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18-004 (5)
I-R! R�/I oT a O v7 SIDE 0 _ 1 o f I N, r' Version 1.7 Commercial BOiIding Permit May 15,2000 I•• a SEGMKAJO S 2tJCS3CJRAL EERMRE > ( QhC IIj 1D 1 Independent Structural Engineering Structural Peer Review Required Yes No SEC339AT 1'I Q.W,NER BUT-HORIZATIQ�I TOO;BEsCOMP. EMD WH N OWNERS AGENT OR'GONTRAtiTOR.APP.UES4FZ''Sl71Lt?it1lG IT I, 1,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 pains and penalties of pedury. I Print Name i Signature of Owner/Agent Date •SECM-0WA aCQASTF I7 TAO S�R�II EIS _, 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:!ll�r�D License Number Address Expiration Date Signatur Telephone SECTION 13-WORKER , COMPENVkn0N,-1N -(ZE-5-00 A (iVl G'Lxc: 152,§25C 6)j 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 GK No r i ' a�ttnJ•rpT _C>sb-\ r/•• _ R20 oyE (5If-L) of �,To fljalllpfoll 1 ,- A � E $laaaachncrlla' - _ __ DEPARTMENT OP BUILDrNG INSPEMONS — 212 Alain Street ' Municipal Building C\ Northampton, Mass. 01000 �VORI"CEWS CO'NOENSATION, CgSUR•ANCrE AI1TI]�A�'1'�' '. v �r Qi'�xlpertni t[cc) do hereby cert.i.gy, under Lhc.pains and penalties of pc9ury, hai O I am an employer providing die foil oNvine �i,orke>'s coinnens-Lion cove agC for 111), empl'ovecs wortang on dies job: (insur-_n=Coo=-m,) (Polio Nu-a cr) (1--:pinion, Dar`) I am a sole proprietor, general contractor or homeowDer(circle orle) and have hired the cootractors bstec+ below wbo hive the foUo%ving workers cot perisidon pabcies: (i`+amc Oi Conimcior) 0 RRrr3r1c-c Coinp UI)•/•2 GUCi Num'----) (t?:p)IidiiQR D'ItC)` (Name of CoRrraaor) -- (LRSara.nc c Numcrr) (-Ex-D rmlion Dwc) (Name of Conn-aelor) Oasura:ne Compan)•/Polie)• Nwnbcr) (Fxpi imdoo Dare) (N'amc of Contractor) (Insuraa(-- Company/PoUcy Numb-j) (Expifauon Da.tr). (said:Ai�xsJ r'ucd if aooa.ary to iaCu&iaro,-tna.:ioa pertaiaias to.0 CCK=-r4:3) _ O I am a sole proprietor and bave no one worhdng for me. ( ) I am.a home owner perforrni.ng all the work myself. NOTe:piex b aw yrc the M rJG bomeouven Nbo a37pI0y pesona w tSa itse��.ccs e�ao repair..•orz oo a d�•c!!_�of ant aoce t�.a L'Y t-ii•.a is ta3icb the bocaoow raic,,o oc oo the Dixw43 s,-rpurtcasa tb-e L-c ox Cc=zAy av;d-rod,o be cntploycs u the,. d=ocapc: ca Acs(GLI h-=1(5)),appt=6=by a bomcoa-oa far:Gcm--x or pcnan ra:7 c.•rd—the IcpJ n==of as-=Player uodar die W.Ac.ea Comgomatioa AaL I uodavLx d did a oopy or taia m'�my bo rot-.urd.d to tbo Dcpo u—d om.or 6.+—roc tb+ cova-asc vvirc=1100 a--td Uu U=to caxtrc'wvcn Cr under soaioo 2 S A of MOL 152 can lmd to the imPosi ioa of a=ia+l PC-.W- 00=Li Tag of a[tae of up to S 1300.00 artdlor i=qriyopmcal oCup to one yrw end 6%iJ poxPja io 6e roan ors Stop Wort Ordcr and a Cim of 5100.00 a d_y apiaA oy- For dcyanr --%J u. on17 perm,t Number _�✓�- r ti px Lot Version 1.7 Commercial Buoding Permit May 15,2000 ECM ON 9-PROFESSIONAL DESIGN AND QNSIRU0,,Q"Ef C S F.QR`BUILDINCaSo-AND STF2U� S' B;IECT O; CONSTRUCTION CO[MQL,PIlRStJ�17V� r0 780xCMi21�b�CQI�h7AIN1 MOF3E TFi�AT 3S DOa C F.OF ENGLOS�D SPACE) 9.1 Registered Architect Not Applicable ❑ Name(Registrant): i Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility I Address Registration Number I f Signature Telephone Expiration Date i Name Area of Responsibility I Address Registration Number Signature telephone Expiration Date Name Area of Responsibility i Address Registration Number Signature telephone Expiration Date s Name Area of Responsibility i Address Registration Number r Signature elephone Expiration Date 9.3 General Contractor Not Applicable❑ Company Name: I i Responsible In Charge of Construction � r i Address Signature telephone Versionl.7 Commercial Building Permit May 15,2000 r rf.. Existing Proposed Required by Zoning This cohunn to be filled in by • r Building Department Lot Size — Frontage ' Setbacks Front Side L:= R:= L:= R= Rear L—�—I Bididing HeigIff Bldg. Square Footage % Open Space Footage (Lot area minus bldg&paved parking) #of ParkinZ Spaces Fill: ' ! volume&Location) i A. Has a Special Permit/Variance/Finding ever been issued for/on the site?. NO O DONT KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds! NO 0 DONT KNOW ® YES IF YES: enter Book `� Page and/or Document# B. Does the site contain a brook, body of wb,ter or wetlands? NO ® DONT KNOW Q YES IF YES, has a permit been or need`to be obtained from the Conservation Commission? Needs to be obtained F Obtained ® , Date Issued: ^� 1 C. Do any signs exist on the g operty? YES NO r IF YES, describe sizg, type and location: r 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: E. Will the conttruction 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 O IF YRt,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial uilding Permit May 15,2000 r.. SECTi©N OAI$TRl7C LO�N E 01 11 .�p��S�ES� X5)000 CUBI,OTEET N L ' G C�SE�3L 'SF�4'C-E Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ R¢pairs E Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description lEnter a brief description here. Of Proposed Work:. SECTJ0N1 USE�GROUPDQNSC, i @NE ; 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 ❑ 28 ❑ 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: I M Mixed Use Specify S Special Use Sp 01VIPL� ,M GtID (G A�Tf(DNS,A.DL9tTi01�1S IDP4RCfiA�JGE IN-USE -. ..._rw_.._ _._ .....'_.c........_.t^_:.c -,..:Jr..�3.. �......J+:m_w.rr."•1.5. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): —�� SE C1 it 611BUIEDI 1 G E1G izT L»Etigrt; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION 9 s li Ali Floor Area per Floor(so 1st 15f DES"'„r 2rid 2nd i I 3r° 3'd 4d' i 4th Total Area(s Total Propo ed New Con truction std^ 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 City of Northampton Building Department _ 212 Main Street Room,100 Northampton, MA 01060 phoneJ413-587-1240 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 SECIl0119 SITEtNFORMATIOIµ {� 1' hr 'sec roc>i to be competed l�yti?ffice_ - N-Property Address + - �illa � 2,61 Unit cam` oxr yet)aDrs€ri► - SECTION2 PROPERTI(OWNtEE2SAIP 1AT3THORIZED AGENT xe 2.1 Owner of Record: 4-'z- Name (Print) Current Mailing f, ress: Signature o- ✓G Telephone 2.2 Authorized Aaent: Name(Print) Current Mailing Address: I Signature Telephone -SECTION.3--.:ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oft al.Use-Only completed by ermit applicant 1. Building OQ� (a B* ildihv Pemait Fee �— 2. Electrical (0)Estimated Total Cost of Construction"from 6 3. Plumbing ( :Building:<Perrnit_Fee I . 4. Mechanical(HVAC) 5. Fire Protection i 6. Total=(1 +2+3+4+5) [Check.Number 3T6 >' - - •-' '.._ T.his-Section Foi•::Official lJse'Ori1 Brildmg Permlt.Number �Dale`^ ;:issued Signature. Building Commissioner/Inspector.of Buildings Date File#BP-2007-0692 APPLICANT/CONTACT PERSON DAVID DULONG ADDRESS/PHONE 189 PANTRY RD WEST HATFIELD (413)320-1195 PROPERTY LOCATION 285 NORTH KING ST MAP 18 PARCEL 004 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST _ ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: REPLACE CELLAR DOOR&WINDOW&CONSTRUCT OUTSIDE STAIR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 064581 3 sets of Plans/Plot Plan _ THE�FOO L OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Commis s- 1ov 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 r 285 NORTH KING ST BP-2007-0692 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18-004 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-2007-0692 Project# JS-2007-001044 Est.Cost: $1000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DAVID DULONG_ 064581 Lot Size(sq. ft.): 8407.08 Owner: DULONG DAVID I&PAUL A LABBEE Zoning: SR Applicant: DAVID DULONG AT: 285 NORTH KING ST Applicant Address: Phone: Insurance: 189 PANTRY RD (413) 320-1195 WC WEST HATFIELDMA01088 ISSUED ON:115120070:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE CELLAR DOOR & WINDOW & CONSTRUCT OUTSIDE STAIR 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 1/5/2007 0:00:00 $50.00390 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo