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32C-067 BP-2005-0897 2 CONZ ST-UNIT#8 COMMONWEALTH OF MASSACHUSETTS GIs#: Map:Block: 32C 067 CITY OF NORTHAMPTON Lot: -001 Permit: Building BUILDING PERMIT Category: Permit# BP-2005-0897 Project# JS-2005--1247 Est. Cost: $4300.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Contractor: License: Const.Class:Use Group: SCOTT JOHNSON 082324 Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC Zoning:NB Applicant: SCOTT JOHNSON AT: 2 CONZ ST UNIT #8 Phone: Insurance: Applicant Address:1482 CAPE ST (413) 628-0217 WILLIAMSBURGMA01096 ISSUED ON:3/29/05 0:00:00 TO PERFORM THE FOLLOWING WORK:CUT IN 1 INTERIOR DOOR, MOVE SINK & ADD 1 SINK UNIT & ADD WASHER & DRYER POST THIS CARD SO IT IS VISIBLE FROM THE STREET Building Inspector Inspector of Plumbing Inspector of Wiring D.P.W. Underground: Meter: Service: �,/ d5 I �7 Footings: // House Foundation: Rough: -c j',(\,/ Rough: 7/5 /s- ,,,j) drivewally Final: Final: 57,2 , '/ ,$3 Final: /S�f s- pp, Rough Frame:( h'iJ a ^0 p�l�w Gas: Fire Department Fireplace/Chimney: Insulation: Rough: Q—il. Smoke: - i Final:6/ 5 a�- Q _& Final: ;,)•6 6 TH IS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ----.2• ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: (/ FeeType: Date Paid: Amount: Building 3/29/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo fallitallikaPOW BP-2005-0897 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-0897 Project# JS-2005-1247 Est.Cost: $4300.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SCOTT JOHNSON 082324 Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC Zoning:NB Applicant: SCOTT JOHNSON AT: 2CONZST - UNIT #8 Applicant Address: Phone: Insurance: 1482 CAPE ST (413) 628-0217 WILLIAMSBURGMA01096 ISSUED ON:3/29/05 0:00:00 TO PERFORM THE FOLLOWING WORK:CUT IN 1 INTERIOR DOOR, MOVE SINK & ADD 1 SINK UNIT & ADD WASHER & DRYER 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: FeeType: Date Paid: Amount: Building 3/29/05 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2005-0897 APPLICANT/CONTACT PERSON Scott Johnson le gdp —D02-t 7 ADDRESS/PHONE Conley Dickinso Hosp NORTHAMPTON ()182-2313 0' PROPERTY LOCATION 2 CONZ ST-UNIT#8 MAP 32C PARCEL 067 001 ZONE NB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �O Fee Paid c,e( — Typeof Construction: CUT IN 1 INTERIOR DOOR,MOVE SINK&ADD 1 SINK UNIT&ADD WASHER& DRYER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082324 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 Co ssion ,/ iel< .4y/40-- k3X-,ar/00,r--- 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. . i - Version 1.7 Commercial Building Permit May 15,2000 / r . 4�� �epa n �t<.useonl . ..t• _ — �� C , df Northampton Via' ,a� y _ ' Vj �� . Building Department " e 1 r--'"- 212;M in Street a sS_ et- ai-'c ' 2 3 2.W `Room 100 va r - �P Northampto MA 01060 T° `f:0 - a s�� ;. \--' phone 413-587-124_1 Fax 413-587-1272 Pot7Si e,,. ' mot � _ S L ~: Ottae-itirrSpeCmfy� .. 'kW - 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 -_ This section to be completed by office --- J1-.-1-Property-Address: • _ _. -__ I (9% C O/v7 Sf Map g)e Lot 6_ Unit -PL 1 /1)4 .EL�ae 3 j 'fS ?,..,. Zone Overlay District Elm St Distract' CB District -PROPERTY OW SECTION 2 NE RSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 41 Y ,6EIW J °"-' !38' /11417V S J y Name(Pri •) Current Mailing Address: I-- Signature Telephone 2.2 Authorized Anen . j ; Name(Print) Current Mailing Address: Signature Telephone SECTION.3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be - Official Use Only completed by permit applicant 1. Building ( ����. i ;(a)Building Permit Fee i i. 2. Electrical i I (b)Estimated Total Cost of = 4430 0 D 1 Y . - l Construction from(6) " t; 3. Plumbing <f3000 ? BuildingPernitFee 4. Mechanical(HVAC) i 5. Fire Protection 6. Total=(1 +2+3+4+5) y 30 0 — Check.Number /7 !) $-Q : This Section For Official Use Only // Building Permit Number 'Date -Issued r Signature: Building Commissioner/Inspector of Buildings Date Versionl.7 Commercial Building Permit May 15,2000 r-• SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use 0 Other ❑ Brief Description Enter a brief description he e./1101/t— S' //U v/c /< / / 7.--. /P7�CE Of Proposed Work: jiv 7-E f 79 n + AI D Q C 4 O7'4-C� &14Sft'E7` , -i—U A y G I, A D 1 .'/N K V M 117 Cud' /N OwE r,v7F/O<. t)ce/�'�..-. SECTION 5-USE GROUP AND CONSTRUCTION TYPE ' 3 USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ElA-1 El A-2 ❑ A-3 0 1A I ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ..__0 H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 0 S Storage ❑ S-1 ❑ S-2 ❑ 5B [ f U Utility ❑ I Specify: I 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):` _ I Proposed Hazard Index 780 CMR 34): ' I SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION • OFFICE USE ONLY Floor Area per Floor(sf) - 1st 5t aO F I 2nd l 2nd: 3ro -J 3'd 4th , 4th Total Area(sf) ..ZO S(;,P fl Total Proposed New Constructionjsf) Total Height(ft) I 2., I . Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa a Disposal System: Public y( Private 0 Zone' Outside Flood Zone Municipal On site disposal system❑ I Version1.7 Commercial Building Permit May 15,2000 �- r Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I Frontage Setbacks Front Side L: I R:l I L:: I R:!..—! I Rear -Building Height __ - Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved ! I I i 3 palling) #of Parking Spaces i I I Fill: ' I, (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 4�4 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: enter Book j Page! and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Ali NO 0 IF YES, describe size, type and location: I toe 3 d��/ �`XTo2 i O D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 1;1 IF YES, describe size, type and location: j 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 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): 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 i Address Registration Number I Signature Telephone Expiration Date E i Name Area of Responsibility Address Registration Number i E i 1 Signature Telephone Expiration Date 9.3 General Contractor Not Applicable Cl Company Name: Responsible In Charge of Construction I r , Address Signature Telephone { , • • • Versionl.7 Commercial Building Permit May 15,2000 r. SECTION 10-STRUCTURAL PEER REVIEW J(780 CMR 110.11) . - Independent Structural Engineering Structural Peer Review Required Yes 0 No Q SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING'PERMIT 1, " Q ' ` C`��^��'����_ .,as Owner of the subject property hereby authorize �CL----::..SCIV\. ? \act on,my behalf,in'3 -Matte relative to work authorized Wthis building permit application. --- -, Signature of Ovine Date I,' ,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 perlur Print Name i Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction�Supervisor: f . / Not Applicable ❑'/ Name of License Holder:' C)n / ►s� - V O J4/J S AV 0 1 ' CS ?cZ 3a'7 License umber /"/ ,F 2 C( c �ST— wr&Al ,-SA/Ai Al/.�- cjogG i ! L/ a23/.2 Uo(o Address Expiration Date /`l() ( 2ZrCAZ/7 Signatur Telephone SECTION 13-WORK RS'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 r • �o�civ�r�Toy rr.. • )2410.111t � E (iii l of North a ton . � � f �Z asaRch ntclla" - DEPARTMENT OP BUILDING INSPECTJO1.'S • — 212 Main Strcct ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION UNSURANCE AFIF DA\rrr • I, `_ co1 T 3612 --g 0/1 - Oi�xJpermittec) < YE.Z-_ c'r c. . 641,-.pt asi-p-a1-p1.a e-f busi-ae-ss/-r-tsidencc at.. �j� Sl (C/ 144141 Y 41/1 I1/ _ (I;honcf=) 71,>- 4'2 7 (so-�t/ci ty atcJD p) do hereby certify, under the pains and penalties of perjury, hit ( ) I am an employer providing the following ;'orker's comnensadon coverage for my employees working on this job. (insures=CoQcan\') 1Yol-ic: .Nt1'":].bcr) -- (E:pinion Dale) ( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired the coon actors listed below who hive the following worker's c000ensadon policies: (Name of Contactor) (Insurance. Coinoanyi?ouc; Nutnhc:) (:ri:uirotion Datc) (Name of Contractor) -- (insttranc: Compa y/PoLie Nunccr) (Lxt)tPtion Date) (Name of Connaeto,) (Insurance Company/Policy Nambc.r) (Expirtion Date) (Name of Contractor) (Losuranca Comratly/Policy Number) _ (Expiration Date). (ea.tt:ti i ioca1 r_'tcv if ooa-,..ry to c,du&inforataaoo pa-oiain6 to.L coca-...c-c:a) I I XI am a sole proprietor and have no one worming for me. ( ) I am.a home owner performing all the work myself. NOTE:plcsc be cw-uc the.,+1 Jc bomcowocn tvbo czriploy poi to do r--.f,-1<-,,m c�.:cJ:o c r.-pair work co.d.•c11_z of not mac th_n h-w_t 3 t$is which the bornoo -oc,-raic}o or oo the _,z.ppurteo_ tJ o s.rt ux�ca11y occ c roi w be carployc3 untie the wo tc r- ----tica Act(G L I 5i2.=1(5))..rpplicatioo by a botncoaae far a lies:or pctail rr y cV?dcocc the Icvtl cuat<of en cployer under ttte Woricol.Coc pom,li.on AaL I undestaad that s.copy of this mtcmm3 may b.,for-s.ar•ded to tha Dcparcmml of lnhs.rriel Ats 'Off oo of lrar.00e for ths oovcrasC vcif cnioo and th_t L•iJtac to soc uc l-ovcnizo undo soctioo 25 A of MOL 152 m lad to the i , i ion of c,inainsl pcudltic norm kmg of.fine of up to S I,500.00 artd'oc impr3oozocxt of-up to on.ycor Lod civil p-.,•ru a in the focal of.Stop Work Ord end a fu o(5100.00sdy.gairni( For dcpa.-tm-",t u.c only 3 2 > 0 Ji Permit Number i`•LaP.. Lot K 6 SignatunofLi cnniticc e ...__. .J Ilk ' 1111111! . I ' ' , ' II I . 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