32C-239 (12) 23 EASTERN AVE BP-2003-0034
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-239 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0034
Project# JS-2003-0098
Est.Cost: $40000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVID NUNEZ 128305
Lot Size(sq. ft.): 15812.28 Owner: HART JOAN M
Zoning:URC Applicant: DAVID NUNEZ
AT: 23 EASTERN AVE
Applicant Address: Phone: Insurance:
41 BRIAR HILL RD (413) 268-3395
W I LLIAMSBU RG MA01096 ISSUED ON:7/9/02 0:00:00
TO PERFORM THE FOLLOWING WORK:I N STALL VINYL SIDING
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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/9/02 0:00:00 1653 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other 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
1-)3 For a. , Map Lot Unit
I'^'�- Zone Overlay District
Elm St. District __ _ CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 7.,/1 ',0,
,
--eq...., 4,,,,1-- --/v/v c._,ves=. ;4(ast
Name(Print Current Mailing Ar ddress:
Signatu Telephone
2.2 horized Agent:
Nc/A.4Z 'i 1 Rrw- HA Qd L 7/) j
Name( t) Current Mailing Address: I
.--L'="---....----- 913 -gC&- T3?c
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Li 7C
/ Ca' _ (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
6. Total =(1 + 2 + 3 + 4 + 5) / — Check Number _
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
• Version1.7 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 Existing Ground Signs Additions 0 Roofing 0
0 0
Exterior Alterations Demolition❑ New Signs [ I Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
Fit`" "DE,cre: -rrb.3: T N51t.1 j • 14.-)i 54i,?. & t- , t ) )I--4
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C 0
H High Hazard 0 _ 3A 0
I Institutional ❑ I-1 ❑ 1.2 0 1-3 ❑ 3B _ 0
M Mercantile 0 4 ❑
R Residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A 0
S Storage 0 S-1 0 S-2 0 5B I ❑
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 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf) 1st
1st 2nd
2nd 3rd
3rd 4th
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
Version1.7 Commercial Building Permit May 15,2000
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 Zone 0 Municipal ❑ On site disposal system 0
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: 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 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 #
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:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
Versionl.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):
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 ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
. Versionl.7 Commercial Building Permit May 15,2000
SECTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l �Ogni 14a✓} , as Owner of the subject property
hereby auth•rize 'py)L AJC,Iv F Z, to act on
my behal , all matters r ti to wo k authorized by this building permit appl catio
o?G 10
Signat,'of Owner Dat•
, 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.
Print Name
Signature of Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder :
License Number
Address Expiration Date
Signature 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 ❑
O' O
ate ' �fl (�ztz of Ntirf 1i&mpftm
$ B assaclinsctfti
DEPARTMENT OF BUILDING INSPECTIONS d
212 Main Street ' Municipal Building
Northampton,
ham Mass. 01060,
WORKER'S COMTENSA'ZION INSURANCE Ak'F1DAVIT
I, al Ltd kt.t,
(Iicensee/permittrf)
with a principal place of business/residence at:
(1 I � 1 1I 1 ul (,.): (phonei/) c),46 r5 —.
(b itxt/city/statrinp)
do hereby certify, 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) (Expiration Date)
( ) 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 Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration )ate)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shed ifnw'-...ry to include information pertaining to all oca ractors)
(y)- I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
• NOTE:please be aware that while homeowners who employ persons to do malnrr+rx.0 r construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or oa the grounds appurtenar d thereto arc not generally coosidacd to be
employers under the'Rocket's cYa•p-nrotion Act(GL152,aa1(5)),application by a homeowner far a license a permit may evidence the
legal status of an employer under the Worker's Compensation Ad-
I understand that a Dopy of this rat t may to forwarded to tho Department of Industrial Aceiderb'Offioo of Insurance for the
coverage verification and that failure to secure coverage trader section 25A of MCOL 152 an lead to the ikon of criminal',penalties
cooaisring of a fine of up to S 1,500.00 and/or imprisonment of up to ore year and civil penalties in the form of a Stop Work.Otdr and a
fine of 5100.00 a day against trx.
For dcpartmersal uac only
Permit Number
Map# Lot#
Signature of Liccnsee/Permittrr -Date