23A-062 14125871272
# 2/ 2
09-26-12;17:0 ;
CITY OF NORTHAMPTON
Construction Debris Affidavit
In accordance with the provisions of MO.L. c. 40 § 54, all debris resulting frorn any work
-- • covered:by a-Building Permit shall be disposed of in a-properly licensed disposal facility,
as defined by M.G.L. c. §150A.
Address of Work: /14ile
_The-Jziebris will be transported by: J o , 6 , .e 1, t4e4;‘,
The debris will be received at: .4%
_ Ade Signature of mat A Itcank
bate
Building Permit Number: .....
Certification of Visual Inspection - Asbestos
C ■it
Green Environmental Ccrsulting,
Projed Name r-() L., `' _ Date:
Project ft: _ Project Address: (.:
25
Client: u,
Work Ared(s) Inspected: Prrc \
Materiai(s) Removed and Quantity: \ \•:\,‘ k
in accordance with applicable regulations and ASIM E1368 "Standard Practice for Visual inspection of Asbestos
Abatement Projects", the Owner's Representative and Contractor hereby certify that they have visually inspected surfaces
in the Work Area and oe found , 10 ibIe debrrs.
Owner's Representative Licensetr/h.xp. Date Date
/
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•<21:.t "/'( -;-/-""),/
Contractor's Supervisor Liconsert/Exp, Date Date
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Projer Trtf cncion
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S(1(1 OttDp loto; Fiow Rule Volume Aritso: Adittste(2.1 fZesults
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Phase Contrast Microscopy (PCM) Air Sample Report
Client: Western Mass Environmental, LLC GEC Project #: 00535
Client Address: 93 Wayside Avenue Sampled by: Adam L eako
West Springfield, MA 01089
Analysis Date: 4/20/2012
Project Name: 63 1/2 Maple 5t. Florence
Project Address: 631/2 Maple Street
Florence, MA
Sample Sample Volume LOD Fibers/
Sample Number Sample Location Type Date (liters) Fibers Fields (fibers/cc) cc
00535-01 Attic-North Final Air C|earance 4/20/2012 1250 8 100 .002 003
00535'02 Attic-Middle Final Air Clearance 4/20/2012 1245 6.5 100 .002 .003
00535'03 Attic-South Final Air Clearance 4/20/2012 1280 10 00 .002 .004
00535'04 Field Blank 4/20/2012 0 100 n/a
00535'05 Field Blank 4/20/2012 0 100 n/a
Analy t Name: Lesko
i�/�
L e - �K)
Analyst Signature: Date:
Fiber count by Phase Contrast Microscopy (PCM), NIOSH 7400 Method Revision s. Issue z.8/1o/e4. Reported results have
been blank corrected as appticable. This report relates only to the samples reported above. This report may not be
reproduced, except ir fulf, without written approval u Green Environmental Consulting, LLC (GEC).
Massachusetts Class "C Asbestos Arialytical License # AA000206
tUttgat:41,
Green E.rronr=1(,?nt;i Ccril,,..Hjnt:.
296 Sylvester Road • Florence, MA, 01062 • Tel/Fax (413) 341-3418
— "
May 8, 2012
Mr. Ray Marciniak
Western Mass Environmental
93 Wayside Avenue
West Springfield, MA 01089
Re: Asbestos Project Documentation
63 1/2 Maple Street
Florence. MA
Dear Mr. Marciniak:
Attached please find project documentation for asbestos final air clearance services performed by
Green Environmental Consulting, LLC (GEC) at the above-referenced address. Mr. Adam Lesko (MA
Project Monitor At 071419) performed Phase Contrast Microscopy (PCM) final air clearance sampling
on April 20, 2012. Air samples were below the clearance level of 0.010 fibers per cubic centimeter
(f/cc).
Green Environmental Consulting, LLC appreciates the opportunity to work with you on this important
project. If you have any questions please contact us at (413) 341-3418.
Sincerely,
Green Env:ronr 1
it
Adam Lesko
President
GreenEnvironn-)entalConsultrg,corn
a ri
The power of actio
Reservoir Woods
40 Sylvan Rd
Waltham, MA 02451
June 20, 2012
Matthew McDonough
Email: mcdonoughrealty @yahoo.com
RE: Service Removal for Building Demolition.
Attn:
This letter is to confirm that, per your request; National Grid has removed the electrical
service and meter, number 11031303, located at 63 1 /2 Maple Street in Florence on June
19, 2012. if you have any questions or need further assistance, please feel free to contact
me at (508) 357 -4661.
Sincerely,
1 2 ,: / /de l)
k i [Li
7<eI J
nationalgrid
Customer Order Fulfillment
Central & Western MA
Office 508- 357 -4661
8 Fax 888 266-8094
Rebecca .Ke yla, us .n cow,
09-21 - 12;19:21 ; 7475600 # 2/ 2
AC ° Db CERTIFICATE OF LIABILITY INSURANCE
� ' 1 9/21/2012
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(lee) must be endorsed. If SUBROGATION IS WAIVED, subject to
the term6 and conditions of the polioy, certain policies may require an endorsement. A statement on this certlIlcate does not confer rights to the
certificate holder in lieu of such endorsement(s)-
PR000CER GO
NAME:
James J. Dowd & Son:; Ins PHONE FAX
14 Bobala Road Jaz, N.,ext): 413-538-7 1 144 I ENC. Ne): 41 r 1- 536 -5070
Holyoke MA 01090 Ae
MAIL
PRODUCER
CUSTOMER ID 0: JACCC)
INSURER(S) AFFORDING COVERAGE NAIC 0
INSURED INSURER A:ACU6.tia Insurance CornpanV 31325
Jacques construction co., Inc.
INSURER U:Cotnuer•Qc I nsurance Company 39754
2 Industrial Drive -
South Hadley MA 01075 INSURER G:
INSURER D
INSURER ! : _
•
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1929497103 REVISION NUMBER:
TIIIS IS TO CCRTIfY TI IAT TI IC POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ADOVC rOR THE POLICY
PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDII ION 01 ANY CON I RACI OR OTHER DOCUMENT WITH RESPECT 10
WHICH THIS CERTIFICArL MAY UL ISSULD OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT
TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
NOR ADDL SUER POLICY OFF POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM1DO1YYYY) (NIMIDO/YYYY) LIMITS
A GENERAL LIAHILITY ceA009041218 4/3/2010 4/J /2011 EACH OCCURRENCE 31,000,000
nAMAr3E t0 REN1 tO
X COMMERCIAL GENERAL LIABLITY PREMISES (Ea occur ienw) 3300,000
CLAIMS -MADE 1" I OCCUR MED MI (Any unn ;mum) _ 55,000
PERSONAL BADVINJUHY 31,000,000
GENERAL AGGREGATE _ 32,000,000
GEN'L AGGREGATE LIMR APPLIES PER . PROM:DTA•COMPmPArlo 32,000,000
POLICY n S F f T R1 LDC 5 -
S AUTOMOBILE LIABILITY wt./298S 12/1/2011 12/1/2012 COMBINED SINGLELIMIT
(Ca accident)
_ — ANY AUTO R6nII y INJIIRY (Par parson) 3500,01)0
_ ALL OWNED AUTOS
BODILY INJURY (Per au:idant) S1, 000,000
X SCHEDULED AUTOS
PRUPERTYUAMAGt 3100,000
X HIRED AUTOS (Per accident)
X NON -OWNED AUTOS 3
S
UMBRELLA LIAR OCCUR EACH OCCURRENCE S __
EXCESS LIAR CLAIMS -MADE AGGREGATE
_ DEDUCTIBLE - S
RETENTION $
A WORKERS COMPENSATION w1A011350917 1/3/2012 9/3/2013 X I TO . WAMIT`:I I CR
AND EMPLOYERS' LIABILITY Y 1N
ANY PNOVRItIURA'AHINER/EXECUTIVE NIA EL. EACH ACCIDENT s500,000
1M
OFFICFRFId8EREXCLUDED') N
(Mwldateryla NH) C.L DISEASE- EA EMPLOYEE $500,000
11 Yrs. describe under
UISCRIPTION OF OPERATIONS below t.L UI PVLIGY LW 3500, 000
DESCRIPTION OF OPERATIONSI LOCATIONS 1 VEHICLES (Attach ACORD 101, Ad(rtleral RemarKs 5011e0ule, !mere opa°, Is requtrod)
Job: 63 1/2 Maple Street, Northampton, MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
Middle Hampshire Development Group, LLC
2 Exchange St.rc:c:t.
Chicopee MA 01013 AUTHORIZED REPRESENTATIVE
drAW
-- 1
�► 1988 -2009 ACORD CORPORATION. All rights reserved.
The Commonwealth of Massachusetts
4
Department of Industrial Accidents
•
Office of Investigations
-� -= ? 600 Washin Street
Boston, MA 02111
7v1 . www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): J)q0 y &le ef/V5/L .ict-t/ C'
Address: ; j 57 :)4/ V4
Ci ty / State /Zip: , 4 12 7, 7 M0 /U #: _ �S ' -,-9/
Are you an employer? Check the appropriate bos: Type of project (required):
1. ❑ I am a employer with 4. am a general contractor and I
6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub- contractors have 8. (demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp. insurance comp. msurance.$ - -
required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing repairs or additions
3. El am a homeowner doing all work ❑
myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no 13.0 Other
employees. No workers'
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work 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
employees. If the 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:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: / City /State /Zip: /tee/4
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 form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a co py of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby c2�er i t pai n penalties of perjury that the information provided a ve is ue and correct.
Signature: //Ma `� 1 Date: 9 ar/
Phone #: L7/ 9 5 # �f
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: Permit/License #
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 #:
Versionl.7 Commercial Building Permit May 15, 2000
J
SECTION 10 STRUCTURAL PEER REVIEW (780 CMR.::110.11) ,
r
Independent Structural Engineering Structural Peer Review Required • Yes 0 No !
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 1(414 ) .. 9 4 1 !..11.. . Vgiii. !- .. .,1..�,G..., ti ?! _ A?' i.:‘ as Owner of the subject property
hereby authors � `'� e f Co, � ) . 7 .1° 71 / 4 --
act on my beh If, in all matt rs rejtve to work authorized by this building permit application. _.
!
Signature of Owner \ ( Date 7-1
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 and4•enalties of,.[ r'u .
Print Name _ .....____ _._... .__.__ . ___
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION. SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder . ' / Gdc s
License Number
Address Expiration Date
.4J -' _ Y/) 537ro 73 3_� . iaC/
Si at Telephone /
SECTION! 13 WO- . FIS'`:; 0MPENSATION 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 No
Versionl.7 Commercial Building Permit May 15, 2000
J
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 ENi,LOSEDSPACE)
9.1 Registered Architect:
Not Applicable 0
Name (Registrant): I - .._._____....
Registration Number
Address i _ ________ .:
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
I
Address __ -- .._A __.__. _ _ __._ ___.____.�,.._.� W.w_..._ w- .�«�- .... --e -~~- Registration Number � �� �
Signature Telephone Expiration Date
I
Name Area of Responsibility
Address _ ...__. Registration Number _ mm "
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
I__
Signature Telephone Expiration Date
e, r
Name Area of Responsibility
µ _ Registration Number ~
Address
Signature Telephone Expiration Date
4 General Contractor
j C_ S �c3 N , .__ . Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
,P ---, Pe _c,- / 1 , 0,' *7-Mir ,
A.-
Signature - y jp Telephone
23595J/
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING ,
Existing Proposed Required by Zoning ,
This column to re filled in by
Building Department
Lot Size j i_ ,,: _._... _
Frontage ___ ._:. _ .. ._..... _ _. _ . _ __. ____ ..
Setbacks Front ,
i
Side L. _ R:— L.{ i R: 1 _.
it i__ ._.._.z 1 ,
Building Height i l ___
Bldg. Square Footage _.m- ....___. 3 _. , % _ __._. p l
Open Space Footage
(Lot area minus bldg & paved , L___ •.-- --
parkin
I.
# of Parking Spaces
Fill:
( i
(volume & Location) ----- --- ---° -- — — - --
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW lit YES 0
t i
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 sr DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO t/
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 #�
I F 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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 M
CUBIC FEET OF ENCLOSED SPACE • '-•'
Interior Alterations ❑ Existing Wall Signs FA Demolition ❑ Repairs ❑ Additions ❑ Accessory Building 1
Exterior Alteration ❑ Existing Ground. Sign 0 New Signs ❑ Roofing❑ Change of Use ❑ Other
Brief Description Enter a brief description here.
Of Proposed Work: t
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ IA I ❑
❑ A-4 ❑ A -5 ❑ 1B ❑
B Business 2A 0
�
E Educational 2B r ❑
F Factory ❑ F -1 ❑ F -2 ❑ ! 2C ❑
H High Hazard ❑ - 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 0
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B
U Utility ❑ Specify:
M Mixed Use ❑ Specify:;
S Special Use ❑ Specify:
1 „
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)
4
, _ Qom✓ � _ €
2 "d 2 nd 's
3r0 3
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft) ________ ..w
Total Height ft n_ _ _- ___ ._ _,.. ��
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public p- Private ❑ Zone ? -_ ,_____ Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Version1.7 Commercial Buildin_ Permit May 15, 2000
De artiTtetil ofeTo l)/ g1
City of Northampton 1 m 4,
RECEIVED Building Department ;, �� �k
212 Main Street e - a .
SEP 2 5 2012 Room 100 W W w
A a s'4,0 A . U
Northampton,; MA 01060 , .
phone 41 3- 587 -1240 Fax 413 - 587 -1272 Plot / i?a
DEPT OF BUILDING INSPECT • k� '
NORTHAMPTON. MA 01060 pact g
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
3 /2 /4,/ / - Map 0 1,4 e 9 Lot p.,, Unit
FA I r terre_.e.- i . Zone Overlay District
Elm ,St: District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: _
Name (Print) Current Mailing Address:
_ a 1 -4 3
Signature Telephone
2.2 Authorized Anent:
Name (Print) ' Current Maili Address
y�3 5-3-?-1/1
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
2. Electrical (b). Estimated Total Cost of
Construction from (6)
3. Plumbing I Building Permit Fee
4. Mechanical (HVAC)
- -
- «—
5. Fire Protection . - --
6. Total = (1 + 2 + 3 + 4 + 5) Check Number /j 8 '07CO
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0341
APPLICANT /CONTACT PERSON PIERRE ST JACQUES
ADDRESS/PHONE 2 INDUSTRIAL DR SOUTH HADLEY (413) 539 -9331
PROPERTY LOCATION 63 1/2 MAPLE ST
MAP 23A PARCEL 062 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /` / �,�i�
Fee Paid ( jj44DD
Typeof Construction: DEMOLISH BARN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 14865
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 _ Permit DPW Storm Water Management
; • 1;47,- ."...o ,
rte
1 ?-7 / 1 7-7
e o : uilding 1 icial 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.
63 1/2 MAPLE ST BP- 2013 -0341
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A - 062 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: demolition BUILDING PERMIT
Permit # BP- 2013 -0341
Project # JS- 2013- 000545
Est. Cost:
Fee: $200.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIERRE ST JACQUES 14865
Lot Size(sq. ft.): 6141.96 Owner: MIDDLE HAMPSHIRE DEV GROUP LLC
Zoning: GB(100)/ Applicant: PIERRE ST JACQUES
AT: 63 112 MAPLE ST
Applicant Address: Phone: Insurance:
2 INDUSTRIAL DR (413) 539 -9331 WC
SOUTH HADLEYMA01075 ISSUED ON:10/1/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: DEMOLISH BARN
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 10/1/2012 0:00:00 $200.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner