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32C-067 (36)
File#BP-2003-0983 APPLICANT/CONTACT PERSON JOSEPH KENNEDY Arl ADDRESS/PHONE 38 HARKNESS AVE L076` /73 PROPERTY LOCATION 2 CONZ ST-MAPLEWOOD SHOPS %'� �'.re".C' MAP 32C PARCEL 067 001 ZONE NB 7 THIS SECTION FOR OFFICIAL USE ONLY: rne0� � / PERMIT APPLICATION CHECKLIST ENCLOSED RE( /?&e ZONING FORM FILLED OUT Fee Paid �. Building Permit Filled out `�L/!� Fee Paid /3 Typeof Construction: INSTALL NEW RAILS&CONCRETE WALKS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 055440 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 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. y Versionl.7 Commercial Building Permit May 15,2000 Dep tx►ent use only `- __..C.ity_srf Northampton Status of Permit: r T�`--r, '1 i Btii4 i, g Department Curb Cut/Driveway Permit___. d,�<� �t -- ,� 1 Main Street Sewer/Septic Availability.____ 1a �r-- Room 100 Water/Well Availability._. ji° 7 20 ort1h�2�x pton, MA 01060 Two Sets of Structural Plans_ },',.R ta�Y phone 413-5;87-1`1 40 Fax 413.587-1272 plot/Sites?sans_-__. .."_ ; ,.. Other Specify __-_ '�r.i� APRLICATF' I ;FL}4 iI1'J"-. 11:R .1'.,,RZPAF , 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 1.1 Property Address: a on.Z • Map Lot Unit Zone�kpk.p w o o� \AC5p5 �,,C." Overlay District1 . Y Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Reco d• 4,--) I� I, M 'Pr `0vl 3? T'\tvkhess A E4s� 1_,,,,,, , Name(Print Current Mailing Address: Lll?— 5-S- 17?)- Signature Telephone 2.2 Authorized Agent: II oL J Name(Prin ) Current Mailing Address: eii,97 Siniature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ' ©QOj (a) Building Permit Fee 6 • 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) T 6 OU 0, Check Number /374er i73-61 This Section For Official Use Only Building Permit Number: Q3±-9 _____ __ Date Issued: Signature: Building Commissioner/Inspector of Buildings Date J • 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 ❑ ❑ ❑ Exterior Alter Lions DemolitionEl New Signs [ ] Changeeof Use [ ] Other [ ] ►�p� Accessory Building[ ] Repairs �[ ] lf4r1 � 7rb�: VAS\-`t\ 'N.L0 {�`\S 0-A, c yrlcred-e w-0.11�1s r �40,A r Gk 51f,7 cv- tencv SECTION 5 - USE GROUP AND CONSTRUCTION TYPE C cis,veiele Lda114 USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly I A-1 ❑ A-2 0 A-3 ❑ 1A I ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A 0 E Educational ❑ 2B I 0 F Factory ❑ F-i ❑ F-2 ❑ 2C 0 H High Hazard Cl 3A 0 I Institutional 0 I.1 ❑ 1-2 ❑ 1-3 0 3B ❑ M Mercantile ❑ 4 ❑ R Residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A 0 S Storage ❑ S-1 El S-2 0 5B ❑ U Utility 0 Specify: M Mixed Use 0 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) 15t 2nd 1st ,: x a 3rd 2 4th 3rd 4thx . Total Area (sf) Total Proposed New Construction (sf) Total Height(ft) Total Height ft 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 r 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 Version1.7 Commercial Building Permit May 15,2000 SECTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 11 - OWNER AUTHORIZATION -TO BE COMPLETED WHEN r OWNERS AGENT 0 CONTRACTOR APPLIES FOR BUILDING PERMIT I, Q i , as Owner of the subject property hereb .0 'orize .�Q •-P�� (/►"�� to act on my b- alf, i all matte - . 've t. . -.rized b his building permit application. 1 • ..-- Signature of Owner i A Date I, •. it Q , as Owner/Authorized Agent hereby declare •t t e sta emen s and information on the foregoing application are true and accurate, to the best of my knowledge and belief. igned u er th pains and penalti s of per' 6\rin Name Signature of Ow r/Agent Date SECTION 12 - CONSTRUCTION SE ES 10.1 Licensed Construction' Supervisor:v Not Applicable ID Name of License Holder: J on�S2 fb"l Q thVl 05 5 li4 0 ` License Number 5 G- ��, SA- %ok5s)C\,Vst Net 0(00 7 -7 -- a-e - oy Address ?.. Expiration Date ijc. qr3 — -C-3-A905 Si ture 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 0 • • .O �O o a a I±t of Naz:t1J&mptwi 1 w i .asaarflnsctta DEPARTMENT OF BUILDING INSPECTIONS el 212 Main Street < Municit�Sal Building 'a Northampton, Mass. 01060 imp"' ORI 'S CO ENSATION INSURANCE A11.411)AVTI �tt ) with a princip place of business/res ence at: 3 8 A64 / F. 1_01. e„ d) c (phone#) S).5- 173S (strec/ci ty/stair/a p) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following workers compensation coverage for my em 1ooyees working on this job: Q Scwej frog► c:tA Ca5("I 7 V000o©og6O t� ` �> - C3 (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) .t r: j (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • (sting additioml sheet if ne ..ry to include information pertaining to all ooutracton) ( ) 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 mainte+ coustr action or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be employers under the worker's onmpe•nsatioo Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal&lotus of an employer under the Wociced Ad forwarded a Compensation A I understand that a copy of this .• _.._.•may be to the Departnieni of Industrial Aotidmt3'Offioo of Imucsnca for the ,.•vertge verification and that failure to coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties • •t of a fine of up to S 1,500.00 m or imprisonment cnt of up to one year and civil penalties in the form of a Stop Work Order and a •••,.of 5100.00 a day',..'•••.• 111, • 4 Foc dcparthl use only Permit Number Map4 Lot# Signature of T .-.....,,io...,.,;r*.-P Late