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38B-008 (11) r* 126 WEST ST-PHYSICAL PLANT BP-2001-0651 GIS#: COMMO WEALTH OF MASSACHUSETTS ?0""9Ap:Block: 38B-008 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: UILDING PERMIT Permit# BP-2001-0651 Project# JS-2001-1181 Est.Cost: $40000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: B Raymond Wischhof 052126 Lot Size(sq. ft.): 14461 .92 Owner: Smith College zoning: SI Applicant. Raymond Wischhof AT. 126 WEST ST - PHYSICAL PLANT AnplicantAddress: Phone: Insurance: 10 BlackbeCircle 413 533-2520 Workers Compensation HOLYOKEMA01040 ISSUED ON:1/25/010:00:00 TO PERFORM THE FOLLOWING WORK:Removal of non-bearing walss, install new non bearing walls for office area POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W Inspector of Buildings Underground: Service: Meter: Footin s• Rough: Rough: House 4 Foundation: Final: Final: Rough Frame: Gas Fire Department ( Fireplace/Chimney: I Rough: Oil: Insulation: i Final: Smoke: Final: I THIS PERMIT MAY BE REVOKED BY THE CIT OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/25/010:00:00 2502 $200.00 212 Main Street,Phone(413)5 7-1240,Fax: (413)587-1272 Building Commissio r-Anthony Patillo File#BP-2001-0651 APPLICANT/CONTACT PERSON Smith College ADDRESS/PHONE 126 WEST ST (413)585-2424 PROPERTY LOCATION WEST ST MAP 38B PARCEL 008 ZONE SI THIS SECTION FOR FF1 CIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED ZONING FORM FILLED OUT REQUIRED DATE Fee Paid Building Permit Filled out Fee Paid Typeof Construction: Removal of non-bearing walss install new non bearing walls for office area New Construction Non Structural interior renovations Addition to Existing AccessoKy Structure Building Plans Included: Owner/Statement or License 052126 3 sets of Plans/Plot Plan THE ALLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. I Denied as presented: Special Permit and/or Site Plan Required under: PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ ONING BOARD OF APPEALS Received&Recorded at Registry of De ds Proof Enclosed I 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 C ission Permit from CB Architecture Committee L f— z o 0 Signature of Building O ficial Date Note: Issuance of a Zoning permit does not relieve a applica is burden to comply with all zoning requirements and obtain all required permits from Board o Health,Conservation Commission,Department ' of public works and other applicable permit granting autho-ities. I Versionl.7 Commerci 1 Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413.587.1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGEI THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR ITWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: tS"'Si014 co54 mialet y affic �- Map F tv k >3 '� U 'F SECTION 2- PROPERTY OWNERSHIP/AU'T'HORIZED AGENT 2.1 Owner of Record: me(Print) Current Mailing Address: fir'U G Signature Telephone 2.2 Authorized Agent: I Name(Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. BuildingO o 0 (a)Building Permit Fee 2. Electrical (b) Estimated Tctel"Cost of Q U D Cdnstruction from 6 3. Plumbing Building Permit'Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =0 + 2 + 3 +4 + 5) / 00o I I Check Number This Section dor._ fficialUSe.Onl wilding Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date r• '� Version 1.7 Commei cial Building Permit May 15,2000 K f ' � b` , UGT�0N SERYIiCES"0 # 3 i�N y C �0S �5 IGE 3 .A Interior Alterations Existing Wall Signs Existing round Signs Additions ❑ Roofing ❑ ❑ ❑ Exterior Alterations Demolition❑ New Sign [ ] Change of Use ( J Other [ ] ❑ Accessor Building[ ] Repairs [ ] scrolfik vslQurp coralsruCP }rx� , USE GROUP(Check as applicab e) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational a2B I El 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: A Mixed Use ❑ Specify: •S Special Use ❑ Specify: COMPLETE THIS SECTION 1F EXISTIN&BUII_DING,UNDE GOING RENb1/ATIONS, ADQITIONS;AND/QR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION&BU11©ING"HEIGHT lb AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Syr Floor Area per Floor(sf) St 1st 2nd a a lix fi 2nd 3rd 3rd 4th 4th I Total Area (sf) Total Proposed Ne Construction (sf), F7? 65 ............................. ..... . Total Height(ft) Total Height ft ------.�------------ I A jA r r Versionl.7 Commercial Building Permit May 15,2000 Water Supply(M.G.L. c. 40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: +blic ❑ Private ❑ Zone: 0 tside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front i Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registr� of Deeds? NO DON'T KNOW �_ YES IF YES: enter Book age and/or Document # B. Does the site contain a brook, body of water r wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or dditions of signs intended for the property ?YES_ No IF YES, describe size, type and location: I I Ilk Versionl.7 Commercial Building Permit May 15,2000 SECTION, S.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - EOR.BUILDINGS AND'STRUCTURES SUBJECTTO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN $5,000 C.F. OF ENCLOSED SPACE) Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address i Expiration Date i Signature Telephone 92 Registered Professional Engineer(s): i Name Area of Responsibility i Address Registration Number Signature Tel phone Expiration Date Name Area of Responsibility Address Registration Number �ft�ture Tel phone Expiration Date I i Name Area of Responsibility Address Registration Number Signature Tel phone Expiration Date I Name ( Area of Responsibility i I Address Registration Number I Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: ?1�4144 Responsible In Charge of Construction l UG�f .ddress 624--S"�4 3.6 301 Signature Telephone r Version 1.7 Commercial Building Permit May 15,2000 CTION 16,-;,STRUCTURAL PEER REVIEW(780 CMR 110.11) .dependent Structural Engineering Structural Peer Review Requi ed Yes......❑ No......❑ SECTION:1,1. -OWNER.AUTHORIZATICN -TO BE COMPLETED HEN OWNE S AGENT OR CONTRACTOR'APPLIES,FOR BUILDING PE MIT I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buildi Ig permit application. Signature of Owner Date I, as Owner/Authorized Agent hereby declare that the statements and information on the forego ng application are true and accurate, to the best of my knowledge and belief. I Signed under the pains and penalties of perjury. Print Name ignature of Owner/Agent Date i SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Apppliiccable ❑ Name of License Holder ��� = G 42 License Number Address A / ? Expiration Date Signerrure Telephone SECTION 13 -WORKERS' COMPENSATIONINSURANCE AFFIDAVIT(M G.L. c.152, 5C(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....... ❑ No...... ❑ i I I i I 44 r 04ttiMrPT0 of ♦ a s fl �ZDrZM11ttQlt � B �lxsaxcElttactla DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ♦ Municipal Building ' NoAhampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, d1 OX/0 .censee/permittee} with a principal place of business/resi ence at: ( city/stalrlap) do hereby certify, under the pains and penalties of pegu y, that: (-Y"I am an employer providing the fc llowing worker's compensation coverage for my i employees working on this job: i (Insarance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Poiicy Numbcr) (Expiration Date) f. (Name of Contractor) ce Company/Policy Number) (Expiration Date) (Name of Contractor) cx Company/Policy Number) (Expiration Date) (Name of Contractor) ce Company/Policy Number) (Expiration Date) (-tach additioml shod ifneoeaaryto include infocmitiol,pertaining to all coobr d ) i ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing a I the work myself. NOTE:please be aware that wbile homcowneta who =ploy pemom to do e_-__co_■*w duction or repair work on a dwelling of tot more that throe units in which the homeowner rest oc on the grounds appurtenant thereto ate not ge o=4 camidcrod to be employexa under the workeez oompeasstion Act(GL15 1(5)),application by a homeowner for a license or pc fd may evid=e ahe legal atasva of an employer underthe Workees COOVam boa Asa, I undendaad that a copy of this st-tement may be focvmIded to tbo Deputmcc,of Indust ial A c idea&Offioe of Im Ar om for the coverage verification and that failure to soatre coverage lmder soctiou 25A of MOL 152 an kid to the imposition of comical penalties coasb mg of a fano of up to S 1,500.00 and/or finpr6OUM Xd of up to one year and civil pcazWes is the form of a Stop Work Order and a fmo of 5100.00 a day against tno. For dgiataorntal uao only Permit Number Si of Licenserlpermi