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25-015 (6) ¢t tw r n1 _ F E Crri� Of �rr� d DEPARTT.ME1,T OP BUILD7\1G 1NSPECTIO1dS 212 Main Street ' Municipal Building Northampton, Ma6s. 01060 WORKEWS CO`UENSATION [NSURANCE A F M ANI-IT —-----– (ii 0MLscclpermittcc) with a principal place of business/residence at: (so-r---,t/ci ty/sulc12i p) do hereby certify, under the pains and penalties of perjury, :hat ( ) Lam an employer providing the following worker's compensation cove ge for Ind' etuployces wor�ang on this job. (La5u-r-:nc-- Cor r=v) (PoLic: Nu_mbcr) -- - ( :-piration Datc) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the foL wmi g worker's coonensation policies: (Name of Cont:-ncio-) (tnsumncc Coinpany/Polk; Ntim!Yr) CFXxP rauon Date) (Name of Contractor) -- Gn-s-,=cc ComoaavlPohcy Number) (Ex pir,:iIon Date) (Name of COM7MOT) (mSw-ancc Compan}•/PoUq, Nwnbu) (E\piraon Date) (Name of Contractor) (Lisu=c-- Compan [Pohcy Numb-r) (E-xpifaiion Date) (etlach a i'ocaJ c'.xd ilnc-cs.:� to inc!uu inf« -boo txrtainins to.1u ooa:rnron) I am a sole propnetor and have no one working for me. ( ) I am,a home owner perfon=g all the work myself. NOTE:plc-,:be caalc t}:a.:w1.^_Jc 6cm-.-nuncra Abo caiplay p-=� w c-rcaau%%ork oo.d.. LLnF of pot n�o c Lb--z u:r'd in winch the bo Suva rriidm«oa the E-Mm ooe C 7 Ijy oecsid d ro be cmployc3 ua c Llx"'u,- 1 ,_lim Aca(GL152-3z 1(5)�afVUzation by a bomco-ua for c Gc�_or pc n n rn-y evident the Icga.l ctnau of ea cxploye undo dip WOrkoel Co�n Aci 1 understand tad a oopy of thi,ast<mcm may bo f ,dA.o- pcpartmrn¢of Ina.ixri cl A d.ucf Offioo of l,-�for tho oovcragc vaif caioo nand th_t U-Lxc W scauc co tm scU'On 2 5 A of MOIL 152(=lad to the inapa On of crimia+l Pcu Wl oomtamg of■rinC of I p b S I-5 c11 oC uP to oac ycsr cad a ail I�atuo in t c form of a Stop Wok Ordcr gad a rim or S 100.00.day. tzx �l Fr dcp=ru>j—only fj . znit Ntru)bcr p:; Lot ,. I 'gDZ film 0 I�nsocAlc n71i LtCL 2 Version 1.7 Commercial Building Permit May 15,2000 EC710N 10-. STRUCTURAL PEER REVIEW(780 CMR'-110:11) dependent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION 11 -OWNER AUTHORIZATION TO BE°COMPLETED WHEN QWNERS,AGENT OR CONTRAGTOR�APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authoriz d by&s building permit application. Signature of Owner Date C as Owner/Authorized Agent hereby decla e t at the statements an information on the foregoing application are true and accurate, to the best of my knowledge and belief. Si nder the pains a d penalt s-e perjury. ;Print Name \u a ure of Owner/Agent Date SECTI(71N 12:-CaNSTRUCTION SER1lICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone SECTIt)N 13 -WORKER S' COMPENSATION INSURANCE~AFFIDAVIT(M.G.L, c. 152,$250(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...... Version 1.7 Commercial Building Permit May 15,2000 SECTIQN 9-PROFESSIONAL DESIGN.ANQ GONSTRUCTIQN°SERVICES- FQR BUILDINGS AI STRUCTURES SUBifCTTC# _. CQNSTRUG'fION C©NTROL PURSUANT Tt 78p CMR 116,,;'(CQNTAINING MARE THAN 35,f 0 C.F,f3F 1=NCkaSED.SPACE) Registered Architect: J Not Applicable I� _ AName(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 mature 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 ;; ddress Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 Water Supply(M.G.L. c.40, § 54) 71 Flood Zone Information: 7.3 Sewage Disposal System: lic ❑ Private ❑ Zone: Outside Flood Zone ❑ tMunicipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING Existin 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 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 e r been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 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 exist on the property? YES NO 1 IF YES, describe size, type and location: l D. re N 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 E() ;JON 4=C©NSTRUCTI S RYICES f iR:t�Ft©A TS°LESS THAN 35„QpO;. w; 7 al:'ENCLOSED SpACE Interior Alterations Existing Wall Signs Existing Ground Signs dditions ❑ Roofing ❑ ❑ ❑ erior Alteration Demolition New Signs [ ] of Use [ ] er [ ] ❑ Accessory Buildin pairs SECTION '-Use GROUP”ANN-CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi Rh Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ L U Utility ❑ Specify: Mixed Use ❑ Specify: S Special Use ❑ Specify: CDtvIP ETE THIS: ECTIt�N`IF EXa"STiI�iG,F3U1LD1NG UN{?ERGOING REN©CATIONS,ADDITIONS AN DIt�R CHANGI 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 Floor Area per Floor sf St x s � 2nd ( 1st_ r ��« � e ..��a�� +}a �fi � '>•«�" 3rd 2nd er. rd 4th 3r �gx5 � � d 4th otal Area (sf) Total Proposed New Construction (sf) Total Height(ft) b t ^ Total Height ft ------------------- c N �. Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587.1272 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 INFO,RMATiON . 1.1 Property Address: rF SECTION 2- PROPERTY OWNER$HIPIAUTHPRIZED AGENT 2.1 Owne r of Record: me(Print) Current Mailing Address: S re Telephone 2 thorized Agent: .---- _ Name(P - Current Maili Address: Telephone SECTfdN"3„ ESTIMA� �CON5TRUCTIOQ ' Item Estimated Cost(Dollars)to be Official Use Only, completed by applicant 1. Building (a) Building Permit Fee I 2. Electrical (b),Estimated Total Cost of . *--� Cabstruction from,. 3. Plumbing Building Permit Fie 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(I + 2 + 3 +4 + 5) Chek,Nurrtber 'Thls S0cti l"or Official liSe on uIldIrtg Permit Number: Date Issued: ;Bignakure; ; Date, Building C�atnmissioner/lnsgector of�B,uiidings ` 152 CROSS PATH RD BP-2001-0230 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25 -015 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:vinyl siding BUILDING PERMIT Permit# BP-2001-0230 Project# JS-2001-0382 Est.Cost: $2000.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group. Lot Size sq. ft.): 43560.00 Owner: NORTHAMPTON AIRPORT,INC. Zoning: SC Applicant: NORTHAMPTON AIRPORT, INC. AT: 152 CROSS PATH RD Applicant Address: Phone: Insurance: P O BOX 221 (413) 584-7980 () NORTHAMPTONMA01061 ISSUED ON:8129100 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING ON HANGAR & OFFICE BUILDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector 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: Building 8/29/00 0:00:00 1903 $50.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo