Loading...
31B-151 (7) W E W w m V � 2 r U H e d < z .0 o Z o a � - u E N a v - o E; W N w 4— a �o w Which of these units has access to the fire escape? + N G Q J BATH �e 3FL 3RR B USE _ z R2 USE a O OZ COMMON NAL � w 0W 3RL 3FR R2 USE B USE z EXIT 2 E P wro Ir ITH MIN WORK & CHANGE R2 USE IN FRONT TO B USE W 0 17 TRUMBULL RD BP-2011-1050 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 31B- 151 i CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation ]�UILDING PERMIT Permit# BP-2011-1050 Project# JS-2011-000959 Est.Cost:$14000.00 Fee:$84.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: MICHELE ST PIERRE— 105558 Lot Size(sq.ft.): 4835.16 Owner: O'CONNOR COLLEEN Zoning:URC(100)1 Applicant. MICHEL� ST PIERRE AT. 17 TRUMBULLIRD Applicant Address: Phone: Insurance: P 0 BOX 1444 (518) 428-2402 NORTHAMPTONMA01061 ISSUED ON.6115120110:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR WATER DAMAGE 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 4 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 Sigpature: FeeType: Date Paid: Amount: Building 6/15/20110:00:00 $84.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 L I Y r a peparfr3ent use only ity of Northampton Status of temtit ''''p@��'' Building Department ' �G JUN 1 20 9 p �iUriJttEDt ItfeUY3y�eGC1 tr S ag z 212 Main Street Auarlatirty SelieriSe P tri Room 100 1iUa�erw7ltCell Rvarlabtlrt� DEPT.OF BUIL5ING'NsPECT10Ns No hampton, MA 01060 Twq Sias ref St rEtt2raf E?Ians ; NORTHAMPTON MAoiwo -587-1240 Fax 413-587-1272 Plat%5tte Ptn APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE O TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 4)00tla/VK ,� Zone, Overlay District ....... ._ _.. .e,. . .F .. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: AeJ er Name(Print Current Mailing Address Signature Telephone C 2-YV2— 2.2 Authorized Agent: ��j jC Zl.i! ..JLC• _ .�._ _ Name(Print) Current Mailing Address: Ot Signature 'Telephone L)2- SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building � ► 00c) (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Constructionfrom6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) _ - -- ---••••••. __ _....._..W igy' 5. Fire Protection _. .. ... 6. Total=(1 +2+3+4+5) U Check Number This Section For Official Use Only Building Permit Number Date Iss�ed Signa e: Buil i ommis ner/lnsp ctor of Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE a Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs,K Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description ',Enter a brief description here. vv*ky,I*Afit "(it r-t�►-f �rX.�) Of Proposed Work ; ' 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 ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ I-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 f SSpecial Use ❑ Specify �,.._....-.,.�...��.p....�....,�... _a ..�.. ..-M.,.m.. �.__. � �w�.�m..��...�,_�-.�.��.� � �.,_..�.. 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 Z I- 55 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) l1st _ 1st 2nd2 3rd .,.. 3rd _.. 4th _. ....... . ..... __ _,...... 4tn Total Area(s€) _ Total Proposed New Construetionsf) 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 ❑ Zane Outside Flood Zane❑ Municipal ❑ On site disposal system[:] Version 1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage __.....:....... Setbacks Front Side L __. m R: _, L _; R Rear Building Height — Bldg. Square Footage % - -- Open Space Footage M % (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 0 DONT KNOW 0 YES IF YES, date issued: l �� IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO yj DONT KNOW C) YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , 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 additions of signs intended for the property ? YES 0 NO 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 0 NO *,,.Q IF YES,then a Northampton Storm Water Manageme t Permit from the DPW is required. i 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 E 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 Address Registration Number ....,, Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor OAf'LY Not Applicable 0 Company Name: Responsible In Charge of Construction Addresiot- s � �� Signatu e Telephone 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 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ► ^iN X31 td" ►N1 as Owner of the subject property hereby authorize u. to act on y behalf in 11ma er r lative to work authorized by this building permit application. aE7 SIgnatufe 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 Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION.SERVICES 10.1 Licensed Construction Supervisor: Not Applicable (� Name of License Holder: �--.b4 License Number AA Addre s Expiration Date Sign ure Telephone 7- SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.162,§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 w The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ? 600 Washington Street -.;.� Boston,MA 02111 =*_ www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nance(Business/Organization/Individual):Address: q. J9V' ;vJ S E City/State/Zip: kt;' Y�, 61060 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.X I am a sole proprietor or partner- listed an the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [_No workers'comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions a. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. I52, §1(4},and we have no employees.[No workers' 13.9 Other "7-P A—,2,9&_ comp.insurance required.] *Any applicant that checks box#1 rust also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. }Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: — Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi unde th i and penalties of perjury that the information provided above is true and correct. Signature: Date: — Phone Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: a t r w5 Massachusetts- Deportment of Public Sxfet� Board of Building Regulations and Standards Construction Supervisor License License: CS 105558 t P:O. B NORTHAIVfRi Gro 0' Expiration: 1130/2014 ('u nun issi1Or Tr#: 105558 4 17 TRUMBULL RD BP-2011-1051 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block:31B- 151 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2011-1051 Project# JS-2011-000959 Est.Cost:$15000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MICHELE ST PIERRE 105558 Lot Size(sq.ft.): 4835.16 Owner.- O'CONNOR COLLEEN Zoning:URC(100)t Applicant. MICHELE ST PIERRE AT. 17 TRUMBULL RD Applicant Address: Phone: Insurance: P 0 BOX 1444 (518) 8-2402 NORTHAMPTON MAO 1061 ISSUED ON.-611512011 0.00:00 TO PERFORM THE FOLLOWING WORK.-FINISH PITCHED ROOF SECTION, CONSTRUCT NEW PITCH & DECK,CONVERT BEDRM TO BATH/CLOSET 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 Shmature: FeeType: Date Paid: Amount: Building 6/15/20110:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Version l.7 Commercial Building Permit May 15,2000 h Departrrrent use oily 1111-1 City of NorthamptonP 241, Stags QfPerr� tE a BuildingDepartment P CuR GuvyR.VewayPertrrrt a 212 Main Street Sewer Septi,, Matialir[rt `ff3 NOR►+ ow MA 010W Room 100 VI&tibW C/el�ffi arlabY ity 3 r r orthampton, MA 01060 Fuya€ es bCieturatPlans phone 413-587-1240 Fax 413-587-1272 Pla>tite Pta,a' �. Other Speeif+r''". k APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE BUILDING OTHER THAN A ONE OR TWr% SECTION 1 -SITE INFORMATION ��- 1.1 Property Address: µA 0l 060 zoo,y �LX l� Elm S `—` SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: M r�he�e SE Rwr�.,�.(`�++ iel _., {✓ - M.._ ofLe�, Name(Print) Current Mailing Si natur Telephone 2-10 -2- 10 -5l`ir• 56A b 2.2 Authorized Agent: _.........__. . Name(Print) Current Mailing Address Signature SATelephone 5W 12,V 7,4.02— SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building L 000 (a)Building Permit Fee 2. Electrical )000 (b)Estimated Total Cost of Construction from 6' 3. Plumbing ..-..:_ _._.._.... .. _. ,.... ,.. 1 t)d U Building Permit Fee 4. Mechanical(HVAC) _ .._ _,... ._. ....____...___ frepkiz 5. Fire Protection �r-UOQ 6. Total=(1 +2+3+4+5) CS 00 0 Check Number This Section For Official Use Only Building Permit Number Date issued Signatu Building Commissioner/Inspector of Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 , r to k, CUBIC FEET OF ENCLOSED SPACE --4 1 Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions 19f Accessory Building - Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Othe "®'-*.. Brief Description :Enter a brief description here. LJvf1c��bery �ft�✓�cd� WOW"' ..� �k}��'y( j"�`t"�� / Of Proposed Work. VtJ4co 1100/h/ �l rJ.kL�nt bac�1'i4r Spe 44dt hvk J 4t-t !i l`� l 111 SECTION 5-USE GROUP AND CONSTRUCTION TYPE � ei1�05 ,Zew&'U 6 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 ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 R-3 ❑ 5A a 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} _.,___ _.. .w Proposed Hazard Index 780 CMR 34). '_........ ...... _ ,... ... SECTION 6 BUILDING HEIGHT AND AREA 104000 votumd-,- BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) St 1 St 2nd 2nd rdrd13 3 pOL? _.f_. th 4 t Total Area(sf) Total Proposed New Construction(sf) y 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 w._, ,,.,; Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2444 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department LotSize _., ._.... .. ;._ .. .__..._ _... _,_.,, .. _..., Frontage ...... . ..__,._, .... .._. ,_..__._,_ .. _ ... _ ... _.__ .,..... .. ,, Setbacks Front _.. Side L:,..,.,.__ R., ...__. L:— __..: R. _._.._ _. Rear Building Height Bldg. Square Footage Open Space Footage _� _„e _ % (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 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page. and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 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 additions of signs intended for the property? YES 0 NO 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 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 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. _..... . . ...... ...,_ .__.._..... , u...__ ..._ ,.r... _..__w___.....m _ ...._ .__._...__. 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 Registrahon Number Signature Telephone Expiration Date Name Area of Responsibility i Address Registration...,. ._ ..,_.,. ,._.. ......,.� ..._.., Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version l.'7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby , authorize __t �40to act n m beh )zall matt rs relative to work authorized by this building permit application. ._ L.- So nature of Owner4. __1. 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,penaltieswo..penury m Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. Not Applicable p Name of License Holder ._ 1 License Number Address Expiration Date Signature Telephone I —T— 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 The Commonwealth of Massachusetts Department of Industrial Accidents - , Office of Investigations 600 Washington Street W <' .Boston, MA 02111 :k µ4 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p� Please Print Leeibly Name(Business/Organization/Individual): Address: Q4t,�1uy� lyv? City/State/Zip: Phone#: � Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with � 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. (VW Remodeling ship and have no employees 'These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. F-1 Building addition [No workers'comp.insurance comp. insurance.: required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions ( officers have exercised their 11.❑Plumbing repairs or additions 3. I am a homeowner doing all work T right myself. [No workers' comp. , exemption per MGL 12.7 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rtderthepifins andpenalties ofperjury that the information:provided above is true and correct. Sisnature: Date: �� zo / Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: L r y 6 �` 1' �X SlJ` •h a 7 3 a r a , 3 k� 4«e i o 1 1 i t C e n. 1, L;.�f-f J41,!,s s TA a.4 K Ail,- . 7 ' t ��� . t": tt.� -- f r E'`*E .._1r"4 � 7 �; . E j 4` : 1" _ J 1 G o� ►J C jr s. Qi ocr,- -r cs It 4 f 4-X 5 i c xf- F C i■ x r t a Jr/ C_ B F € (d,rc-r, /C"i z i k. i i I F"' 4150- 3 00 k r City of Northampton Massachusetts ` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 02060 INSPECTOR Louis Hasbrouck Phone:(413)587-1235 Chuck Miller Building Commissioner Fax: (413)587-1272 Assistant Commissioner RECEIV Jl -7ED w►1iB"a FAX THIS TO: 413-587-1272 REQUEST FOR PERMISSION TO VIEW RECORDS OR HAVE COPIES OF DOCUMENTS MADE *PLEASE KEEP THESE DOCUMENTS IN CHRONOLOGICAL ORDER* DATE: ( MAP: BLOCK: 1 'r FILE ADDRESS:_ J VIA 0c) NAME: c eL Sk ' Revij ADDRESS: cka v''j 'S- �of+ � vvv&o" PHONE #: G 2,.q - UNDER MASS GENERAL LAWS WE HAVE THE RIGHT TO MEET THE ABOVE REQUEST WITHIN TEN (10 S OF THE ABOVE LISTED DATE. I _.... v ,. .,�„�.K,�..�... �� � ..�, w 3 P Y��++w:.1Mv.ev..m Mtw�++..x.a ..-.mmwi� File#BP-2011-0565 APPLICANT/CONTACT PERSON SCOTT NICKERSON ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413)896-3347 Q 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 : RENOVATE EXISTING BEDRM TO CL SET/BATH ow New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053156 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOJtMATION PRESENTED: _LZApproved 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 Commission Permit DPW Storm Water Management Demolition Delay l Signatureof 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. 17 TRUMBULL RD BP-2011-0595 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 3 1 B- 151 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: BUILDING PERMIT Permit# BP-2011-0595 Proiect# JS-2011-000959 Est,Cost:$49500.00 Fee: $297.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: SCOTT NICKERSON 053156 Lot Size(sg. ft.): 4835.16 Owner: O'CONNOR COLLEEN Zoning:URQ1001/ Applicant: SCOTT NICKERSON AT: 17 TRUMBULL RD Applicant Address: Phone: Insurance: 197 NORTH LEVERETT RD (413) 896-3347 Workers Compensation LEVERETTMA01054 ISSUED ON.-312112011 0:00.00 TO PERFORM THE FOLLOWING WORK.-REMOVE PITCHED ROOF SECTION, CONSTRUCT NEW PITCH & DECK 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 Sip-nature: FeeType: Date Paid: Amount: Building 3/21/20110:00:00 $297.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2011-0595 APPLICANT/CONTACT PERSON SCOTT NICKERSON ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413)896-3; 7 PROPERTY LOCATION 17 TRUMBULL RD MAP 31 B PARCEL 151 001 ZONE URC(I 00Y THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: REMOVE PITCHED ROOF SECTION,CONSTRUCT NEWPITCH&DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053156 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFqRMATION PRESENTED: _VApproved 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 Commission Permit DPW Storm Water Management .Demolition Delay 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. File#BP-2011-0595 APPLICANT/CONTACT PERSON SCOTT NICKERSON ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413)896-3347 0 PROPERTY LOCATION 17 TRUMBULL RD MAP 31B PARCEL.151 001 ZONE URC(100)/ THIS SECTIONFOROFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 00Q Q Fee Paid 7oe (X7 i Typeof Construction: REMOVE PITCHED ROOF SECTION. CONSTRUCT NEW PITCH&DECK New Construction Non Structural interior renovations Addition to Existinp, Accessory Structure Building_Plans Included: Owner/Statement or License 053156 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRE N' : Approved INFORMATION 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:§ 7 Finding 1Z_ Special Permit Variance* orL .11(x NA Ttk M6 S 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 Perrnit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature of Building bTficial Date I 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. Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 , k Northampton, MA 01060ri �' } -^ L 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 SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office i,• Map Lot Unit t¢ Zone Overlay District i SIM St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address Signature Telephone 2.2 Authorized Agent: _ c�7`f /\tr4tr✓ems I�� rl Lr�rr11 ..,_..c,.r.� _..... Name Print Current Maillno Address: 1310 y... Signature Telephone SECTION 3-ESTIMATED.CONSTRUCTION COSTS' Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee .p,Z O . 2. Electrical (b)Estimated Total Cast of Construction from 6 _.._... ..._ . 3. Plumbing µ r!? Building Permit Fee 4. Mechanical(HVAC) __ . ..... _ . ___. _ f 7� '3 5. Fire Protection 6. Total=(1 +2+3+4+5) O Check Number This Section For Official Use Only Building Permit Number . Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version l.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by �-~�-- Building Department Lot Size .l:� _ Frontage Setbacks Front Side L::__, :R:_ _` L: R:LIL ------ Rear _ _-Rear Building Height Bldg. Square Footage __-..._ _.... % Open Space Footage (Lot area minus bldg&paved ( ' parking) - #of Parking Spaces - --- _._ _,. .. Fill: _..._.. (volume&Location) -_ A. Has a Speci ermit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued: 1F YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water 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 Obtained Q , Date Issued C. Do any signs exist on the property? YES Q NO 1F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavatio frig)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 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes Q No SECTION 11 -OWNER AUTHORIZATION-TOBE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING.-PERMIT I, ..._..... _..._ _..._.... __._....,. ..._�.... 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 er Y _ - /2 �o I, SCS. _._..__ . __,._..._/�!a c.I L�_✓,�_.h. as Ow /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 r* Print Name Si to a of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License HolderC� . ._ . _..,. _;0.001V.__...?C.l L_G. rfr 6 /�� License Number 12 Address Expiration Date Sig rr Telephone SECTION 13-WORKERS';COMPENSATIONINSURANCE 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 buiI5LWPerrmit. Signed Affidavit Attached Yes No Zoning Board of Appeals-Decision City of Northampton Hearing No.: ZBA-2011-0008 Date: February 1,2011 APPLICATION TYPESUBMISSION PATE: Residential Finding I1/10/1011 Applicaffs Name: Owner s Name: Willi NAME: NAME, Bk: 10498Pg:310 Page: 1 of 2 O'CONNOR COLLEEN O'CONNOR COLLEEN Recorded: 03/08/201109:42 AM ADDRESS-. ADDRESS: PO Box 1444 PO Box 1444 TOWN: STATE: ZIP CODE: TOWN: STATE: ZIP CODE: A01A NORTHAMPTON 0101 NORTHAMPTON MA 01061 PHONE NO.: FAX NO.: PHONE NO.: FAX No.: (413 519-5616 0 (413)519-5616 0 EMAIL ADDRESS: EMAIL ADDRESS: Site Information: Surveyoes Name: STREET NO.; SITE ZONING: COMPANY NAME 17 TRUMBULL RD URCHOQY TOWN: ACTION TAKEN: ADDRESS: NORTHAMPTON MA 0 10 60 Grant MAP: I BLOCK- I LOT: MAP DATE: SECTION OF BYLAW: 318 1151 1001 Chapt.350-9.3(1)(D):Pre-existing TOWN: S'E'AT* ZIP CODE: 8001C1Nonconforming Structures or Uses May be 1238 -- - r4086: Changed,Extended or Altered with a PHONE NO.: FAX NO.: Finding from the Zoning Board of Appeals. EMAIL ADDRESS. NATURE OF PROPOSED WORK REMOVE PITCHED ROOF SECTION,CONSTRUCT NEW PITCH&DECK HARDSHIP: CONDITION OF APPROVAL: FINDINGS: The designated Zoning Administrator granted the Finding based on the materiels and graphics submitted with the application and additional plans submitted at the hearing. The Findings of the Board Administrator under Section 9.3 for reconstruction of the roof at the rear of the 4-unit related to the side yard setbacks as follows.- 1. The Administrator found that the change would not be substantially more detrimental to the neighborhood than the existing nonconforming house. The house Is approximately 6'from the side lot line and the 3rd floor addition would be approximately 8'from the side lot line over existing first floor footprint 2. The Administrator found that the home would not extend any closer to any front,side,or rear property boundary than the current zoning allows and that the pre-existing,structure already extends. 3. The Administrator also determined that the new construction would not create any now violation of other zoning provisions and Is a minor addition compared to the remaining size of the structure.The now roof line would be lower than the primary roof fine at the front of the structure;and does not Involve a sign. COULD NOT DEROGATE BECAUSE' FILING DEADLINE-- MAILING DATE. HEARING CONTINUED DATE: DECISION DRAFT BY: APPEAL DATE. 12128/2010 1/22/2011 2(10)2011 REFERRALS IN DATE: HEARING DEADLINE DATE: HEARING CLOSE DATE; FINAL SIGNING BY: APPEAL DEADLINE-- 1/1&2011 31IW2011 1/27/2011 20012011 3m01f FIRST ADVERTISING DATE: HEARING DATE: VOTING DATE' DECISION DATE: 111312011 1/27/2011 1/27/2011 2(1)2011 SECOND ADVERTISING DATE: HEARING TIME: VOTING DEADLINE: DECISION DEADLINE: 4.*00 PM 127/2011 4)27/2011 MEMBERS PRESENT: VOTE. David Bloomberg votes to Grant Ge*TMS@ 2011 Des Laurlers Municipal Solutions,Inc. Zoning Board of Appeals- Decision City of Northampton Hearing No.: ZBA-2019-0008 Date:February 1,2011 MOTION MADE Sr. SECONDED BY: VOTE COUNT: DECISION: David Bloomberg 1 Approved MINUTES OF MEETING: Available in the Office of Planning d Development. 1, Carolyn Misch,as agent to the Zoning Board of Appeals,certify that this is a true and accurate decision made by the Zoning Board Administrator and certify that a copy of this and aft plans have been filed with the Board and the City Clerk on the date shown above. I certify that a copy of this decision has been mailed to the Owner and Applicant tit The appeal period for residential findings granted by the Zoning Board of Appeals Zoning Administrator are thirty(30)days from the date of the decision. Ali appeals are heard by the full Zoning Board of Appeals. E � V E FEB - 1 2011 CITY CLERKS OFFICE NORTHAMPTON, MA 01060 March 4, 2011 I, Wendy Mazza City Clerk of the City of Northampton, hereby certify that the above Decision of the Northampton Zoning Board of Appeals Zoning Administrator was filed in the office of the City Clerk on February 1, 2011, that thirty days have elapsed since such filing and that no appeal has been filed In this matter. Attest: CK..- City Clerk City of Northampton GeoTMS®2011 Des tsarists MuYni/c�i/t�py�'{���a}l�S�/�olutQQio`�»��a,��inan �n VA .. AURUL. DONOEM s City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE O DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: is•section to be completed by office, NcLbt1n�t 2 SECTION 2-PROPERTY OWNERSHIPiAUTHgFtWEQ AGkNT . 2.1 Owner of Record: Co ll en Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Anent: n Name(Print) Current Mailing Address: V/ 3 --� �a Sig Telephone SECTION 3-ESTIMATED CONSTRUGI IOt+!'COSTS Item Estimated Cost(Dollars)to be Official UseOnty completed by permit applicant 1. Building S_Q O:9ullding-Perm. Fee 2. Electrical (0)Estimated Total.Cost:.of Cortstruction from 6: . 3. Plumbing BuHdlri Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) / J—.0 o Ctiedc Number d` This Section For ai Use Only Building Permit Number. __ Date Issued: Signature: Building Commissioner/Irispector.Cf BuildingsDate SECTION 5-DESCRIPTION Of'PROPOSED WORK jcheck a1taEplicablel New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors 1­71 Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks [jam Siding[0] Other[Ol Brief Descrip' n of P p Wd Work: �►✓ .� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION'7a-OWNER AIITAORFZATION! TO IBE COMP,II ETEDEN OWNERS AGENT OR CONTRACTOR APPLIES FOR Bt11LI�ING:P�IT 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 c—/c as Own /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best Howled e and belief. Signed under the pains and penalties of perjury. Print Name Si at OwnedAgent Date File#BP-2011-0595 APPLICANT/CONTACT PERSON SCOTT NICKERSON n ADDRESS/PHONE 197 NORTH LEVERETT RD LEVERETT (413)896-3347 Q PRQPPRTYI 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: REMOVE PITCHED ROOF SECTION.CONSTRUCT NEW PITCH&DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053156 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATIONNTED: Approved ditional 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: § 9' 3 ��� 6 Y 7 Finding___,.-' Special Permit Variance* OrL 116NATu-rL6S 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 Ehn Street Commission Permit DPW Storm Water Management Demolition Delay c2z2=1— I Signature of Building O cial 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. Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413587-1240 Fax 413.587-1272 APPLICATION TO CONSb&Cf,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to-be completed by office .Map Lot Unit M-11 A BVI Zone, Overlay.District Erm�Sfi.Distllct .. CB Dlstr3ct SECTION 2-'PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: � _ f ,� — Signature Telephone 2.2 Authorized Agent: Name(Print) Current Ma i(i Address: Q/p_r y q1j -CLV6 _73 y4 Signature Telephone SECTION 3-:ESTIMATED.CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Officiab Use,O.rily completed by permit applicant 1. Building (a)Building Permit.Fee O ,. 2. Electrical S O o I - r ) t3 i ©nstructioii from 8 # __._M __. 3. Plumbing ,3 S-60 I Building Permit Fee C� -,.�, 4. Mechanical(HVAC) ---------- .',L �/ Mi+i•�W 5. Fire Protection ` --- ---- 6. Total=(1 +2+3+4+5) f 0 O Check Number This Section For Official Use.Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version l.7 Commercial Building Permit May 15,2000 8. NORTHA MFT©N.ZOJN N..q Existing Proposed Required by Zoning This column to be filled in by rr--�7�--7--��---- ;—� Building Department Lot Size - - -7- ---- Frontage Setbacks Front iAD EZIU Side L: 0-7 R•C>� LEE R:� i i I Rear ! t==U Building Height r ' Bldg. Square Footage / int-; % ! s Open Space Footage (Lot area minus bldg 8t paved parking) #of Parking Spaces Fill: volume&Location z A. Has a Speci ermit/Varia nce/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued: j IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES Q IF YES: enter Book ! Page! and/or Document# � � B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtainedQ Obtained 0 , Date Issued: , C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavatio Ing)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 10-STRUCTURAL PEER REVIEW.(780 CINR:. 1011) Independent Structural Engineering Structural Peer Review Required Yes Q No SECTION 11-OWNER AUTHORIZATION. TO•SE COMPLETEM-WtiEN' !' OWNERS AGENT OR CONTRACTOR APPLIES EOR'BUILdING:PERMIT _ ......._........____._.__-.:._.._.___ _--� .........__.___.-.----_. .__.. ____r _____..._.__W_ _ .._ __.__ ,as Owner of the subject property hereby authorize'`__..._..__........... __..._...____.. _ .._ oto act on my behalf,in all matters relative to work authorized by this building permit application. i Signature of Orr, as Ow /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,underthe.paineand penalties of Dedury. Print Name _ I Si to of Owner/Agent Date SECTION 12-CONSTRUCTION.SERVICES 10.1 Licensed Construction Supervisor. 09 Not Applicable ❑ Name of License Holder: _�G orf r^ I r 6 _ # License Number Address Expirati&Date Sig Telephone SECTION 13-WORFfERS':;COMPENSATIONINSURAcNCEAFFI©AVIV 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 buil di rmit. Signed Affidavit Attached Yes erNo 0 CJ ICC°Y1 0 1 -4- leot J SCD � C-e jr'r if A 4r,710 f 'fj / I- ' 19"11"k v�o.'.'� t:,.U(' C.ir re vj /lL r o o + zz r il^c e CIC4 Cow C.Al- if Ea -TOry "4t LIGE lie, IC/ G7 vEv It 13 Cp A Ji f 4c Lo.1 0A .'4 r E. F2:' fir' r'.,i Ei�•� �..� [ w,, � ) e c- 14, i'S V r #.k 6 i - -7� Sco cc ql 3 7 6 3 3 q Vi -le s 47 410 PJ aJ2 ItJ 1000 Lincoln Drive East,Suite 313 Marlton,New Jersey 08053 Tel (856)596-5555 by WPyPlhaeuser Fax(856)985-9806 March 8,2011 Cowls Building Supply Kyle Belanger 125 Sunserland Road Amherst,Ma.01002 Re: Sealed Calculations iLevel®TC#:96365 15 Trimble Street Northampton,Ma.01060 Enclosed are iLevel®ForteTM calculations and a Job Summary Report for joist and beam applications that have been prepared for the above referenced project based on information provided by Kyle Belanger—Cowls Building Supply The calculations have been identified in the Job Summary Report and by the date and time in the lower right hand corner of each sheet: 3/7/20113:42:25 pm Many uniformly loaded joist and beam calculations can be verified by referencing the applicable span charts within the appropriate product literature. These common conditions covered by span chart literature may not have been addressed via individual calculations within this package. Each analysis reflects the iLevel product,depth,and size that can structurally support the input loads shown.The professional engineer's seal on this letter verifies that the analyses presented conform to accepted engineering practices and use code-accepted product design values.Although I have not personally reviewed the project plans or visited the jobsite,we guarantee that our products,as shown in the attached calculations,have been engineered to support the design loads provided in accordance with iLevel criteria. All notes and design load information shown on these calculations should be reviewed with the building designer and/or the local code official to ensure that the loads,spans,and other conditions are correct and/or acceptable for the specific application. Building inspectors and/or owners should identify the"Silent Floor®","TJI®", "Microllam®LVL","Parallame PSL", or"TimberStranda'LSL"markings on iLevel®products to confirm that this letter is valid for the products actually installed. Please feel free to contact me if there are any qu stions regarding the analyses, I can be reached at(800)-854-5647. Sincerely, 41t► Robert A.Kus , PE East Divisio ngineer MA:39354 ■ Forte 30B SUMMARY REPORT • software 96365.4te Eggx;": f E a;,,'i' T✓;•y�,F- �,. ✓ f "li,a S gPlece(s) ";F. �91/2" Member Name Result olutioErrorFloor:Flush Beam Pass 13/4" 1.9E Microflam@ LVL Forte`"Software Operator ,lob Notes 3/7/2011 3:42.25 PM Geoffrey McClain FLUSH BEAM iLevel@ Forte TM v2.1,Design Engine:V5.2.1.1 Weyerhaeuser 15 TRUMBLE ST. 96365.4te (856)596-5555 NORTHAMPTON,MA 01060 geoff.rncclain@weyerhaeusercom call#96365 Page 1 of 2 • Forte MEMBER REPORT Level,Floor.•Flush Beam PASSED software 2 piece(s) 13/4"x 9 1/2" 1.9E Microllam® LVL Overall Length'13'10" 0 0 t&4.. T x All Dimensions are Horizontal;Drawing is Conceptual Design Results ActuN O Location Allowed Result LDF Load CombYntfon(Low tsattatR) system:Floor Member Reaction(lbs) 1994 @ 1 1/2" 3981 Passed(50%) -- 1.0 D+1.0 L(All Spans) Member Type:Flush Beam Shear(lbs) 1720 @ 1'1/2" 6318 Passed(27%) 1.00 1.0 D+1.0 L(All Spans) Building Use:Residential Moment(Ft-lbs) 6750 @ 6'11" 11775 Passed(57%) 1.00 1.0 D+1.0 L(All Spans) Building Code;IBC Uve Load Defl.(in) 0.343 @ 6'11" 0.340 Passed(L/475) -- 1.0 D+1.0 L(All Spans) Design Methodology:ASD Total Load Defl.(in) 0.496 @ 6'11" 0.679 Passed(L/328) 1.0 D+1.0 L(All Spans) Deflection criteria:LL(V480)and TL(L/240). Bracing(Lu):Al compression edges(top and bottom)must be braced at 13'7 1/2"o/c unless detailed otherwise.Proper attachment and positioning of lateral bracing Is required to achieve member stability. Suring Support Raecdons(bs) Suppoft Total AvalloW Required Dud Mor We Rodin Snow Wind Soismk Accauoriu 1-Column-Sprue Pine Fir 3.00" 1.75" 1.50" 623 1401 0 0 0 0 11/4"Rim Board 2-Column-Spruce Pine Fir 3.00" 1.75" 1.50" 623 1401 0 0 0 0 1 1/4"Rim Board .Rim Board is assumed to carry all bads applied directly above It,bypassing the member being designed. Tributary Dud Floor Lire Roof L)re Snow WMd Selserk Loads Location 1NfrIU+ (0-90) (Loa) ttwe aow2-n) (W) (L") 0." Commol s 1-Uniform(PSF) 0 to 13'10" 691, 12.0 30.0 0.0 0.0 0.0 0.0 /Residential-Living Areas LEVEL®Notes -- 4 SUSTAINABLE FORESTRY INITIATIVE 8.evel@ warrants that the sizing of its products will be in accordance with iL.evel®product design criteria and published design values.(Level®expressly Y disclaims any otter warranties related to the software.Refer to current!Level®literature for installation details.(www.iLevel.com)Accessories(Rim Board, Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the reed for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation Is compatible with the overall project.iLevel@ products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards. The product application,Input design bads,dimensions and support information have been provided by Kyle Belanger-Cowls Forte—Software Operator Job Notes 3/7/2011 3:42:25 PM Geoffrey McClain FLUSH BEAM iLevelO Forte T"'v2.1,Design Engine:V5.2.1.1 Weyerhaeuser 15 TRUMBLE ST. 96365.4fe l (856),S96-5555 NORTHAMPTON,MA 01060 geolf.mcclain@weyerhaeuser.com call#96365 Page 2 of 2 COLEEN'S BIG BEAM 2 Pcs of 1 314" x 11 7/8" 1.9E Microllam® LVL TJ-Beam 6.36 Serial Number. ✓ ,; -.! User.1 12/91201011:04:31 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pagel Engine Version:6.35.0 CONTROLS FOR THE APPLICATION AND LOADS LISTED RIM .a b fig. Product Diagram is Conceptual. LOADS: Analysis is for a Drop Beam Member. Tributary Load Width:2'9" Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Floor(1.00) 0.0 120.0 0 To 19' Adds To DEAD LOAD FROM WALL ABOVE SUPPORTS: Input Bearing Vertical Reactions(lbs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 1.75" 1045/1563/0/2608 L1:Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam®LVL 2 Stud wall 3.50" 1.75" 1045/1563/0/2608 L1:Blocking 1 Ply 13/4"x 117/8"1.9E Microllam®LVL -See iLevel®Specifier's/Builder's Guide for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Result Location Shear(lbs) 2562 -2256 7897 Passed(29%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 11955 11955 17848 Passed(67%) MID Span 1 under Floor loading Live Load Defl(in) 0.338 0.622 Passed(U663) MID Span 1 under Floor loading Total Load Defl(in) 0.843 0.933 Passed(U266) MID Span 1 under Floor loading -Deflection Criteria:MIN IMUM(LL:U360,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 12'1"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by iLevel®. iLevel®warrants the sizing of its products by this software will be accomplished in accordance with iLevel®product design criteria and code accepted design values. The specific product application,input design loads,and stated dimensions have been provided by the software user. This output has not been reviewed by an iLevel®Associate. -Not all products are readily available. Check with your supplier or iLevel®technical representative for product availability. -THIS ANALYSIS FOR iLevel®PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IBC analyzing the iLevel®Distribution product listed above. -Note:See iLevel®Specifier's/Builder's Guide for multiple ply connection. Operator Notes: 40/12 LOADING @ 2'9 TRIB PROJECT INFORMATION: OPERATOR INFORMATION: SCOTT NICKERSEN Joe Baillargeon COLLEEN JOB Cowls Building Supply 125 Sunderland Rd. North Amherst,MA 01059 Phone:413 549 0001 Fax :413 549 4686 joe@cowls.com Copyright 2007 by iLevel Federal Way, WF.. Microllam- is a registered trademar Y. c` '_Leve: . ■ COLEEN'S BIG BEAM Vdey celu.yUx<.. 2 Pcs of 13/4" x 117/8" 1.9E Microllam® LVL TJ-Beam®6.36 Serial Number. User' 12M/201011:04:31 AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Paget Engine Version:6.35.0 CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 18' 8.001, ^ Max. vertical Reaction Total (lbs) 2608 2608 Max. Vertical Reaction Live (lbs) 1045 1045 Required Bearing Length in 1.75(W) 1.75(W) Max. Unbraced Length (in) 145 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 1352 -1352 Max Shear at Support (lbs) 1535 -1535 Member Reaction (lbs) 1535 1535 Support Reaction (lbs) 1563 1563 Moment (Ft-Lbs) 7164 Loading on all spans, LDF = 1.00 , 1.0 Dead + 1.0 Floor Shear at Support (lbs) 2256 -2256 Max Shear at Support (lbs) 2562 -2562 Member Reaction (lbs) 2562 2562 Support Reaction (lbs) 2608 2608 Moment (Ft-Lbs) 11955 Live Deflection (in) 0.338 Total Deflection (in) 0.843 PROJECT INFORMATION: OPERATOR INFORMATION: SCOTT NICKERSEN Joe Baillargeon COLLEEN JOB Cowls Building Supply 125 Sunderland Rd. North Amherst, MA 01059 Phone:413 549 0001 Fax :413 549 4686 joe@cowls.com Copyr iUh*_ 20U9 by iLeve Federal_ Way, WF. Micrci'_am 1 s a registered trad=marl: of iLevel . I REPORT THAT THE PROPERTY LINES SHOWN HEREON ARE THE LINES DIVIDING EXISTING OWNERSHIPS, AND THE LINES OF STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED, AND THAT NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR FOR NEW WAYS ARE SHOWN. GEOFFREY V.BURGESS AND CHRISTIAN A.WNDERMAN SURVEYOR' BOOK 7401,PAGE 324 CHRISTIAN CAMPE AND ELIZABETH WAWAM BOOK 9588, PAGE 141 FOR REFERENCE TO LOCUS SEE: • MILIEU:D.ST.PIERRE AND COLLEEN M.O'CONNOR µ•pp' \ BOOK 9826.PAGE 30.3 _�---� . SEE: PLAN BOOK 193,PAGE 75 LOT 1 1F Z 4.869f SQ. FT. ,II P°'`Ing ' _.'_R_ /- • I !7 IL y� , MARLENE STEINBERG. n BOOK 8728,PAGEI1II1III 7'I8I1I I I • -- P D BOOK 4731, —G 189 BARRY S.GO&EN 1 S i� , BOO6601.PGE 9 !17 /19 m4 K A ! �cHy�J ii ji 1 —� ii g it IIi2 -`4�, —"1 I I I II II II I � II 1 �Tl N 88'33'13'W 69.48' 44.31'I' I I I I 44.33'M -- N 68'33'13'W N 88'3313 W TRUMBULL ROAD - F.K.A. PARK STREET LEGEND O FOUND IRON PIN F— ❑ FOUND CONCRETE BOUND Ld ■ FOUND STONE BOUND Ld • RAILROAD SPIKE FOUND UNMARKED POINT I REPORT THAT THIS PLAN FULLY AND ACCURATELY DEPICTS THE LAYOUT OF EACH UNIT, ITS LOCATION, N UNIT NUMBER, DIMENSIONS, APPROXIMATE AREA, MAIN ENTRANCE, IMMEDIATELY ADJOINING UNITS, AND "THE ANNA IMMEDIATE COMMON AREA TO WHICH IT HAS ACCESS, AS BUILT. V I REPORT THAT THE PROPERTY SHOWN HEREON IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS AT TF SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167 0 17 TI ` n o NORTHAMPI SURVEYOR: \ �' 1-3h MICHELE D. ST. PIERI I REPORT THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY SCALE- 1'-2V WITH THE 1976 RULES AND REGULATIONS OF THE REGISTERS HAROLD L E OF DEEDS OF THE COMMONWEALTH OF MASSACHUSETTS. RECISTERED q 235 RUSSELL STRI T. 413-584-7: RANDALL E. IZER /35032 HKmil 0' I REPORT THAT THE PROPERTY LINES SHOWN HEREON ARE THE LINES DIVIDING EXISTING OWNERSHIPS, AND THE LINES OF STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED, AND THAT NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP OR FOR NEW WAYS ARE SHOWN. RSURVEYOR-.-- �• , GEOFFREY V.BURGESS AND CHRISTIAN A.GUNDERMAN BOOK 7401,PAGE 324 CHRISTIAN CAMPS AND ELIZABETH WADHAM BOOK 9589,PAGE 141 FOR REFERENCE TO Lows SFE• \ MICHELE D. ST.PIERRE AND COLLEEN M. O'CONNOR 44,00' \ BOOK 9829.PAGE 303 _ SEE: PLAN BOOK 193,PACE 75 r LOT 1 IF 4,8691 SO. FT. i v 9 i _1R I #7 IL- -- j \ 2F r-- ��p BOOK ENE 8721L PAGE:7e \ '0 SANDRA ANN PUTALA �yxW�i j• D BOOK 4751,PACE 186 m as 0 I I I I Ogg 4 I = 1 BARRY S.GOU.TEIN _1 4 I I I I D SUSAN L STUBBS Y 8 1 1 BOOK 6601,PACE 49 iQ6 #17 I Z 3J f #19 j I f j I m vl S 11 o I 1 2 ~�� II II 11 I D 11 -- N 1 44.31'I I I I I I 44.33' I 1 1 N 683313'W -- N 88'3313 W TRUMBULL ROAD N F.K.A. PARK STREET LEGEND O FOUND IRON PIN F- ❑ FOUND CONCRETE BOUND w ■ FOUND STONE BOUND • RAILROAD SPIKE FOUND UNMARKED POINT IV) REPORT THAT THIS PLAN FULLY AND ACCURATELY DEPICTS THE LAYOUT OF EACH UNIT, ITS LOCATION, UNIT NUMBER, DIMENSIONS, APPROXIMATE AREA, MAIN ENTRANCE, IMMEDIATELY ADJOINING UNITS, AND "THE ANNA' IMMEDIATE COMMON AREA TO WHICH IT HAS ACCESS, AS BUILT. (� I REPORT THAT THE PROPERTY SHOWN HEREON IS NOT LOCATED WITHIN A FLOOD PRONE AREA AS AT TR SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR COMMUNITY #250167 0 7 TF _ SURVEYOR: NORTHAMPT��� �' 1-9h MICHELE D. ST. PIERF I REPORT THAT THIS PLAN HAS BEEN PREPARED IN CONFORMITY SCALE: i•-2(r WITH THE 1976 RULES AND REGULATIONS OF THE REGISTERS HAROLD L EE OF DEEDS OF THE COMMONWEALTH OF MASSACHUSETTS. 235 RU SPR T T 413-594-75 RANDALL E. IZER #35032anal 0'