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31B-230 (14) 64 GOTHIC ST BP-20C r)53C GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B-230 CITY OF NORTHAMPTON Lot: -004 Permit: Building Category: Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0530 Project# JS-2002-0811 Est. Cost: $37800.00 Fee: $189.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Tom Dawson-Greene 013633 Lot Size(sq. ft.): 0.00 Owner: NORTHAMPTON ARCHITECTURAL Zoning: URC Applicant: Tom Dawson-Greene AT: 64 GOTHIC ST Applicant Address: Phone: Insurance: P 0 BOX 556 (413) 296-4421 CH ESTERFI ELDMA01012 ISSUED ON:11/20/01 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT WALLS FOR INTERIOR NEW OFFICES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring U.P.W. Building Inspector Underground: Service: Meter: Footings: Rough:]/ Rough: 1115)0z, 124).-. House# Foundation: � C Ii""« Driveway Final: ,1::3!d `o c�ec `_ Final: Final: Z- $/uZ/zl - Rough Frame: tilt/4"L LS O,A all, /sl,7h — - '--`5„0,9 '�� Gas: ,� dvi Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: eh- 7�q•oa . ,ti9 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. r 4,fr____ _ :C_"'s .ter Certificate of Occupancy :ege' Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/20/01 0:00:00 3453 $189.00 212 Main Street, Phone(413) 587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo -fr.. If "e'r V. / 5 -7-Y02 2"WV 0',0,&2Y//71 kr"'7- ii_i1 /1-09 • -3 511t-• --)4 4) ; Lis , File#BP-2002-0530 APPLICANT/CONTACT PERSON Tom Dawson-Greene ADDRESS/PHONE P 0 BOX 556 (413)296-4421 PROPERTY LOCATION 64 GOTHIC ST MAP 3 l B PARCEL 230 004 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST' ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ip J Fee Paid �j� 7 Typeof Construction: CONSTRUCT WALLS FOR INTERIOR NEW OFFICES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 013633/]��""'�" 3 sets of Plans/Plot Plan tageJ4C-n THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Denied PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan OR Special Permit and Site Plan Major Project: Site Plan OR Special Permit and Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Varian e* 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 Po ,bility Board of Health Permit from Conservation Commission Permit from B Architecture Committee Permit from Elm Street Commis Signature of Building Official Date // zoy 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 � t� IIw _ i Df Northampton Status of Permit: I.t•/•'' u Iding Department Curb Cut/Driveway Permit f J Lc NOV i 9 2001 �I2 Main Street Sewer/Septic Availability Room100 Water/Well Availability rtha npton, MA 01060 Two Sets of Structural Plans o nc 8!l!!.D!NG f�1�$3-587 1240 Fax 413 587 1272 Plot/Site Plans___— �+naTu6?'O>�,MA 01060 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 00(4 Unit G1B, 64 Gothic Street Map 31B Lot___ 230 UnitGl Northampton, MA 01060 Zone Overlay District Elm St.District" CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Noriha ton Architectural Investment Corp_ 64 Gothic Street, Northampton, MA 01060 Name(P n E ar L. endry, President Current Mailing Address: (413) 584-7224 - ------------- Signatu Telephone 2.2 Authorized Men . C ntrac - haser effective 1/2/02 E&S Realty Trust Edward D. Ethered&e L Trustee___ -_ 64 Gothic Street, Northampton, MA 01060 Na e(P ) Current Mailing Address: — — - ----- — --_013.1_5_416DD ------- nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 22,500.00 2. Electrical (b)Estimated Total Cost of 3,300.00 Construction from(6) 3. Plumbing Building Permit Fee 5,200.00 4. Mechanical(HVAC) 5. Fire Protection 6,800.00 6. Total=(1 +2+3+4+5) 37,800.00 Check Number 34153 189.00 This Section For Official Use Only Building Permit Number:__ _ 6 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date: Version!.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations XiK Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0 ❑ 0 Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] �� %`�� Accessory Building [ ] Repairs [ ] SECTION 5-USE GROUP AND CON RUC N TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE /C A Assembly A-1 ❑ A-2 0 A-3 0 1A I 0 • A-4 0 A-5 0 1 B ❑ B Business C 2A 0 E Educational 0 2B El F Factory El F-1 ❑ F-2 ❑ 2C 0 H High Hazard El 3A ❑ I Institutional ❑ I-1 ❑ 1-2 El 1-3 ❑ 3B ❑ M Mercantile 0 4 ❑ R Residential 0 R-1 El R-2 0 R-3 0 5A 0 S Storage 0 S-1 ❑ S-2 El 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 all interior except new door Floor Area per Floor(sf) 15t__1-19 71_ s f Uni t< G 1 B 15t-__1,2Z1-sf__ 2nd 3rd 3rd 4th 4th Total Area(sf)_l,921_ 51--____ Total Proposed New Construction(sf) Total Height(ft) N/A Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public [X Private ❑ Zone: Outside Flood Zone El Municipal ID On site disposal system 0 Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING All interior renovations Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 1.114 ac. same — no change Frontage 266.4 same — no change Setbacks Front 20 same — no change Side L: 42' R: 15' L: � R. Rear 60' same — no change Building Height �� 35 9 Bldg. Square Footage 17.6 same Open Space Footage (Lot area minus bldg&paved 40 same parking) #of Parking Spaces 61 same Fill: (volume&Location) N/A N/A A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES X Variance Special Permit (2) IF YES, date issued: July 2. 1991 Site Plan Review IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES X IF YES: enter Book 3783 _ Page 206-208 and/or Document# B. Does the site contain a brook, body of water or wetlands? NO X 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 X IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES No X 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: Edward L. Jendry, AIA Not Applicable ❑ Name(Registrant): _MA Rem. Architect Registration Number 64 Go_ ic___S_tr_e_et,. Northat pton, MA 01060 ___ Address , ��4108 ii ♦ '''� Expiration Date .it 4111, ��Signatur " " Telephone August, 2002 9.2 Registered Profe ional :ngineer(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 __Th J aB_ wson S� one ElNot Applicable Company Name: Tom Dawson-Greene Responsible In Charge of Construction 14 Antin Road_ sterfieldd MA 01012 Addres L ___ �� _ _(413)_296-44i1 __ 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 ❑ No XI SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, /Contract Purchaser Edward D. Etheredge as Owner of the subject property hereby authorize Tom Dawson—Greene to act on y bey If, in all m-,ters ra-;.moo work authorized by this building permit application. 0110 __ /2j / / 4 �i 11114.40_1 S rf • e of Owner Date , 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. Pri tN • ature of caner/Agen Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: r /(c� Not Applicable ❑ Name of License Holder:_ 7 / .f C/ll LJ v, '1ta r��-- License!Amber A14"itiLl' id PO eVin—C ChVileVYC(0/6( riff 11 6 35 Address Expiration Date Si nature Telephone 0-,I/3 A ®o 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 0 ACORD CERTIFICATE OF LIABILITY INSURANCE M 11ii9izooi PRODUCER (413)527-5520 FAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE INSURED Tom Dawson Green Contractor INSURER A: Patron's Mutual Insurance Co. 14 Antin Road INSURER B: PO Box 556 INSURER C: Chesterfield, MA 01012 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY CTR0000546 09/08/2001 09/08/2002 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY n MT- LOC JEC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S. VVC $ WORKERS COMPENSATION AND STA7T- H- OR E EMPLOYERS'LIABILITY TORY LIMITS ER E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Etheridge & Steuer,PC BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE ��NNOO��OBLIGATION OR LIABILITY 65 Gothic St. OF ANY KIND UPON THE•. PAN , S AGENT'c.. ENTATIVES. Northampton, MA 01060 AUTHORIZEDREPRESENT-TIVE ACORD 25-S(7/97) ©ACOR' ORPORATION 1988