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32C-067 2 CONZ ST-MAPLEWOOD SHOPS(REAR) BP-2009-0079 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2009-0079 Project# JS-2009-000101 Est. Cost: $13500.00 Fee: $67.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group JOSEPH TYPROWICZ 093516 Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC Zor r;? Applicant: JOSEPH TYPROWICZ AT: 2 CONZ 5 r - jF EAF Applicant Address: Phone: Insurance: 417 SPRINGFIELD ST SUITE 210 WC AGAWAMMA01001 ISSUED ON:7/23/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:REBUILD CATWALK DECKS (REAR) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service; Footings: Rough: Rough: Foundation: gray s'iaz1: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: , 0 9 A 6'6 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 7/23/2008 0:00:00 $67.501970 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo File#BP-2009-0079 APPLICANT/CONTACT PERSON JOSEPH TYPROWICZ ADDRESS/PHONE 417 SPRINGFIELD ST SUITE 210 AGAWAM PROPERTY LOCATION 2 CONZ ST-MAPLEWOOD SHOPS(REAR) MAP 32C PARCEL 067 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out //X `/9Fee Paid +/�`r°Typeof Construction: REBUILDALK DECKS(REAR) New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 093516 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRIVIATION 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 Demolition Delay 7/2_5/0 Signature of Buil ing 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 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 PiotiS, Pln?; r�� rr {i viri tir Other,Splecif L2 <<, (I 1/ l'4' I 1 `, APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH;ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DJWLLLINU L 1 3 2008 i ' i SECTION 1 -SITE INFORMATION I a_.. .__ _ J This s�ttio�`to'li pr Eby office 1.1 Property Address: 0 1 onz Map Lot :. ------ntapituravd-- 2 Zone Overlay District Elm St.District CB District SE T1ON 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 wrier of ecor 4 /Aea5Y---- Name rint) Current Mailing Address: Signature Telephone 2.2 Authori d Aq AA et � e el C: � _"1 gAm\ . - ` � `�Q maw.t �.� _.___ _ �i_1...�-Q_.__ _ ,c) �,. Name(Print) Current Mailing Addre Signature �� .'��(;f _ Telephone SECTION 3-E TIMATED�CONSTTRRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building - ( c� (a) Building Permit Fee • f. 5 )3 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) _ j 3, 55;LI CO Check Number /97° !° � C 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 0 Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use 0 Other 0 Brief Description Enter a brief description here. Of Proposed Work: ,Q \ . A 0 e_- \\L SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly I A-1 El A-2 ❑ A-3 0 1A I ❑ A-4 ❑ A-5 0 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 El R-3 ❑ 5A I ❑ S Storage El S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify M Mixed Use ❑ Specify: SSpecial Use ❑ Specify: r_.�__..... �.,._.._.,��.r�_...w.w...m.,...._.._.,.........��..�.,...._�_..�... .._._._. ,.. ��.�,_.. ,� 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) 1� 15i 2nd _.. 2nd 3 d 3rd — 4m 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 Zone❑ Municipal 01 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 Frontage Setbacks Front Side L: R: L: R: • Rear Building 1Teight Bldg. Square Footage Open Space Footage .,._ _ (Lot area minus bldg&paved parkine) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW JR YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 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 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained C) Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 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 9.2 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 Q`OIu Ic,L 1-k.S2ff R...__,... 1+CJQ ;-t-l�l L - Not Applicable ❑ Company Name: 4c;teP H 1,{_F c,A c t c z _ Responsible In Charge of Construction SQg 5 a 5 at Ata Ovir, .w A ress .$2161 (01 a) Sig ture Telephone Sr Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) I 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 I, 0. as Owner of the subject property h_ _.yauthonze 19pccU.)iL—z-- oi'Y)Q _ .41'1 for 0, QQb1�1Rv\l �ls)C _._ to my beha f, •.att s relative to work authorized by this building permit application. tvqi 0 i / 7/ Signature of 06 er Date I, aL 1` _._..__... _ , as Owner/Authorized Agent hereby`declare tha the stat ments and information on the foregoing application are true and accurate,to the best of my knowledge and %- :f. Sig -. •er the pai L . cep: .lb s of perjury. / A'rint Name AI•• • . • • - . ' .: 1 ee al Q;. Signature of•, er/Agent ',ate SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: ,..:IC. N _ .1 tir.D. 1 .1. —._.. ... _ a _ _..._.. i .__._o_ . .1_(0 License Number Ac1 � - Add ss � . � � �-�-� _. ._ �.. Expiration Date Sign urevikS, 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 la No 0 • . _ ' t The Commonwealth of Massachusetts ' a.�. Department of Industrial Accidents 0 Office of Investigations • 600 Washington Street 7 Boston,AL4 02111 . • www.mass gov/din - -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeeibIv Name(EusinesslOrganizarion/Indivich,ai): 1Z„c ;Z lti!t-L kko'MQ. 1 -y,p to v emevCt 1 1 L.- Address: N 1(A JQ V l IN q (S r..lb T• S V 14-e. @,10 ' City/State/Zip: q uJ o,r(N. 4 1 © rO©J Phone.#: y i 3-7 8ci-(o r10 a Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.� I am a employer with�_ � 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. -�Remodeling ship'and have.no employees These sub-contractors have 8. ❑Demolition workingfor me in an act employees and have workers' Y capacity. + 9. ❑Budding addition • [No workers'comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. We are a corporation.and its 0 �P 3.❑ I am a homeowner doors all work officers have'exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption`per MGL 12.0 Roof repairs insurance*+ere required.]t c. 152,§1(4),and we have no ' employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeownei who submit this affidavit int{irat;n5 they are doing an word and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have • employem lithe 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: A 1r ( 13, Policy#or Self ins.Lic.#: RUC (JL Expiration Date:- 3 2.6''GR Job Site Address:01 C or\2_ -437. City/State/Zip:• I4)0r41c,ni#1T r'I W1,1 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 imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investisations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjuty that the information provided above is true and correct Simiatur �1. M 4 Date: Phone#: Li (3- 'M ei-- ii,c10, _ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License T Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone�`: