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17A-215 GBS Ground Breakers Services 116 Mountain Road - Hampden, MA 01 036- Phone: (413) 566- 2250 July 10, 2013 Vis Taraz RE. ,E-1 7 . /46 North Maple Street 3 Florence, MA ,U1- Vis.taraz .gmai1.com DEFT o' ' ON iJ∎P010'0 RE: Shed Demo • Obtain Demolition Permit • Demolish building • Take debris to a Recycling Facility $ 1600.00 • Break up and remove concrete floor/foundation $ 400.00 • Truck in loam • Spread and rake out loam • Spread grass seed $ 600.00 Total: $ 2,600.00 i Thank you, 7/ 2 `i'/2o/ Scott Rurnplik CITY OF NORTHAMPTON Construction 1..ebris Affidavit in accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: I IVO r 444 41 a /are e _____—The-debris will be transported by:_ -- The debris will be received at: VP,lie ,e6 c vv. - Signatur of Pe it Applicant 'Date 7 TT (3 Building Permit Number: _ _ Rightfax C2-1 7/24/2013 5 : 00 : 15 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE [DATE(MM/DD/YYYY) 07/24/2013 T TIFICATE 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 and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: P L KRYNICKI INS AGCY PHONE FAX 459 MAIN STREET (A/C,No,Ext): (A/C,No): E-MAIL INDIAN ORCHARD,MA 01151 ADDRESS: 28RL S INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY I GROUND BREAKERS SERVICES INC.DBA GBS INSURER B: INSURER C: INSURER D: 116 MOUNTAIN ROAD INSURER E: HAMPDEN,MA 01036 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DDIYYYY) (MMIDDIYYYY) LINTS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ~— CLAIMS MADE OCCUR_ DAMAGE TO RENTED I $ PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ EI POLICY E PROJECT 0 LOC PRODUCTS-COMP/OP AGO $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ • SCHEDULE AUTOS (Per person) • HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) • UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ _ - RETENTION $ $ A W• ORKER'S COMPENSATION AND x WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-0542N313-13 05/26/2013 05/26/2014 LIMITS ANY PROPER TOR/PARTNER/EXECUTIVE ® N/A E.L EACH AH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION CITY OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED ATTN CHUCK MILLER BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 212 MAIN ST AUTHORIZED REPR 7.7 NORTHAMPTON,MA 01060 4 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. 07/23/2013 15:25 413-543-9134 PL KRYNICKI INS PAGE 01101 e ACORD CERTIFICATE OF LIABILITY INSURANCE °AT D/YYYY, 07//23/23/2013 _ 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 PRODUCED,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 Bonnie Turntrerg Pl.KRYNICKI INSURANCE AGENCY PRONE FAx 413-543-9119 413.543-9134 Atc,No, Aic,No]: - -MAIL ADDRESS 459 Main Street CUSTOMER ID; Indian Orchard MA 01161 INSURERS)AFFORDING COVERAGE NAM i) INSURED INSURER A: First Financial insurance GROUND BREAKERS SERVICES, INC DBA GB$ INSURER B: Safety Insurance INSURER C: Westchester Surplus Lines Insurance Inc. 115 Mountain Road INSURER D; Hampden MA 01036 INSURER E: _ INSURER F: _ COVERAGES CERTIFICATE NUMBER: 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 SE 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 -ADDL.SUBRr .a TYPE OF tNBURANC`E INSR WVD PDI Y NUMBER (MMIDDJxYYY)IIM/DDIYYyY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000. 7 COMMERCIAL GENERAL LIABILITY GE-TO RENT D 100,000. _ _ , PREMISES{Ea oocunenzel $ CLAIMS-MADE V OCCUR MED exP(My one person) $ 5,000 A 553FW22570 08410/2012 08/10/13 PERSONALaAOVINJURY $ 1,000,000. _ _ — GENERAL AGGREGATE $ 2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG ,$ 2,000,000. 7 1 POLICY EGOJ 7 Loc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . (Eeaoordent) $ 300,000. ANY AUTO — ALL OWNED AUTOS ALL INJURY(Per person)�$ B J SCHEDULED AUTOS 6209644- 5/20/13 5/20114 BODILY'INJURY(Derr eCOde $ J PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ 3 . -+ — UMBRELLA LIAR OCCUR _ EACH OCCURRENCE $ I EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DEDUCTIBLE — - — $ RETENTION $ _ _ y f 3— WORKERS COMPENSATION AND �OFRY AAT tS T I DER EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE f E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? I N/A See Remarks" IMandelory in NH) £.LDISEAIiE-EAEMPLOYEE S _^ If yes,deecilbe under DESCRI�TIDN OE OPERATIONS below E.L.DISEASE POLICY LIMIT 9; C `Environmental Liability (324309368001 08/10(2012 08/10/2013 $1,000,000.OGC./$2,000,000.Agg. 'DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES!Attach ACORD 101.Additional Remarks Schedule,IT more space is required) Grading of Land;Debris Removal-Construction Site;Excavation;Carpentry;Wrecking-Building or Structures NOG;Landscape Gardening;Tree Pruning,Dusting, Trimming;Tank Const-Not Pressurized HOC. "Vehicle Schedule:'03 KW,VIA#2NKMHZ7X33M707925,Plate APN56247;'08 KW,Vin#2NKMHN7XX8M21$227, Plate APN70935.'00 International,Vin.#1HTSCAAM1YH2707O3,Plate#GB63. "`Workers Compensation certificate being faxed directly from company. + _ CERTIFICATE HOLDER �__ CANCELLATION � SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TN CITY OF NORTHAMPTON EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVEREB IN ACCORDANCE WITH THE POLICY PROVISIONS. 21 MAIN STREET ATTN:CHUCK MILLER AUTHORIZED REPRESENTATIVE NORTHAMPTON MA 01060 + - { �1I,A...I. . . �J� '•�� ID 1980-2009 ACORD CO' , ION.All rights reserved. ACORD 25(2009/08) The ACORD name and logo are registered marks of ACORD . • City of Northampton - . ' Massachusetts �$ -4. ,4�; .' DEPARTMENT OF BUILDING INSPECTI ONS w '; f 1! x ar ' 212 Main Street • Municipal BuildingJb a ''` r � _' Northampton, MA 01060 &p ,.-`i. INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location a. The Commonwealth of Massachusetts �--= Department of Industrial Accidents , « r Office of Investigations 600 Washington Street rf Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le•i 51 Name (Business/Organization/Individual): G I Gd J ge.a.A-05 Sewt es "..6 co -F ? 4)- Address: 1 ! 10 Al o.J/v 'Al g City/State/Zip: (4 ,til..A A) D(o3& Phone#: 13 3-6 as Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. I❑ New construction listed on the attached sheet. 7. �11 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8.)6-Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance ; comp. insurance.$ 5. We are a corporation and its 10.0 Electrical repairs or additions required.] 3.n I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 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 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: 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify th ains 1112 lties of perjury that the information provided Bove is true and correct. Signature: - f Date: 1 ')3 1/3 Phone#: 1 ( 3 56 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#: de SECTION 8-CONSTRUCTION-SERVICES- 8.1 Licensed Construction Supervisor: J Not Applicable ❑ Name of License Holder: . C U� 1 D. WV i p2it A License Number 12,5 mvA ,� j Id w fr1 A Q 16 30 Add Expiration Date ( `1(3 5 aas� Signature Telephone 9alRegistered Home Improvement Contractor i7- Not Applicable ❑ Company Name Registration Number — Address Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MG 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 ❑ 11 :Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature • IF- J SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) - ,, . -- New House ❑ Addition ❑ Replacement Windows Alteration(s) EJ Roofing n '''....Or Doors D Accessory Bldg. ❑ Demolition New Signs [D] Decks [(] Siding[D] Other[D] Brief Description of Proposed �P/�d ,f'`/s �'/ _ / Work: �—i-'< <'!�°p( Alteration of existing bedroom Yes Adding new bedroom Yes --�No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet sa If New h-use and or addition to existing housing, complete the following: a. Use of builds One Family Two Family Other b. Number of room 'n each family unit: Number of Bathrooms c. Is there a garage aft. hed? d. Proposed Square foota.- of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves _Number of each ' g. Energy Conservation Complianc- Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetland? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below fi • hed grade k. Will building conform to the Building and Zon g regulations? Yes No. I. Septic Tank City Sewer P ate well City water Supply SECTION,7a'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, Di ,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 oiK and belief. Signed_under.the pains and penalties of perjury. Print Name Signature of Owner/Agent Date • r Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Inf motion Existing Proposed Required by'Lo g'"" This column to be filled in by Building Depart iient Lot Size Frontage Setbacks Front i 3 1 I Side L: ` R: L:' . R:` ` _ ` Rear Building Height 1 i Bldg. Square Footage I I % i a 1 --._ Open Space Footage (Lot area minus bldg&paved .� i ► I parking) . 1 1 1 s #of Parking Spaces Fill: i (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES Q • IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO (3 DON'T KNOW 0 YES 0 IF YES: enter Book ! I Page; I and/or Document#1 1 B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES i NO l IF YES, describe size, type and location: j D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. RECEIVED Department use;only City of Northampton Status of Permit JUL Z 3 Building Department Curb Cut/Dnveway Permlt r. 212 Main Street Sewer/Septic Ayailablllty'• Room 100 Water/Well Availability CtNOHrHA69PTON MAoloso Northampton, MA 01060 Two Sets of Structu��il Plans p one 413-587-1240 Fax 413-587-1272 PIotSIte.Plans. F` Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION"• 1.1 Property Address: This section to be completed by office '1/4j/ /1) 0 5/-� G(19 71- Unit " V Zone Overlay District FJ (NC: R Elm Sf District _,CB District -SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED.AGENT 2.1 Owner of Record: V 's ara z Name(Print) Current Mailing Address: Telephone Signature 2.2 Auth ri e A ent: v k- 0, i M �r Name( rint) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Offirial Use Onfy completed by permit applicant _ __: 1. Building (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of ' _ Coristruction from (6). _ 3. Plumbing Building Permit Fee • 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Tlr:. This Section For=Official Use Only Date Building Permit Number ' = Issued:•Signature.. _ Building Commissioner/Inspector of Buildings Date s• File#BP-2014-0080 etc APPLICANT/CONTACT PERSON SCOTT RUMPLIK ADDRESS/PHONE 125 MOUNTAIN RD HAMPDEN (413)566-2250 PROPERTY LOCATION 146 NORTH MAPLE ST MAP 17A PARCEL 215 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT A Paid 4 Fee / 72 tc■l( Building Permit Filled out Fee Paid Typeof Construction: DEMOLISH 15 X 15 SHED New Construction — Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 102465 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN.F94 MATION 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 7/-zt 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. 146 NORTH MAPLE ST BP-2014-0080 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-215 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-2014-0080 Project# JS-2014-000164 Est. Cost: $2600.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCOTT RUMPLIK 102465 Lot Size(sq.ft.): 28575.36 Owner: TARAZ VIS Zoning:URB(100)/ Applicant: SCOTT RUMPLIK AT: 146 NORTH MAPLE ST Applicant Address: Phone: Insurance: 125 MOUNTAIN RD (413) 566-2250 WC HAMPDENMA01036 ISSUED ON:7/26/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMOLISH 15 X 15 SHED 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 7/26/2013 0:00:00 $20.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner