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17C-214 (25) 99 MAIN ST-I1'S TAVERN BP-2017-0208 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: I7C-214 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-2017-0208 Project# JS-2017-000354 Est.Cost:$3000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCOTT CALLAHAN 97309 Lot Size(sq.it.): 44474.76 Owner: FLORENCE FAMILY ENTERPRISES LLC zoning: GB(I00)/ Applicant: SCOTT CALLAHAN AT: 99 MAIN ST- JJ'S TAVERN Applicant Address: Phone: Insurance: 33 WESTVIEW TEAR (413) 320-6269 EASTHAMPTON MA01027 ISSUED ON:8/17/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT KNEE WALLS TO CEILING 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 St Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: OI: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeType: Date Paid: Amount: Building 8/I7/2016 0:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Filed BP-2017-0208 APPLICANT/CONTACT PERSON SCOTT CALLAHAN ADDRESS/PHONE 33 WESTVIEW TERR EASTHAMPTON01027(413)320-6269 PROPERTY LOCATION 99 MAIN ST-D'S TAVERN MAP I 7C PARCEL 214 001 ZONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT / ,//� Fee Paid (� Building Permit Filled out Fee Paid Tvueof Construction: CONSTRUCT KNEE WALLS TO CEILING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 97309 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOKMATION PRESENTED: &4pproved 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 'Edition Delay 7 -/7/6 Signa • of'soil:i i wial 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. Version .7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: BE ElVED Building Department CurbCut/DriveaayPt 212 Main Street Sewer/Septic Availability AUG t 7 2446 Room 100 Water/Well Avasabiiiy orthampton, MA 01060 Two Sets of Structural Plans at, eammnsisa-; }. e4 3-587-1240 Fax 413-587-1272 Piot/Site Plans 1 hAMPIDM, Otter Specify 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 as Ma,meek Wil �� ^� Map `7e, Lot 02f y Unit %oto 14 )N''o C211%1U4 Zone Overlay District �' �CAvEfi�N Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 'fiCtt./5NB rO2N41.S aOS Name(Print) Current Mailing Address: 43 , spa•Ace/0 Signature Telephone 2.2 Author/ A nt: Sot✓ 1t.UMu t' W N cta taOn keD6 ODA SS teACCai iM fe Name(Print) Current Mailing Address: J 4+3 433•`7x11 Signature / Telephone SECTION S-ES• ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of S bx7 Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) .vv� 5. Fire Protection II , 6. Total=(1 +2+3+4+5) uXDCheck Number e This Section For Official Use Only / ir Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wali Signs 0 Demolition 0 Repairs❑ Additions Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roo0ng❑ Change of Use❑ Other 0 Brief Description Enter a brief description here. � Of Proposed Work: E.X•S''•ciS`Set +G,,,1C1\S 'W C { C.+{ AD S>tttR( cvtleiP3t€ 1Yt+ems SECTION 6-USE GROUP AND CONSTRUCTION TYPE �R "�` USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 0 1A I 0 A-4 0 A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B I 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A 0 1 Institutional 0 I-1 0 I-2 0 I-3 0 3B f1 , M Mercantile 0 4 0 R Residential 0 R-1 ❑ R-2 0 R-3 0 5A 0 S Storage 0 S-1 0 S-2 0 58 , 0 U Utility ❑ Specify; M Mixed Use ❑ Specify; - S Special Use 0 Specify: - .. COMPLETE THIS SECTION 1F EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): . . SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st if a) 1' 2"c 2O° 2,an 3" 3rd 4m 4ih Total Area(sf) [.Ir f,Y) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(MAI.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public cs Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system] Versionl.7 Commercial Building Permit May I5,2000 8. NORTHAMPTON ZONING Requiredby Zoning This erg umn to be filled in by BuildinggDepartment Setbacks Front MM. Side Rear Bldg.Square Footage 1111.111111111.111111 Open Space Footage �� (Lot area minus bldg&paved Open } trki vo ( lu ®® (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES U IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO iti&Z DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained a , Date Issued: C. Do any signs exist on the property? YES NO Q IF YES, describe size, type and location: *S—\,crA,y \2ukt&`rtes‘ta �.,/ D. Are there any proposed changes to or additions of signs intended for the property? YES 0N {,Y} IF YES, describe size, type and location: 'W' • E. WU the construction activity disturb(clearing,gradin ex vation,or filling)over I acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version].7 Commercial Building Permit May I5,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable tti 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 Not Applicable 0 Company Name Responsible In Charge of Construction Address �..�_. Signature Telephone Version!.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ti' 1 me --V1J.hs) as Owner of the subject property e-• $ � � hereb - - odze -G ROS—u}�rr� to act • y behalf, in all matters relative to work authorized by this building permit application. •et)ture of r �— INS _. Date I,_ iCI t'-) ` /M."% VN . ,as OwnerlAuthorized 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 perjury.. Print Nam: _-n - _- il6(16 .nature of• -dR•i_rt Date SECTION CONSTR CTION SERVICES 10.1 Licensed Cpnstructlo4 Supervisor: Not Applicable ❑ Name of License molder: . R. C l75%t; . ��'� ��� License Number 55 ?'t,Ire..J -7CftZ.€e C; TL^Fzi-tr',}k:r1 7i- -7-- ( i Address Expiration Date Sign re Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150k Address of the work: (IS Nkc„c-,510c/'(c4_i The debris will be transported by: The debris will be received by: \i c\ '� ( x Building permit number: J Name of Permit Applican, } , _I, Date J '``f Permit Applicant C-`----------- r JS\s-c ao`" c4 a1A. ,S cr eJ � CrS -9 , e 91 1 \ ) 7 1 ? T , (. ..4„icx,,,,,,-)i-pri I ________ __ f ,6),,co,,, c-- ___ II �I ) 1 i ix .isa��Q \ The Commonwealth of Massachusetts Department of Industrial Accidents 1 "'I. 1 Office of Investigations =e5:atitir 3� 1 Congress Street,Suite 100 ., t� Boston,MA02114-2017 ' �� www.mass.govldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �+ Please Print Legibly Name (Business/Organization/individual): SSC©I,( CR,ctal Address: '3 5!!����rtr.,..�pQ j k- -5 e-- int .._ City/Slate/Zip: 1 ' Phone #: -32-0= a .s Are you an employer?Check the appropriate box: Type of project(required): I.® 1 am a employer with 4. 0 I am a general contractor and 1 employees(full andtor part-time).* have hired the sub-contractors 6. ®New construction2. [am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity, employees and have workers' [No workers' comp, insurance comp. insurance.. 9. 0 Building addition required.] 5- 0 We are a corporation and its 10.[] Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ` c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp- insurance required.] *Any applicant that checks box a I must also fill out the section below showing their workers'compensation policy information. t I lomeownex 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. tic. t(: 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 MOL,c. 152 can lead to the imposition of criminal ocualties 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 DR for insurance coverage verification. I do hereby ea under the pa , -es of perjury that the information provided above a true and correct. irAf I 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#: —