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File#BP-2002-0697
APPLICANT/CONTACT PERSON Kohl Construction
ADDRESS/PHONE 31 Campus Plaza Rd (413)256-0321
PROPERTY LOCATION 25 MAIN ST-3RD FLR
MAP 32A PARCEL 138 006 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out P/a
Fee Paid Com'/!T277
Typeof Construction: 3RD FLR BATHROOM RENOVATION TO CREATE 2 BATHS&HANDICAPPED
ACCESS BATH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 078992
3 sets of Plans/Plot Plan
THE FO 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 'ssion
2 /9/cc) L
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.
Versionl.7 Commercial Building Permit May 15,2000
YI.Io:let-y:N' Ff4e_.el ..
•rthampton 43aTtEA,mofl• ,:
(_ t' G E � :JL�S •epartment 5?air,c) 4ilat, t/ a ani
u I i--------T] % i n Street 9i4/i n -Yrut, to c s
I —,t ' • •t 100 ?alp tor `raIt angisi ili )
,' FEB — o Atha - - n, MA 01060 .nipi *,;ir.l , n wFi(a
�I
phone 413-58 -12 Fax 413-587-1272 Ptl3 akrk,
L— m.rCicBS e174"1* iii:., :
APPLI:ATIONIO_CONST , ENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section lobe completed by office
1.1 Property Address: /� ��//fJ,�, + ' IF a'V'i,n„ /
Z6 MAIN ST t34teen_ Map n • Lot Unit 00CJ
U +•oily s irt414bn 4:,i,-
Zone — ''OverlaYTis riot, 'firm
a •
Elm St. District_ _ CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 1
2.1 Owner of Record:
C140115A COP 3L Campus PAaa4 /?q Al4/ty---
Name(Pr ll) Current Mailing Address'.
26A - n3a1
Signature Telephone
22 Authorized Agent: ''11
h ot)6L /V
AS -_ .. A 3t"A
K.N / nS
7P✓ /'A42.4 kij . /1/464E7
Name(Philp ON, ) � Current Mailing Address
ash 03a ,
Signatu Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
I. Budding /0 r 000 (a) Building Permit Fee
2 Electrical (b) Estimated Total Cost of
700 Construction from (6)
3 Plumbing Building Permit Fee
/O, t o o
4 Mechanical (HVAC)
5. Fire Protection /�
6. Total =(1 + 2 + 3 4 4 ( 5) 20, 90o Check Number dWBG J $3d —
�/�
This Section For Official Use Only
Building Permit Number. —SPOz 6q7 Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Version i.7 Commercial Building Permit May 15,2000
Sit la do ;IOC tMO 453'1'kili.3 '')3YYa}jXr,r Fs;T r fV I 4+}dp1itt
tjLtlt .. :Jr 3 k}La69i)-E '\113 Mir:, E - t
Interior Alterations ✓ Existing Wall Signs
Existing Ground Signs Additions 0 I Roofing 0
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ 1 Repairs [ ]
a y ..;......7r, ; 3 Kpi.. [SATH ti•°'°'m r ENovATro.✓ to (Rea" 2 2A74'S ANO Mietio '10)E4 4712,t4.
xc rtcl 41 tk.5:. ^I 16)n i- °,� Aut t �°IliFl�r
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly S A-1 0 A-2 ❑ A-3 IA 0
A'4 ❑ A-5 ❑ IB ❑ _
B Business Ef 2A 0
E Educational 0 23 ( ❑
F Factory 0 F-1 ❑ F-2 ❑ 2C 0
H High Hazard 0 3A ❑
_—_1
i Institutional 0 I-1 0 L2 0 1-3 ❑ 3B ❑
M Mercantile d 4 ❑
R Residential d R'1 ❑ R-2 ❑ R-3 II 5A ❑,
S Storage ❑ Si- ❑ S-2 0 58 01
LI Utility 0 Specify:
M Mixed Use ® Speafy:
Su51 NESS MERCAtOTIkE r A-3 (eeesrAtt-ArvrL, R-3
S Special Use 0 Specify:
COMPL5T 'lIS6*GT4ON-IF EXISTING BUILDING UNDERGOING REt4$XTIONS AD41TIONS AND/OR CHANGE IN USE
Existing Use Group: M Proposed Use Group-
Existing Hazard Index 780 CMR 34): N A r Proposed Hazard Index 780 CMR 34):
SECTION 8 8CIL INGMEIGHT;AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION L. . c) KSr, �h't5°I` ;'
No 5F. CHANCE L,
Floor Area per Floor(st) '
f
t.,__ /01 j 2m 3 $ � zr�
2°d /01222
3d l0 1 &C Orr
��
4'" /01275
Total Area(sf) 4/, 029 Total Proposed New Construction(sQc "
NQ Cr',w4 c'
Total Height(It)t) 33 CNANN' t r.E7 x'`
Total Height ft NO £'z "e " :0”,'-'..4. `
w
Versiont7 Commercial Building Permit May 15,2000
7.Water Supply(M.O.L.C.40,¢54) 7.3 Flood Zone Information: - 1 7.3 Sewage Disposal System:
I
Public O Private 0 Zone: Outside Flood Zone 0 ( Municipal 0 On site disposal system a
P. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: It: L: It
Rear
Building Height
Bldg.Square Footage %
,
Open Space Footage ,o
(Int area minus bldg&paved
parking)
#of Parking Spaces ,
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued tor/on the site?
NO DON'T KNOW v YES
IF YES, date issued:,,,,,,
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document ft
B. Does the site contain a brook, body of water or 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: S-rozearum sich4. vgerot
D. Are there any proposed changes to or additions of signs intended for the property?YES
Noj
IF YES, describe size, type and location:
Version2.7 Commercial Building Permit May 15,2000
* 'u .4C) iAt i) ^L(N I AN') (,jIZIS`Ci4J)lRltl[) .y n.p ) {LII i)li(* xl ) lYLJc ILII- S RLISB(cu tam
DOM: .t LIPith e),.1171rit7i)kbSl.V�ti ye) A:)L) rhJ:) { r 2i 3)Jr,0,> . «_ 1 tdj ?71< x),;,..
9.2 Registered Architect:
Not Applicable 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 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 D
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Versioni.7 Commercial Building Penult May I5,2000
�tiv a _ i';lel tri rt- �:- ! 11='A r I: lr, I ,m1
independent Structural Engineering Structural Peer Review Required Yes ❑ No 0
-1:11` iT;nr p l ri Dirk' I %'pl I c5 ) ." I T 1
crit rn=iE7 CO/9 ,fil;f7F trILIF= t ?ttilRie
I, , as Owner of the subject property
hereby authorize to act a
my behalf, in all matters relative to work authorized by this building permit application.
SignatureAA
of Owner y, I\V Date
I, NOUGI-
`_ A. oHl- , 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 perjury.
ht,t, 4- , s . K.. -
Print Na !
r C z. 5 O2
Signa of Owner/Agent Date
ry< lle7 t j�. r f,I w,d, 'V SS's '',k+':
4 •
10.1 Licensed Constructiont� Supervisor: KOHL.
Applicable ❑
Name of Liegase Holden tIOVGL AC, A_ KOHL CS 09g5792
License Number
31 CamPOs P ata k, HAo,try to-25' OY
Address' Expiration Date
G. 56 -03a
SignfSre Telephone
• e%Pic),,Id S;41tp1 KERS'COMPENSA11ONY,NSU NCEAFtFIdAVlT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavi
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes E( No 0
0.<IWIP1.
az,„O
20 '1,
(iiN of nrYl11lit} fern I i_.
'iii r jet. 91 u.uhnanb lif_
o_f_. :
any DEPARTMENT OP DI)!WING INSPECTIONS !7.
212 Main Street ' Municipal Building 'p
Northampton, Macs. 01060 as•
WORIQ,R'S COMPENSATION INSURANCE AntIDAVIT
L
lln•lcto.5_ A' knl, 1 of K ifi CtletrrtiCl/Q0_ Ileg
(li6ose/pcm ittec)
with a principal place of business/residence at:
ce
3t ___ ____`"`"""" ____ TTTT- 7 u S Plaza_ LA (phone#) tit/i a 5 -03 24
(mceddry/swnlap)
do hereby certify, under the pains and penalties of perjury, that
Y`) I am an employer providing the following worker's compensation coverage for my
employees wotidng on this job.
1AS1fRA/ CAtu/ortcZir.C. 14K96 60093 2 .io .O2-
(lnsur n¢ Coop mv) (Policy Number) (r.�.'piration Dale)
( ) I am a sole proprietor, general contractor or homeowner (dude one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Inn:ranc Company/Policy Nadal-a) (E,:nmuon Dam)
(Name of Coutramor) (Insuranc Company/Policy Numb^_r) (Ex-au-anon Date)
(Name of Contactor) (Insuranc Company/Policy Numbcs) (Expuaoon Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(evad a61:U.m1/Sera J ommuy to mc4h mo vane peruimn5 to.11 mmmu3)
() I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pimsc be aware that wdi)o homoowocm wbo employ pcicm to tb o-ai•n.-..n+ ®vuuw.r repro work on.dwclling of
not mere than aro,mina in which the homeowner revdm or m the groaned gputeuaot them x not ema^ny aomidot m be
owloym undo the wv4c s compmartica Am(GL151y 1(5)1 application by•hammw a for.base or ymn Cally cvibmcc We
legal trams of an eoloyer under to Wake?.CuCOvona.tion Ad
I undwand that a copy of this me®-m may be fmr.,d.d to We pcpvmvf of InSsn.l A c4 -..0ILoo of lmnooe for dr
coverage vnf'.eeioa and llut Llutc to a mus mcye tmdc.eaiw 1SA of MOL 151 an lad to[ha impmuim chimera]pmaltia
oomtans ofa fere of up to Sljno.00anNeYEmpriac®:m of up bore yor and civil pcJtia in tbc form of a Stop Work Ordo and.
fim of S100.00 qday tginga um.
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