32C-067 2 CONZ ST-22 MAPLEWOOD SHOPS BP-2000-1 156
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-067 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2000-1156
Project# JS-2000-2039
Est.Cost: $4681.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VICKI R. LINDSAY 062135
Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning:NB Applicant: VICKI R. LINDSAY
AT: 2 CONZ ST - 22 MAPLEWOOD SHOPS
Applicant Address: Phone: Insurance:
P 0 BOX 995 (413) 323-9729
BELCHERTOWNMA01007 ISSUED ON:6/22/00 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT NON BEARING PARTITIONS,(2)
HANDICAP DOORS ei-e(.
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
nspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
uilding 6/22/00 0:00:00 MO $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2000-1156
APPLICANT/CONTACT PERSON VICKI R.LINDSAY
ADDRESS/PHONE P 0 BOX 995 (413)323-9729
PROPERTY LOCATION 2 CONZ ST-22 MAPLEWOOD SHOPS
MAP 32C PARCEL 067 ZONE NB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 1770 L t 0 --
Typeof Construction: CONSTRUCT NON BEARING PARTITIONS,(2)HANDICAP DOORS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 062135
3 sets of Plans/Plot Plan
THE,FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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 Commi 'on Permit from CB Architecture Committee
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.
Version1.7 Commercial Building Permit May 15,2000
;� \—\ Department use only
\-yi
(� R U f Northampton Status of Permit:v 1' Pay BO ,g Department Curb Cut/Driveway Permit._... .
1 9 2cc 2', Main Street Sewer/Septic Availability
'a Room 100 Water/Well Availability°
NtSr'tharnpton, MA 01060 Two Sets of Structural Plans
Tort ct phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
ha.,';- . 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: 4 tsl_
This section to be completed by office
2-2- Wl QVO®PSlir\CF ) J Map 3aC Lot 17 Unit
t\bp A.� , Zone_ ^Overlay District
C 1�-- t f Y1W� Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
(11•1 Mick5I-VJCCO W-eQ0, f j---7A)C.-- M•k/Q CW-\ SI-Ri' 719D . 2.7kit,ces
^'9me(Print) u en'�a TVlailin ess:
Signature Telep on
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
ce completed by permit applicant
1. Building ,( ' ,+<y__\4Vl .106.- (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 A
6. Total = (1 + 2 + 3 + 4 + 5) bl.;'el .. (i Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
T
0SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
BIC FEET OF ENCLOSED SPACE
Interior Alterations � Existing Wall Signs Existing Ground Signs Additions 0 Roofing 0
O 0 0
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
0 Accessory Building[ ] Repairs [ ]
wtN-D s Ars yr 3n.t,r-- \.,
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 0 A-2 0 A-3 0 1A 0
A-4 0 A-5 ❑ 1B 0
B Business 2A ❑
E Educational 0 2B I ❑
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
I Institutional 0 1.1 0 1.2 0 1.3 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S-1 0 S-2 0 5B I 0
U Utility 0 Specify:
11110 Mixed Use 0 Specify:
S Special Use 0 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
(e't -5P2nd
3rd
2'
4th
3rd
4th
R c� )
Total Area (sf) 1 (v J Total Proposed New Construction (sf)
øotal Height(ft)'J - "
--le I / Total Height ft
•
• Version1.7 Commercial Building Permit May 15,2000
l
7. Water Supply(M.G.L. c. 40, § 54) I 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
blic ❑ Private ❑ Zone: Outside Flood Zone 0 Municipal 0 On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size t
Frontage
Setbacks Front
Side L: R: L:
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 Regis ry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
Does the site contain a brook, bodyof water or wetlands? NO DON'T KNOW
B.
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 ns exist on the property? YES NO 1N4k
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)
L Registered Architect:
Not Applicable El
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
nature 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 0
Company Name:
V I , — l; \ LAJD3I
Responsible In Charge of Construction
7b. 697c 9q -e,r v;.Y0i00-7
i r s
Signs ure Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11)
dependent 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, , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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 perjury.
Prin 0me
1. L,„ Lei i qI Oo
Signature of Owner/Agent Date
.-iCTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0 i
Name of License Holder: `� \C V.- Ll/ CS QZ 1;
c
License Number
Wck\
d ress )-4,42 '
Expiration Date
'?- 323 9 `? Z
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 ,i.
•
ov.lIw.(p),o
R� `,.n �,}E (iiit� of Northampton ' =.
7.4
,(=> DEPARTMENT OP BUILDING INSPECTIONS — �'
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORICER.S COMPENSATION INSURANCE AFFIDAVIT
.> ' I, q,c,\44,_ L two
(iiccn permi(tee)
with a principal place of business/residence at:
X • T-C9 , No 9 te /`<< 1k) fl4 (phone:-) 12 r T)Z
7
.,
(srrw/city/statonp) ]
do hereby certify, under the pains and penalties of perjury, 951 1
( ) I am an employer providing the following worker's compensation coverage for my
employees worlong on this job:
Unsure nee Company) (Policy Number) (r;pirzition 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 compen adon policies: .
(Name of Contractor) (lnmtranc; Comoanyi?oue,• Number) (.1-xplrat:on Date)
(Name of Cootraaor) -- (Laurance Compaav,Policy Nttocrr) (E.x-piration Date)
(Name of Coturamo;) (Imsuranc Company/Policy Numbc ) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiratioo Date).
(anacti itiocal '-x cct ifnacc:ary to melt&inform,jon pc asar_
taining to di
•
( I am a sole proprietor and have no one working for me.
( ) I am.a home owner performing all the'work myself.
NOTE:plcsc he awafc t1:,:w1c1c boatooµocn who employ pesom to do c-.ir-,r-r..vy, ^.:dro)o:rrrair..oric on i d..cll_ng of
not once alto thtx=its in w',z ch the bornoo+.ncr rctido or oo the ground,zppurtcnsri tbcen o-c oo(cc-lc-41y occrid..�i to be
employes un4,--tlx t.vd cr':c cp elino Act(GL152.ss 1(S)),rpplirvioo by•homooava fore hcea—a pa-mil ray c-idraoe the
IegJ tau of an ccployer under tut Woricd.Comepom.t_;on Act
) I u.odcxand tb,r a copy of thi,ctarcm�m m
ay be forwarded to tbo Dcgertca¢oflnda.sri.l Acndcmf Office of Ir>am-•ono for the
eovcrnc vciLc tioo and thu f_iltnt:to secure coverage larder section 23 A of MOL 132 can lad to the iapeaaioa of mminal pccultics
oomistiag of a foe of up to S 1.300.00 and/cc imprison of up to one yen end civil pco Jtio in dx form of a Stop Work Order and a
fun of 5100.00 a city aptin.
-'------j
for dcpkr noni u,c only�r,�. Permit Number
Si ` `W Map:: __ Lot
(nalttrt,of Liocnvr/Pcntuttcc 113 te
N9
N
GIN� TIMATE FOR OFFICE RENOVATION
eikN
Scope of Work:
• Erect non -bearing metal stud and drywall partition as per plan S Sps� �
• Install sound deadening insulation in partition wall
• Install two handicapped accessible metal door bucks and birch veneer doors—
bucks and doors to be 90 minute fire-rated
• Install two handicapped accessible lever style keyed entry locks and two closers
• Tape drywall and leave ready for painting
• Install vinyl cove base
• Construct small loft as per plan — Zx ��I �� � h oe-
• Install window supplied by client in non-bearing partition wall
• Demolish and dispose of existing "closet" and sales counter
• Dispose of construction refuse and leave office space ready for client to paint
Estimate specifically excludes priming, painting or staining of walls, doors, window or
loft space. This work to be done by others.
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