32C-260 (28)Version17Commercial Building Permit May 15 2000
SECTION 10 STRUCTURAL PEER REVIEW 780 CMR 11011
Independent Structural Engineering Structural Peer Review Required Yes 0r
No ItSECTION11OWNERAUTHORIZATIONTOBECOMPLETEDWHENOWNERSAGENTORCONTRACTORAPPLIESFORBUILDINGPERMIT
1 LA S 4 dmMas Owner of the subject property
hereby 1 hore 1 0 J
sr iv o work aut y this building permitapplication
Owner D to
as OwnerAmitf4erircd
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 un er f d enalties o lei
Print Name
t lb 24 t 1 wW
Signature of OwnerAgent ate
SECTION 12 CONSTRUCTIONSERVICES
101 Licensed Construction Supervisor Not Applicable
Name of License Holder l l C57119 C7
License Number
D 5 12DD r4 Fib3 cL4k ol31
Address Ex iration Date
Signature Telephone j
iSECTION13WORKERSCOMPENSATIONINSURANCEAFFIDAVITMGLc15225C6
J
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
Version17 Commercial Building Permit May 15 2000
SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTURES SUBJECT TOCONSTRUCTIONCONTROLPURSUANTTO780CMR116CONTAININGMORETHAN35000CFOFEIJsLOSEDSPACE
91Registered Architect
Not Applicable
Name Registrant
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineers
Name wArea of Responsibility
Address Registration Number
Signature Telephone Expiration Date
iII
Name Area of Responsibility
Address Ristration Number
ISignature Telephone Expiration Date
Name Area of Responsibility
YAddress Registration Number
fSignature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
SiSignature Telephone Expiration Da9PPto
93 General Contractor
Not ApplicableCompanyName
Responsible In Charge ofConstruction
Address
Signature Telephone
Version17Commercial Building Permit May 15 2000
8 NORTHAMPTONZONING
Existing Proposed Required by ZoningThiscolumntorefilledin by
Building Department
Lot Size M r a
Frontage
Setbacks Front
Side LwI R L R
Rear
Building Height
Bldg Square Footage 4 wyr
Open Space Footage m
Lot area minus bldg paved
parking r I t 3 4Z
of Parking Spaces
Fill
volume Location
A Has a Special PermitVarianceFindingever been issued foron the site
NO 44 DONT KNOW 0 YES 0
IF YES date issued
IF YES Was the permit recorded at the Registry of Deeds
NO Q DONT KNOW 0 YES 0
IF YES enter Book Page and or Document
B Does the site contain a brook body of water or wetlands NO 44 DONT KNOW Q YES Q
IF YES has a permit been or need to be obtained from the Conservation Commission
Needs to be obtained 0 Obtained Date Issued
C Do any signs exist on the property YES 10 NO 4
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 exc vation or filling over 1 acre or is it part of a common plan
that will disturb over 1 acre YES 0 NO 4
IF YES then a Northampton Storm Water Management Permit from the DPW is required
Version17Commercial Building Permit May 15 2000
SECTION 4CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35000 rf
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Demolition Repairs Additions Accessory BuildingExteriorAlterationExistingGroundSignNewSignsRoofingElChangeofUseOther J
Brief Description Enter a brief description here
Of Proposed Work nrIbe t y8
SECTION 5 USE GROUP AND CONSTRUCTION TYPE
USE GROUP Check as applicable CONSTRUCTION TYPE
A Assembly A1 A2 A3 1A IA4 A5 1B
B Business 2A
E Educational 2B r
F Factory F1 F2 2C
H High Hazard 3A I
1 Institutional 11 12 13 0 3B
M Mercantile 4
R Residential R1 R2 R3 5A
S Storage S1 S2 5B
U Utility Specify
M Mixed Use Specify r
S Special Use Specify
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS ADDITIONS ANDOR CHANGE IN USE
Existing Use Group Proposed Use Group
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34i
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USEONLYBUILDINGsCMcBt5FloorAreaperFloorsf4
1
2nd 2
3 3d
Total Area sf 6d Total Proposed New Construction s
2 t
Total Height ft 114 y fTotalHeightft
7 Water Supply MGL c 40 54 71 Flood Zone Information 73 Sewagepisposal SystemPublicPrivateZoneOutsideFloodZoneMunicipalOnsitedisposal system
Versionl7 Commercial Building Permit May 15 2000
fa D Olt Use on 4
Cit of Northampton t
18 20 Building Department212MainStreet pe aeilt VZZAWAr
NorthamofvstomNorthampton MA01060 e a
i
I sitep
phone 413 5871240 Fax 413 5871272 r Y 24 v
lathe era Fx c dr1fr164t4
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
11 Property Address This section to be completed by office
0 Qlk O nn i Map Lot Unit
0 06 Q Zone Overlay District
a We Elm StDistricti CB District
SECTION 2 PROPERTY OWNERSHIP AUTHORIZED AGENT
21 Owner of Record
E5How P J1k Patc LfoqhNamePrintfCurrntMailAddr
1 1 f
Signature Telephone
22 Authorized Agent
Name Print Curr nt MailingAddress
41496 0131
Signature Telephone
SECTION 3 TIMATED CONSTRUCTION COSTS
Item Estimated Cost Dollars to be Official Use Only
completed by permit applicant
1 Building QC Ia Building Permit Fee
2 Electrical b Est Total Cost ofcell8IConstructionfrom6
3 Plumbing Building Permit Fee
4 Mechanical HVAC pl t A
5 Fire Protection
6 Total 1 2 3 4 5 l Li 5 00 00 Check Number Q15
This Section For Official Use Only
Building Permit Number Date
Issued
Signature 1 9 ii
Building CommissionerInspector of Buildings Date
File BP 2012 0503
APPLICANTCONTACT PERSON GREGORY J BROWNE
ADDRESSPHONE 335 ADAMS RD GREENFIELD 413 687 1666
PROPERTY LOCATION 90 POMEROY TER
MAP 32C PARCEL 260 001 ZONE URC100
THIS SECTION FOR OFFICIAL USE ONLY
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fe Paid
uildinl Permit Filled ou
Fee Paid r v
TypeofConstruction CONSTRUCT DET 1 CAR GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin Plans Included
Owner Statement or License 76573
3 sets of Plans Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED
Approved Additional permits required see below
PLANNING BOARD PERMIT REQUIRED UNDER
Intermediate Project Site Plan ANDOR Special Permit With Site Plan
Major Project Site Plan ANDOR 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
12SignatureofBuildingOfficialDate
Note Issuance of a Zoning permit does not relieve a applicantsburden 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
90 POMEROY TER BP2012 0503
GIS COMMONWEALTH OF MASSACHUSETTS
MapBlock 32C 260 CITY OF NORTHAMPTON
Lot 001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit Building DO NOT HAVE ACCESS TO THE GUARANTY FUND MGL c142A
Category GARAGE BUILDING PERMIT
Permit BP20120503
Project JS2012 000841
Est Cost 1550000
Fee 5500 PERMISSION IS HEREBY GRANTED TO
Const Class Contractor License
Use Group GREGORY J BROWNE 76573
Lot Sizesq ft 2330460 Owner MUERLE LINDA
Zoning URC100 Applicant GREGORY J BROWNE
AT 90 POMEROY TER
Applicant Address Phone Insurance
335 ADAMS RD 413 687 1666
GREENFIELDMA01301 ISSUED ON1128201100000
TO PERFORM THE FOLLOWING WORKCONSTRUCT DET 1 CAR GARAGE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring DPW Building Inspector
Underground Service Meter
Footings
Rough Rough House Foundation
Driveway Final
Final Final
Rough Frame
Gas Fire Department FireplaceChimney
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 Signature
FeeType Date Paid Amount
Building 1128201100000 5500
212 Main Street Phone 413 587 1240 Fax 413 587 1272
Louis Hasbrouck Building Commissioner