-►hu., 51-AT101z) j
S Special Use Specify:
COMPLETE THIS SECTION(F EX(STING 61JILD[NG k1NDERGO11V6 RENOa/�ADDITIONS"ANWOR CHANGE IN USE
Existing Use Group: _! Proposed Use Group: E
Existing Hazard Index 780 CMR 34):` Proposed Hazard Index 780 CMR 34): I
-� SECTION 68E111:DING lE1GHTANQAREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION1 c '
Floor Area per Floor(sf)
St i ..
1st ZOO 1 I s
2nd
2nd r]T7
3rd 3 rd
4th i r i 4th i
Total Area(sf) 3 f L4 Total Proposed New Construction(sf)
i
Total Height(ft) ° t
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 19 Municipal gg On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department
212 Main Street . '
Room,100
Northampton, MA 01060 a
phone 413-587-1240 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
aSECIION 7 SITEINEORMATION'
---- -1:1-Pr a -4ddres : ��- Tfi�ssec�ronta�ecomp(e#ed��-office_
SECTION 2 RROPERTY OWNERSF.i AUTHORIZED-AGENT
2.1 Owner of Record:
� �'�-oRfs►•SGE JAG-+- V S�r'1t°J5/S �S��r"_+ �nG ,
Name(Print) 41 j'c/t t t e% l c��/v i PrC xrrlf'.tsT Current Mailing Address
Signature Telephone
2.2 Authorized Agent:
vlD C,LAKK Iii; RCCKLAND 17115
Name(Print) Current Mailing Address:
E wD P,- I+ A lA P rpN 0 10 6 c)
Signature Telephone Jr^ —1 1
SECTION-3--ESTIMA"TED:CONSTRU-TION:COSTS
Item Estimated Cost(Dollars_)to be Official Use-t3nlyr
completed b permit applicant
1. Building Z 5 oa t> Budding,Permit Fee }
2. Electrical �O p (b)Estimated'Total:Cost of }
I -'='Coristriiction`froiim 6 '`
3. Plumbing O ( Butldmg_PermrtFee
4. Mechanical(HVAC) Q
F-- i t
ttN;Gn eWO ' MDNsr'y 4V AIt-PrgiE I .
5.Fire Protection i
6. Total=0 +2+3+4+5) -Check Number
This Section ForOffcial"Use Onl
Budding Pemalti�l"ufq ec. Dafe <
.,.r Issued-
r
Signature:
Building Commissioner lnspecforof,Buildings Date
WEE D�--
File#BP-2006-0102
APPLICANT/CONTACT PERSON David Clark
ADDRESS/PHONE 116 Rockland Hgts NORTHAMPTON (413)586-4347
PROPERTY LOCATION 90 PARK ST
MAP 17C PARCEL 255 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY;
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 7T e Q4f-
Fee Paid r�
Typeof Construction: CONSTRUCT 35 X 14 PORCH,2 DOOR ENTRANCES&ADD STAIRWAY TO
CELLAR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 000635
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF,QRMATION 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 Commissio
x - -*2/4�i
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.
90 PARK ST BP-2006-0102
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 17C-255 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0102
Project# IS-2006-0154
Est. Cost: $27000.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: David Clark 000635
Lot Size(sq.ft.): 45738.00 Owner: FLORENCE CIVIC&BUSINESS
Zoning.URB Applicant: David Clark
AT. 90 PARK ST
Applicant Address: Phone: Insurance:
116 Rockland Hats (413) 586-4347
NORTHAMPTON MAO 1060 ISSUED ON:812105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 35 X 14 PORCH, 2 DOOR
ENTRANCES &ADD STAIRWAY TO CELLAR
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 8/2/05 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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