24D-243 ammo BP-2008-0417
GIS#: COMMONWEALTH OF MASSACHUSETTS
411111111111111111. CITY OF NORTHAMPTON
Lot: -614 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0417
Project# JS-2008-000614
Est. Cost: $12000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KRIS THOMSON 084152
Lot Size(sq.ft.): Owner: SANDERS ERIC H&LISE A
Zoning:URC Applicant: KRIS THOMSON
AT: 61 CRESCENT ST
Applicant Address: Phone: Insurance:
257 MONTAGUE RD (413) 549-1027 ()
LEVERETTMA01054 ISSUED ON:10/25/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN UNIT4/5
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Numbing 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 Signature:
FeeType: Date Paid: Amount:
Building 10/25/2007 0:00:00 $60.00723
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
, File#DP-2008-0417
APPLICANT/CONTACT PERSON KRIS THOMSON
ADDRESS/PHONE 257 MONTAGUE RD LEVERETT (413)549-1027 0
PROPERTY LOCATION 61 CRESCENT ST
MAP 24D PARCEL 243 614 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 7108
Typeof Construction: REMODEL KITCHEN UNIT4/5
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 084152
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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 Commission Permit DPW Storm Water Management
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
Department use only
G of Northampton Status of Permit:
E l ing Department Curb Cut/Driveway Permit
G01
1 a � 2 Main Street Sewer/Septic Availability_
2 , Rom 100 Water/Well Availability
QC\ champ on, MA 01060 Two Sets of Structural Plans__
`' ,. fae8 40 Fax 413-587-1272 Plot/Site Plans
0 04 - Other Specify
c
APPLICATIOFII 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 s igt��Q b/c�mpld by_ off ce
A/0{17.4. —
61 Gze.-9 c&47- s- . * s- Map 91p3 -6(J` L
trine tl ri'A..J'Tb�/ M (yr O&D Zone ) t(17 Overlay District
�_ �f f�) 77_ �,__ Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
I-i a SAND E-25 G( case-Qvr sr. Aloat7 rnp7V
Name(Print) • Current Mailing Address:
yr3 — Sla - 04 q7
Signature ‘:-01/1-'1/744Telephone
2.2 Authorized Agent:
Kr 1 s IAN,cf45 bh _.w....__ _.��.__. Z-�71 6h" ? .V�?r e '
Name(Print Current Mailing Address: A- OJO S
Signature "' Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 10 O OO (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
)/ OOO Construction from (6)
3. Plumbing Building Permit Fee
1 /0uo
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 1 Zj OGG Check Number 7;J 1400 —.0.'
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
, 4
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 Existing Wall Signs 0 Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other 0
Brief Description Enter a brief description here.
Of Proposed Work: ( IA- e,I (20% (�l_,�X f
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 CI A-3 0 1A I ❑
A-4 ❑ A-5 ❑ .1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I 0
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A 0
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 0 3B ❑
M Mercantile ❑ 4 El
R Residential ❑ R-1 0 R-2 0 R-3 0 5A ❑
S Storage ❑ S-1 ❑ S-2 0 ) 5B ❑
U Utility n Specify`
u
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) __µ,_,. ..,.____....,. _.
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
w_
1st
2nd
2nd i
3rd 3rd _
4th "
th 1
Total Area (sf) Total Proposed New Construction(sf)
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 0 Zone Outside Flood ZoneD Municipal El 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 __.. .... .. _M.,
Frontage .__,..._ .._. r._..
Setbacks Front __..
Side L:"..._.. R:
Rear . ......,._.
Building Height
Bldg. Square Footage
Open Space Footage
(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 �i►�® YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q 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 Q
CeN
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained tQ Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO i
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, ex avation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO ��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
oi
Version1.7 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 ❑
Name(Registrant): __ .__....._...
Regis t tion Number
Address ___ ....._ ,._ .__ _.
Expirati n 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
i
Signature Telephone Expiration Date
I
Name Area of Responsibility
i
..._, _._ .._.. ) .. _ . ._«..
Address Registration Number
Signature Telephone Expiratioh Date
Name Area of Responsibility
Address Registrabon Number
Signature Telephone Expiration Date
9.3 General Contractor
____„ _- Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
. '11/4 .
Versionl.7 Commercial Building Permit Mav 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) •
I Independent Structural Engineering Structural Peer Review Required Yes C No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, km S hk u+r�te-S ,as Owner of the subject property
hereby authorize . _Kei+S S`r-7/7-1(14-p
to
act on m alf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, r t 5 ` " �U!`1� A ✓� __-._ ,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 t t\piai an r nalties of perjury.
F-r 1 S vo s0►%1 3
Print Name ,... .,__. _ ..)0/ I<1 07
Signature of Owner/Agent Dat
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
��v'tS(L;avv of • t 15 2-
Name of License Holder: ------ - --- - -
License Number
Address Expiration ated
,,.....,....7
Signa 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.
wr
Signed Affidavit Attached Yes (110 No 0
A . 1
�i. \ The Commonwealth of Massachusetts
Department of Industrial Accidents •
"'=' i'`i J� Office of Investigations
;',�� Washington ashin�aton Street
- -7 Boston,M 4 02111
° ' www.mass.gov/daa •
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LecibIv
N rn e (BusinessJOrgani7arion/Individual) 1e._r /5 --Tic)6 vv's cll.--
Address: 2 5 7 N o c.&t ci<,,v_ 12—Crt • LC_lh€Y' et J O /0 S 4-
City/State/Zip: Phone.#: 4 ( 5-4 7 — )0 Z'7
Are you an employer?Check the appropriate box:1.❑ I am a employer with
Type of project(required):
4. fJ I am a general contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
2.�I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
shin and have no e..7.loy ees These sub contractors have. g• Demolition
working for me in any capacity. employees and have workers'insurance.:
9. Buildinv addition
[No workers' comp.insurance comp. in�r
required.] 5. We are a corporation and its 10. Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 11.0 Pbimhing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12. Roof repairs
insurance required.]t C. 152,§1(4), and we have no
employees. [No workers' 13.ii Other
comp.insurance required.]
*Any applicant that checics box#1 anus also fill out the section below showing their workers'compensation policy inf. ..ion.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must sub j t a new affidavit indicating such.
Kona-actors that check this box must attached an additional sheet showing the name of the sub-contractors and state •' -then 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 Arirrress: 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 impositi n of criminal penalties of a
fine up to S 1,,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a ST P WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forty ded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb certify a der ains and penalties of perjury that the information provided above is true and correct
Signature: Date: 10/II/07
Phone r: 4 ( 3 — 5- 4 S _j Q z 7
Official use only. Do not write in this area,to be completed by dry or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
II-
1.1'
k 1 J� I V f l�l = �C
E
9 ,
0 Sihle-
OCT-1' '7 --- '0 .---L. -
2 4 2007 ,..
i Fr)
ps.CMONS I
DEr-12 ;',.....c,,i,o rilif, ,
;_________„••_._
041‘
Lot,en n t7
0
Lja..I ( @ (€2 , (t^Cor t 1 oac.k b o r i c c�
140v-e., s'COtl6 141 A ' 4 " (s.k.o K i5 e\ ecf.fl(i)
, $l Vk. 4 cY ;a) JtQ 1 1 k._ L4„,e.
d I rl 5 a 0 ,,J cc.i6 S c t i c( Vt %,,i is(a-t.„cf
Nc., v L, ) k...'iv1dok3 S
N 0 C G.ck.( lc a. v -tic c-•,2.1r,(ov'' L...Jck j I S
l.l.'' -.._, _,-- --- ---- - __
- K.(4-C_&_ 4\ ( Nx6_ ( icy rr'
(O ( GresL& t s V 4< S
YY-.r; 5 'fl scsliN.
tatinkikrEP-4*t. - �km coo Sy rn \--,.,r '
�' � / _ 1�—b9 4 'is1 d( v» \ , ,
GJ
rd ,,
, / 70 O. cr.5 Ili 1
,44,0 s i 4- ) i ,1) , , - 47
0
orwEiwo, �,�Z-� — ) I
4) (-1.-) ,-
(:,,,o>i la Cqi , ,.
..
Q7 dogk))0 aa2- i.1- E:11) 611196.0( (d34g1V 47Zg
J
Via. .L '5 4" 4;I i`J 5. 1 fib.) Ill8 aj g *hi Idi .
g �5ZZ9 5; L * 1.6? Ili y)1,e.wIN
i1.50
si a 41i)
_.:ter ___ __.:4k C)
libE * * (ibtiM ,',
iz (a.4a 3N5{�) JM C) 11�J0`� ))�x1 �1.. goi
J (, I ,