11A-058 (7) BP 2003 0647
GIS#; COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: BulldinE
Category BUILDING PERMIT
Pte# BP-2003.0647
Protect# JS-2003.1066
Est.Cost$500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group; Jeffrey Cranston
Lot Size(sq. ft.): 616374.00 Owner. BRISSON PIERRE R&SUSAN H
Zoning URA Applicant- Jeffrey Cranston
AT.- 124 HAYDENVILLE RD
Applicant Address: Phone: Insurance:
P O Box 307 (413) 268-3504
WI LLIAMSBURGMA01096 ISSUED ON:1/27/03 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE WOOD FLOOR WITH CONCRETE
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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/27/03 0:00:00 668 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Pardo
File#BP-2003-0647
APPLICANT/CONTACT PERSON Jeffrey Cranston
ADDRESS/PHONE P O Box 307 (413)268-3504
PROPERTY LOCATION 124 HAYDENVILLE RD
MAP I IA PARCEL 058 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid NVE
TvoeofConsttuction: REPLACE WOOD FLOOR WITH CONCRETE
New Construction
Non Stmctual interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,RNIATION PRESENTED:
ppmved_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:
Cub Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Comunission Permit from CB Architecture Committee
Permit from Elm Street Co salon
Signature of Building Official Dat
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.
Versioti Commercial Building Permit May 15,2000
f t� � {gy(
City of Northampton
Buildl Department � �
- 2fi'2 Main Street l��
Room 100
Northampton, MA 01060
_.sJANpfio&teM� 35$7,1240 Fax 413-5871272
J'
APPLICATION TO CONSTRUCT_, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
. OTHER THAN A ONE OR TWO FAMILY DWELLING
JAN � �
SECTION 1-T6°fCE INFORMATION
f��/� �t''This sect(o mPl'Eed bYA(tice
1.1 P oe tv Add ss: ✓ ," ;y„r
Lill 06 mF1 o/oS3 =RZone
i Ilk
v islrict
SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e P /6'/ S0641CN1 (*1e
Name(Prirt c \ Current Mailing Address.
�l3 ayey��s'
Signature. Telephone
2 2 Authorized Aeent,
Name(Print) Current Mailing Address,
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bpermit applicant
1. Building SV 5 b0 •� (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of.
Construction from:'6
3, Plumbing Building Permit fee
4. Mechanical (HVAC)
5. Fire Protection
& Total =(I + 2 +3 +4 + 5) Check Nuo
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
CONSTRUCTION SERVICES FOR PROJECTS LESS.THAN 35,000
CUB FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations DemolitionEl New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessary Building[ ] Repairs [ ]
IPMCU1n x1o"dYW —A r¢ .4 "/ Com"."k 4.
SECTION 5• USE GROUP AND CONSTRUCTION TYPE.
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 10 A l ❑ A-2 ❑ A 3 ❑ IA ❑
A-4 ❑ A 5 ❑ 1B ❑
FIBusiness ss 2A ❑
tional ❑ 28 ❑❑ F1 ❑ F-2 ❑ 2C ❑
azard ❑ 3Aional ❑ 1 1 ❑ 12 ❑ 13 ❑ 3B ❑ntile ❑ 4 ❑ntial ❑ R 1 ❑ R 2 ❑ R-3 ❑ 5A ❑
e ❑ S1 ❑ S2 ❑ 58 ❑
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): Proposed Hazard Index 780 CMR 34):
SECTION 0,BUILDING(HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION %!
n
Floor Area per Floor(sf)
a � s
�00 4zf9
r: 2nd k�
t-
2 na 3rd
fF
3'a 411,
Hh}
4th gx
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height It
Versionl.7 Commercial Building Permit May 15,2000
7. Waley Supply (M.G.L.c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public $ Private ❑ Zone: Outside Flood Zone ❑ Municipal On site disposal system El
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Depinunent
Lot Size
Fronto e
Setbacks Front
Side L' R: 1- R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
packimin
#of Puking Spaces
Fill:
volume&imcation7
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 Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
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: % 3x�
D. Are ere any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
Version 1.7 Commencial Building Permit May 15,2000
SECTION 9-PRDtgSIQ pL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDIN S AND STRUCTURES SUBJECT TO
CONSTRUCTION CO"NTa,PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 3S,DOO C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
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 f8
Company Name:
Responsible In Charge of Construction
Address
Signature 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......❑
SECTION 11.OWNER AUTHORIZATION-TO BE.COMPLETED WHEN
OWNERS,AGENT DR 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 Owner Date
I, 1 , as Owner/Authorized Agent
hereby doehilrelVat 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.
cc 7/- art' sSd/✓
Print Name
03
S,crinature of Owner/Agent Date
,EGTIQN 12-CONSTRUCTION SERVICES
10.1 Licensed Causing a vi r- /1 Not Applicable ❑
Name of License Xoltler: ✓GH✓5�`�
(l License Number
f66X X57 A/IaJAw5� n.xa 0)0!?h 02-25�d
Address Expiration Date
77a'
aa'Ls-
belach.re
gCi 13-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G)G:'c.152, 4 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....... 9) No...... 0
4SWJ1P2
��" (rifg of �dnrflTam}rfnn
8 �
e
DEPARTMENT OF BUIIDIT(G ❑dSPECIIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
QICCRSCf/perIDltltC)
with a principal place of business/residence at:
(ph,,O) SP6-6,603
(C.tee1/city/stafrinP)
do hereby terrify, under the pains and penalties of perjury, that,
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) IFxPhation Date)
O 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 Compazy/Policy Number) (Expinnaou Date)
(Name of Contractor) (Insurance Compauy/PoEcy Number) (Exp niton Date)
(Name of Contractor) (Imstmnce Company/Pob y Number) (Exphatioa Date)
(Name of Contractor) (Insurance Company/Potiry Number) (Expiration Date)
(etl h v.LiRimal rV%l ifamauY N rocJ141e wfmID.rim pcbimpg b sll a�vGNn) ..
( ) F am a sole proprietor and have no one working for me.
Q�( I am a home owner performing all the work myself.
NOPE plw.e be nwuc tlm xy;la hommwua wha�loy N+ou*u M..,.:.�..r ccasrrtiw a<rzra'vwad:w•Evaing o[
vol may Wen Wtm miuwwEid+t6e 6ommwoccaidnamthe&ouvde NPvkaemfb�eR vct a�M�°IlYaomidaef wbe
�laym vadatheucNXam&derthn W
rp im Aa(GLI32sal(3)b ryglimwbyabommwar Lore&muapamamvy cr'- - Nv
legil n+eu a.n mployw akn'a Coatpmtiou Aa
I avdc-T-Mi tawpyofW nit®enm.ybfo--dr bWe Dap dMGI,152.1 d fld , pafi afar omfmL
muea8e wf.fi im cod 51,500 t-Wm riingacodaseaim23AofMOLISRmladen fie aofa sk,Wi rpemltia
anwtegafa6ae ol'upbt1,30p.00 mNa®ptiavomem ofupmam ywaad avap®loa vibe lam ofa Scup Wak OrGr mda -'
5oa afSlOn.00 a daY a�iaa me
For dlvauaf+l u+e m7'
Permit Number
a as Mapa iota _
6aaMe of Lioensee(Perminee