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25C-251 (39) Louis Hasbrouck From: Louis Hasbrouck Sent: Monday, March 12, 2012 4:34 PM To: 'Bruce Shallcross' Subject: RE: Towers Bruce, The insurance certificates are fine, and we can slip the demo debris certificate. We still need a contractor. checked and Harold's could sign as the contractor because of their crane license (they would qualify under the "specialty trades" exemption) but they'll need to sign the permit application. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg 212 Main Street Northampton, MA 01060 (413) 587 -1240 From: Bruce Shallcross [mailto:hampfair@verizon.net] Sent: Monday, March 12, 2012 3:46 PM To: Louis Hasbrouck Subject: RE: Towers Louis Attached are the insurance certificates for removal of the towers. Art Lyman is handling the electric and will deliver notice when that is complete if he hasn't done so/ The towers are being removed intact for set up elsewhere. We won't have a debris certificate but can tell you where they will be erected Bruce From: Louis Hasbrouck [mailto:lhasbrouck @northamptonma.gov] Sent: Tuesday, February 28, 2012 1:27 PM To: Bruce Shallcross (info (athreecountyfair.com) Cc: Charles Miller Subject: Towers Bruce, The Photo towers can be demolished. The Grandstands, the Judges Tower and any other buildings built prior to 1901 would need demolition review. I can't issue the actual demolition permit until you get a licensed contractor and until you provide a signed statement from an electrician that all power to the towers has been disconnected and secured. You must also provide a Debris Disposal Affidavit (required by mass law); essentially a statement of where the debris will end up. Call me if you have any questions. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg 212 Main Street 1 /DgryYYY} A R D � DATE {PdM CERTIFICATE OF LIABILITY INSURANCE U3l0 DMY • 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(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Barbara Simpson Russell Bond & Co., Inc. PHONE (AFC No, ExI): 800- 333 -7226 Ma No): (800) 677-6779 295 Main Street ADDRESS: BSimpson@RussellBond.core Suite 866 INSURER(S)AFFORDING COVERAGE NAIC # Buffalo NY 14203 INSURER A: First Financial Ins. Co. 11177 INSURED INSURER B Richard Huntley & Sons and Richard P Huntley and INSURER C: PO Box 172 INSURER D: INSURER E Leeds MA 01053 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAM ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 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. INSR TYPE OF INSURANCE INSR POLICY NUMBER tMWIDDNY (MMIDDfYYYY) LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABLRY PREMISES (Ea occurrence} 5 • 100,000 1 " I CLAIMS -MADE i OCCUR MEDEXP onep&son) $ 5,000 A _ 241F000220 07/03/2011 07/03/2012 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS - COMP/OP AGG_ $ 2,000,000 - 1 POLICY J I PF [1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea MOM ANY AUTO BODILY PJ..URY (Per person) $ ALL OWNED ^ SCHEDULED - BODILY C1JJRY (Per accidert) $ AUTOS AUTOS NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) 5 UMBRELLA LIMB OCCUR EACH OCCURRENCE ^ y EXCESS LIAR CLAIMS-MADE AGGREGATE y � DED 1 1 RETENTION $ t I $ WORKERS COMPENSATION I WC STATU- 1 1 AND EMPLOYERS' LIABILITY Y 1N TORY ANY PROPRIETOR/PARTNERIEXECUTIVEI t I N/A E. L. EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? (Mandatory In NH) EL. DISEASE - EA EMPLOYEE 5 lf�ie describeuder DESCRIPTION O OPERATIONS below E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Three County Fair Association THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fair Street ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Northampton MA 01060 1411414144'.— ' ©1988 -2010 ACORD CORPORATION. Ail rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD A f V ORD D ATE (MMfDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03 /01 /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 policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy. certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Webber & Grinnell Ins, Agency, Inc. PHONE i 413.586 (A/C, 413 586 6481 8 North King Street ADDRESS: Northampton, MA 01060 PRODUCER 00002048 CUSTOMER 1D #; INSURER(S) AFFORDING COVERAGE NAIL # INSURED INSURERA: Union Ins /Acadia Harold's Garage, Inc. INSURER Safety Ins. Co- CAR 19 Holyoke Street INSURER C: A•I.M• Mutual /A.I.M. Northampton, MA 01060 INSURERD: Acadia Ins /Acadia INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: Exp. 12/12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 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. INSR TYPE OF INSURANCE IN R SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MMIDD/YYYY) (MM1Dp/YYYY) GENERAL LIABILITY CFA01056261811210312011 12(03/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PR S RENTED PREMI E SES ( (Ea occurrence) $ 100,000 h11 CLAIMS -MADE ` OCCUR MED EXP (Any one person) $ 5 , 000 A PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 7 POLICY n PE LOC $ AUTOMOBILE LIABILITY 500071102109/2012 02/09/2013 COMBINED SINGLE INGLE LIMIT $ 000 000 f f ANY AUTO - BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ B X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON -OWNED AUTOS . 5 UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE 5 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION YIN WM28006342012012 01/01/2012 01/01/2013 1 T O RY U M T $ ER AND EMPLOYERS' LIABILITY C �ICRR JE ECUTIVEI y NIA ALLOFFICERS EXCLUDED E.L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) y E.L. DISEASE - EA EMPLOYEE 5 1,000,000 If yes, DESCRIP O E.L. DISEASE PO LICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS belay D INLAND MARINE CIM00771922002/09/2012 02/09/2013 $50,000 LIMIT $1,000 DEDUCTIBLE DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) 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. Richard Huntl ey & Son AUTHORIZED REPRESENTATIVE i !l (t�, '1 1 D. OILt�fit Ll ��IK— PO Box 172 Lee MA 01053 Richard Webber, CIC /SANDI ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD a255 -asi RECEIVED March 6,2012 ` R — 6 2012 DEPT. OF BUILDING INSPECTIONS NORTHAMPTON, MA 01060 I disconnected the power to the two photo towers at the fairgrounds in Northampton. Signed, t✓ Louis Hasbrouck From: Louis Hasbrouck Sent: Tuesday, February 28, 2012 1:27 PM To: Bruce Shallcross (info @threecountyfair.com) Cc: Charles Miller Subject: Towers Bruce, The Photo towers can be demolished. The Grandstands, the Judges Tower and any other buildings built prior to 1901 would need demolition review. I can't issue the actual demolition permit until you get a licensed contractor and until you provide a signed statement from an electrician that all power to the towers has been disconnected and secured. You must also provide a Debris Disposal Affidavit (required by mass law); essentially a statement of where the debris will end up. Call me if you have any questions. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg 212 Main Street Northampton, MA 01060 (413) 587 -1240 1 NOTICE = =u f NOTICE TO - =_` -=� TO O = � EMPLOYEES -= _ -_ EMPLOYEES - 1 5 • • The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617 - 727 -4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned • chapter by insuring with: ASSOCIATED EMPLOYERS INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803 -0970 ADDRESS OF INSURANCE COMPANY WCC 5004106012012 02/04/2012 - 02/04/2013 POLICY NUMBER EFFECTIVE DATES Chase Clark Stewart & Fontana P 0 Box 9031 Inc Springfield, MA 01102 -9031 (413) 788 -4531 NAME OF INSURANCE AGENT ADDRESS PHONE Hamp, Frank & Hamp Ag Soc dba Three County Fair Fair Street Northampton, MA 01061 EMPLOYER ADDRESS 12/28/2011 EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER _ - ' „ i ,11. 4' rt • 11 . r* .11V W- • eA.4, l', ir*4 - ‘, i „_ — . ,..., . , . , - . a,i P - ' -'• ' - -'.25 . , , ,,, , , , , , .:.-4 , -.,:-. - --..:: -• ' • •,, ,. . • . '''01 ) . ••, . '-'•i=:. 4. • ' '' ' ''''''' ;14 ,,,.., ' ,:, , ,,, i . ' •••: • • , • •• -e,'.".;5-',f,'1":?4,:i.'''; ,•': ' . ., , i..:?.-.111'5.3' ' ' • ' ' , '•' ' :f,it:,,,..--,.k.,Tp: ' • •- •.:" .if.i .,,,,, . , i ' : . 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The Cornrnonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information n Please Print Legibly Name ( Business /Organization/Individual). 1 I rte_ In - c _i_ r R Address: 54 c Ree;1 City/State/Zip: p� Phone #: � Ui a ho Ci -7 ty p: �. a� -�, � _ ` �3 �—`�- Are you an employer? Check the appropriate box: Type of project (required): 1. [] I am a employer with 14 4. ❑ 1 am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. El I am a sole proprietor or partner- Iisted on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contactors have 8. L i Demolition for me in any capacity. employees and have workers' g Y P ty 9. ❑ Building addition [No workers' comp. insurance comp: insurance. required.] _ 5. ❑ We are a corporation and its 1 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 y [N p 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. No workers' 13.❑ Other 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 nano 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: 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: � (� -cam Date: Z4 l ( l Phone #: Y- 223 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 #: Yorsiool7 Bold�gPnoo�D�uyl5 ~ . SECTION � . . ��`- -� ^ �� . ^~ �� Independent G�u�u�|Engineering S�uo�oa|Peer Review Requi�d ' Yee v No v SECTION - ' OWNERS AGENT OR CO mAPPLJESFORBUILDING pERMIT . L .asOwnoofthenubjoctpmperty . ------------- hereby authorize /___________ to act 00 my behalf, in alt matters relative to wor authorized by this build�gparmVappU Sigoature of Owner Date �_______ I, - __ , as Agent declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. . S eii• +».��-yu����____-�_-____---___-_----__ '-_-_ - ---_ Print Name ----- _____ —___ ' Signature of Owner/Agen Date - ' SECTION 12 SERVICES 1o1 Licensed Construction Supervisor: Not Applicable [] _ ' Name af License Holder : ___-_ __-�__-__________' License Numbe _ ���____ _ _,_ _ . Address Expiration Date ---------- -------- _ _-________-__--_-_-� Signature Telephone SECTION 13 . 1 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 buiiding permit. Signed Affidavit Att �� xr\ aohed Yes�� *�� No �~/ ' ~ 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 •EILOSED SPACE) 9.1 Registered Architect: ' Not Applicable ❑ Name (Registrant): . _.._._,__. ______ _ _. m�..�._ - -. –m_ _.....�......4.._— —_w. Registration Number Address Expiration Date Signature Telephone 9:2 Registered Professional Engineer(s): Name Area of Responsibility i Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address ^� Registration Number _ _ I Signature Telephone r Expiration Date . , .._..._.. Name Area of Responsibility Address Registration Number _ Signature Telephone Expiration Date Name Area of Responsibility __ _, _, Address Registration Number . _ w..___- ....,._.__. Signature Telephone Expiration Date 9.3 General Contractor - ___....._ , _ .. ._.. _ ___ _._._.__... Not Applicable ❑ Company Name: __ Responsible In Charge of Construction Address Signature Telephone • Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON. ZONING Existing Proposed Required by Zoning . This column to . lie filled in by Building Department Lot Size , ._._ ..__w__.__:._...._....w., ... ._._ "_ ._____.__.. _... . Frontage . ___ ___. ". ___ , ..... .. ._ .___:___. _ ._.___.: Setbacks Front '" mm Side L.::..."._._ R :�._._. J L L. Li R:__ L M _. ; - -- Rear , _._..._..,. Building Height "° Bldg. Square Footage _ _ ___ -__ Open Space Footage % _ ____ (Lot area minus bldg & paved ..� parking) # of Parking Spaces i Fill: , . �.._ (volume & Location) __._ .__ "_ _____.__ __ ,__ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? Q ;,‘ V W CRS NO 0 DONT KNOW YES 0 IF YES, date issued: I v 44 a5 C D.5- IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW (3 YES 0 IF YES: enter Book e 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 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO C IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES (3 N 0 IF 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. p Version 1.7 Commercial Building Permit May 15, 2000 i s t SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 ` CUBIC FEET OF ENCLOSED SPACE _•; ' ' l Interior Alterations ❑ Existing Wall Signs AI Demolition 0 Repairs ❑ Additions ❑ Accessory Buil — - -.... Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other a, ,,.,; ,,, Brief Description Eim a brief description here. Q c4 S See j a--��C , m Of Proposed Work: _ al'atx1 C. e D D -�o hn 1 , ..... 'v w eR s - u� $c ,�, tt. ?e usc_ el, seep 1.e ., _ SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly 0. A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 0 1B B Business ❑ 2A , ❑ E Educational ❑ 2s . r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ' ❑ H High 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 I 0. - U Utility ❑ Specify: M Mixed Use 0 Specify: � ,� .�_W.. ._._.^ � a r , .�...� __ ._ 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): T, __ _____ 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) i 1st_ _ _ _.., 1 r 2 2ntl R _, 3 M _______ _ ._..,_...- ...._. 4 th 4 __ Total Area (sf) Total Proposed New Construction (sf)„_ _ Total Height (ft) _._._..__ Total Height ft , _, 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone ? Outside Flood Zone❑ Municipal 0 On site disposal system Versionl.7 C B Permit ay 15 200 RECEIVED : �� M D0 e{artmelit €u City of Northampton ) 2 2012 Building Department , fiDnne ay er tt# : tt 212 Main Street S tft ban OFetnwrrorcnoNil Room 100 UaI. fai tIORTWJAPTON.MA0106 , 1 orthampton, MA 01060 phone 413 - 587 -1240 Fax 413- 587 -1272 Plot/Sttef' fans ; s 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 c-- ` � - Map Lot Unit . U ,Z YJ " . CON • O t O Va Zone Overlay District Elm St. District _ _ CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: N lc�� �?A. )...:..T. t1 p.._e4,..CGR-'l Gtti S� C ; Name (Print) Current Mailing Address: Q ■Na k eR,sr, - N, , 9R- � _�..__.. � ...-� ct _ _ �• _ Signature '8..p.: Telephone 4 \ r3 c� p �Q a 3 1 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 completed by permit applicant 1. Building (a) Building Permit Fee 3 2. Electrical (b). Estimated Total Cost of Construction from (6) „,r 3. Plumbing i Building Permit Fee 4. Mechanical (HVAC) _. . 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check; Number This. Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date 1 )0 t)6(,& 9 o . File # BP- 2012 -0732 APPLICANT /CONTACT PERSON HAMPSHIRE FRANKLIN & HAMPDEN AGRICULTURAL SOCIETY ADDRESS/PHONE P 0 BOX 305 NORTHAMPTON (413) 584 -2237 Q PROPERTY LOCATION 54 FAIR ST - FAIRGROUNDS MAP 25C PARCEL 251 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / Fee Paid Typeof Construction:_REMOVE 2 PHOTOTOWERS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 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 Demolition Delay 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.