41-009 (10) JUN-1 ,-2002. 16:08 FROM:ACCUTECH INSULATION 4135926184 TO:978 897 0779 P.006'009
E.P.A.AGENCY #99 53844
CT,MA,RI,VT,NH,ME NY GENERATORS
WAFT[MANAGEMENT GENERATORS
MEET EPA Region 2
EPA New England 290 Broadway,26th Floor EMERGENCY RESPONSE
New England Environmental Transport,Inc. 1 Congress Street New York,NY 10007-1866 •
P.O.Box 144•Portland,cr 06480 Boston,MA 02114-2023 (212)264-6770 TELEPHONE
(560)342-0667 • Fax;(860)342-4866 (617)918-1111 #1-800-272-3867
Out of State 1-800.272-3867
FB# ASBESTOS DISPOSAL & DOCUMENTATION FORM
Job Number P.O.# 21-3952 GENERATOR/BUILDING OWNER
Contractor AccuTagh Insulation & Contracting. Inc. M4seachusetts Highway Department
Address jlgper Street Delta p rk North r King Street
City Chicopee State.IA Zip Nort:hautpten MA to 0160
Telephone Number (411) 5_92-532 6 • Phone Number : 1 : .—
Date Container Del. 5114/02 Date of Pickup 6/1 0/02 GENERATING LOCATION
Type of Container I 00 CY
Slgennt Building
Address
VOLUME 2.31 CY Friable ] Non-Friable 0 1 7 capRr State
Bag Q 25 Drum❑ Wrapped 0 Other 0 rthawpthr —.MA 01060
RQ, ASBESTOS, 9, NA2212, PG III Phone Number
I certify the above named material does not contain free liquid as defined by 40 CFR part 280.10 or any applicable state law,is not a hazardous waste as defined by
40 CFR part 261 or any applicable state law,has been properly described, classified.and packaged, and is In proper condition for transportation according to
NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150.
Shipper's Certification: I hereby declare that the contents of.this consignment are fully and accurately described above by the proper shipping name,and are
classified,packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national
government regulations.
AUTHORIZED SIGNATURE
Transporter!: ArreuTrarh Jneulatinn is _Contracting• inc., DG t Chicopee.Street Delta park. ChiTelee. MA 01013
Name Address
Driver: Registration#: MA/F22-384 Date:x/02
Signature State/+R
Acknowledgement of receipt of materials.
Transporter 2: Waste Mane!ement N.E.E.T. Inc. PO Box 144 Portland CT 06480 1-800-272-3867
Driver: Registration#: Date:
' Signature State tit
Acknowledgement of receipt of materials.
.....
•
TEMPORARY STORAGE/TRANSFER FACILITY: WASTE MANAGEMENT N.E.E.T.,INC. • 203 PICKERING STREET• PORTLAND,CT 08480
PHONE:(800)2723867 PERMITS SW 1130223 .
Received By: - Date:
Certification of receipt of materials covered by this manifest.
Transporter 3:
Name Address Telephone e
Driver. "" -Registration#: Date:
Signature State 10
Acknowledgement of receipt of materials.
Landfill Name: SnurhPrn Alleghanies Landfill Phone No: (814) 479-2537
Location: Ilavirlgyille;. PA Permit At )00081/CT/008/960716/2845
Approximate Volume of Asbestos Received:
Discrepancy If Any:
Received by: V ,Date:
Certification of receipt of materials covered by this manifest.
ne.mko• Imo. h U'rWTr.O
JUN-11:2002 ,16:07 FROM:ACCUTECH INSULATION 4135926184 TO:978 897 0779 P.004/009
•
•
Control No1413 7
THE COMMONWEALTH OF MASSACHUSETTS
4Department of Labor and Workforce Development
Division of Occupational Safety
--= P
399 Washington Street,5th Floor,Boston,Massachusetts•02108
ASBESTOS CONTRACTOR LICENSE
ACCUTECH INSULATION&CONTRACTING,INC.
200 DEPOT STREET DELTA PARK
CHICOPE.E MA 01013
LICENSE: AC000005 EXPIRES: Tuesday,April 22,2003
IN ACCORDANCE WITH MGL CIt. I49 §6B AND 453 CMR 6.04
THIS CERTIFICATE IS ISSUED BY THE DEPARTMENT OF LABOR AND WORKFORCE
DEVELOPMENT,DIVISION OF OCCUPATIONAL SAFETY FOR THE PURPOSE OF ENTERING
INTO OR ENGAGING IN ASBESTOS WORK.
•
THIS LICENSE IS VALID FOR A PERIOD OF ONE(I)YEAR
•
Robert J.Prezioso,Deputy Director
ma.1197
•
•
•
•
•
•
•
•
•
•
•
JUN-1.1-2002. 16:07 FROM:ACCUTECH INSULATION 4135926184 T0:978 897 0779 P.003/009
.1-. 'Cumuli'or pion use of btrlly: •
RAaidentlel '
• 2 r Is the tinily atartet flt gtpte f rosldontla!wWr 4 units or less? la Yes V1 Ho .
s y ootnm .
• MaBaachu>rette 6iehvav D narts�. u,VP h kin C, 4aft., .
Atst • helm
peon_ HA 'ritOft __( •6 .
coode , 4,4 Ti{;al�ie
4. Fealties Ot'a •
wna On-Ite Wager:
Jots Joey ma as ahnna
Am
• — .Aw
•
. C-0a7ew• flab • TskNiarc
• 5. ,'General Cordrager: •
• RT6t. Corp. ^'_B _G .er raagal P c. S.ar 2.9
•
_ Stow, ?f& 01776 • • .•,..5978) 897-4353 . •
tmo�clrvo gat*4nx • • VC-3780489—ag_• LLlmro2
tsaegentWaame bap:Aimar 'Part 10449 a
• • A. Whittle gee t#ta of the loamy?_1 e 500(,w f t)'?(e of floors)Agbiltp"21/11PliEr end Q/8ppsal
• 1. Th n orterof ashestra•cantaining vane Miggall front sIe to temporary storage slte'(H accessary)In TM disposal Mg. .
•
• AccuTech Inauiatiou & Copersetiags_Iac.• Depot Street, Delta Pork
Am AAIw
• C__ i.copPOLHA 01op. - _ 1413} 592•-5326. • •
• A6Ytass • , $ab • Thistreats
•
' 2. Transporter of iaosfe material from removal/temporary storage ego mrfhnt disposal site
Lo an
Ro'Yruck1nh•Coap 9.
an Inc. 25.Silver Street
Aamr. AlJAv •
l ' , C 064$0 (gaol 347-n667 •
Atria Renew • ' • $ hoar
Shahalmsfst'Ttantlie 3. Bettis transfer stilton end owner(H epplkabte): •
Soldifivas It/A. • '•Rblbe . Attar
ernes NO •
-Mog _ •
—
'Wiwi, • _ Aix* . Tam • •
• ' 4. Rini*mil SW. .•
- : Socltherts A.1.leajh+tn'tee L 3Fill ' • 'DCA MIR Snry/rte,
•
llolltpAaa DaeortA6a� .
Alikna
• • Davidevillee 'P4 . 1592A • • - (814 479-2537 .
p1ar10•.' rdgWtssa •
• D Calllfleit/aii • • • .
•Zia liedentIgn d 1lershy states,tinder the penalties of per)itry,tint he/she hes read the Soa>nwnvwehh of Massachusetts Regulations
.tor the Remit,Containment or Encapsulation of Asbestos,453 fMR LOO end 310 CMR 7.15;and that Mc Information contained In
tide nagQbrtaan to arts and ccmett to ths•east atlisAtet trnowladge ud hdbt -
Analia St.,Ge rr:a •• —. - 4/19/x2 .
NahC ar • AccuT ch InsuLutioA ,
so Ns, • Adufnietratiye Aaaiataut •Oa_lt:re_ctittg.Inc , 419) x,22-•5326
tom lot 01.1 40/41000 hisbeta S .
r.1!a�n ,
•Depor 8trcetr Delta Park Chicoao11.•MA . QUM
Aertr cl►eee • It ea* .
• Fee aitattpt ply,Town,district,muntdpal housing atdhorny,avnter-occupiad ruldentlil of four until or lase)9%Xyes 0 no •
. Sltctler tl(from front of term):• 7,51;`,1111 '
JUN-11-2002.16:07 FROM:R000TECH INSULATION 4135926184 T0:978 897 0779 P.002/009
. -. ._�.
6bmmarrsrealt ofMassaohtrs tt . •'
AII��Of ,� , �,;;..
A4bestasiNvtIlleatiailFo ,.,, •
• A AzbmtosAbakimeolPe eniption "?>> ' }.. 1,1,2
- REVISED 05102/02 #7 REVISED 5/10/02 07• a•
t Nat/ OIG
00II REVYS>3D 5/07/02 #7
. _
• • Abandon goose• • 1667 West tlaraptou-RaSd .
IIISTRUC110ID Nom :; ;•
1•Winans olorb • ttnrttinmpten''MA 111.060 None
lam oat Detanmppleed ROW thns. War I' , •
ter r MIberseeekae bp�IN+e4OS41%AM t
Edebearoenlei M
Protentse uoeAaRon ' 2• le the tiel roocupled? Dyer�)No ,
enemas el=CM-745 fpoattigr ••
prk fiti$Cart/r 3. Atberbs lAnt odor.; ,
x/WeriArpraert k
PWAX*emen • Aceutech I aiAetion b Gont>:actiuR, Inc. Depot Street, DoltA-Paste .
Depunroeni el tuber glIN AA=
me 1pdq tas - ~ ` ••
ncetto Ionngahemmis Chi coven. MA• • ' . 01013 (413)•5?2-5326
ol4,flClyt@12 (ton Wow . ' to at > •
toapdor tgb • • .
NNW AC000005 Written
diem&SW P9tefa mtr • ilxeeulli►Mte+e1*reC - • .-
mune N• , • 4. 0nSlte Protect Suporfrte1/R4VielIC • .'
Z Sohnt COO Fenl Anthr�ny tiny. • •A57I2'i3�
Ti • Atw • aIpailiadm/
tamommodth of
Itssecisesollo • 6. Proluot Monitor. • • '
PA.R.OttO To,be determined. • , • • . .
Pew,MA 01112,. • AI® •all ekseni ' .•
�7 •
6. Aebeetoc kody11Ce1 tab: '
E Akomo ylo;#O To bp d etermined .
ow laruo�hlp dr
RA Brikvonciti
X5/13/02 'ems>'te -
o - ,dYa e i:Jwi.. 1 .i!IAI02 htdataetsAneeile/ 7. P,u * Mid m nddat°" apocl tlskt5fri NaL- .14:00PM
(SOtSuo•) •
=t1 .opoodos . •
sublet CFlt Used At to 11 VPS(40 0. ,Whetineptpro(eclfsthis? (drdaone): ®, qrt. "r"64
4~Pwde4 •
0. Deearbe the asbesto!ibelef11011t riIOCOdWes to bo untied(Circle'dr, adnue kf aimm®r - __ •
,l:k �'sYL.;; Mahe d alt RI:rig* - . •
I. `.•.,1r 7.' 10. to the Job boing conducted DI ktt(oors•0 outdoors 7 • • • -
4^; `:f `. , 11• Total amount or each type of Asbestos C edadnina Matedefs(AGM)to behandiad on pipes or duck(kW 0. a tither
747"r""- `')111'1'''''''
'`;44'',u. curb=(square IL) I to be removed,enclosed or anoepsldecl9d:. .
J':_ 453** •6A6 ekat . • •
• • 106410110WO dtt 67831/8csas6ar...- /-. gaol aralcrn ply kei ago .:._ ,
• . caln4aMdm!,fterelpgr<r pig i iodate.—_.J tar pmme •.—/•1 ••ieVIms 7.
• aG as ,besot / .ad beef —/, • '
12. Oascd&etbe decortlandratlon syetem(s)to be oeed: r
t 6 a clean dro c3oth ar, reeove
•• ti. .d
13. Ooserto the ocettatnert dtlan matted&tacos*wall 310 CMR 7.16 and
_,53 GPM 6.14(7.)10): • .
•M• `A.`_-. _ - .l. Y4 in 6'• •al• and d: eyed in a
•
• - 14. For Emergency Asbestos Abatement OperaU Ions.the DEP and DU otflcdeb who evaluated en emmyoaoy; • '
•AdrelAcaMiaibr • • NW �---
HIA "
A shIli tIPIS rrtY •
Awa/A Writ . ��
•
•
18. tke trweninn wine calve armlv we w M R.t.a 1411 i 7tr 97 FIT nA.r Id Ida nndrd1 =Via n Nn .
•
CITY OF NORTHAMPTON, MASSACHUSETTS
DEPARTMENT OF PUBLIC WORKS
125 Locust Street
Northampton, MA 01060
413-587-1570
Fax 413-587-1576
George Andrikidis, P.E.
Director,City Engineer
Guilford B. Mooring, P.E.
Assistant Director of Public Works
October 09, 2001
E.T. &L Corporation
873 Great Rd., Suite 202
P.O. Box 295
Stow,Ma. 01775
Subject: Disconnection of water service to#76 Chapel Street., and#1467 Westhampton Rd.,
Northampton.
Dear Ms. Jennie Lee Colosi,
The water service at#76 Chapel St. has been shut off at the property line and the water meter
removed from the premises as of February 20, 1997.
Water service does not extend to#1467 Westhampton Rd.
erely,
Charles Borowski
Superintendent of Water, Northampton
CB/gpw
2 'd 9LST [AS ETfr uo4dwey4JoN ,o Rgtj eEt. :60 TO 60 loo
** Z9 ' 39dd 11:i101 **
Massachusetts Electric
A National Grip Company •
October 3, 2001
Dino Pianos
76 Chapel Street
Northampton, MA 01060
Dear Customer:
This is to verify that Massachusetts Electric Company removed the electric service at 76
Chapel Street, Pole 17, in Northampton, Massachusetts effective October 3, 2001 for
building demolition.
Sincerely,
Peter C. Bernard
Manager District Engineering
PO Box 507
Northampton,MA 01061-0507
41,3.582.7200
20/20 ' d ELL0L688L6T6 01 T89L 28S 0d3S 1Sl0 3313 SSIW dd 4J 0b : 0T 1002 CO 130
uul— J—u1 WCU 11 UtS bay btate leas lbpf fd) MX NU, 41J In b2(2 N, 01
Lie�J
1y
Ray State Gas Company
October 03, 2001
Ken Stanley
E. T. L Corp.
Stow, Ma
01775
Dear Ken Stanley,
The address listed below has had the gas servicetsl
disconnected and is now ready for demolition.
ADDRESS: 76 Chapel St
TOWN : Northampton
STATE : Massachusetts
Sincerely
Jeffrey D. Mannheim
Senior Distribution Clerk
2025 Roosevelt Avenue P.O. Box 2025 Springfield,MA 01102.2025 413.781.9200 Fax:413.781-9222
THE COMMONWEALTH OF MASSACHUSETTS
MASSACHUSETTS HIGHWAY DEPARTMENT
INTEROFFICE MEMORANDUM
TO: John Hoey, District 2 irector
FROM: Russell McGii'crra , eputy Director,Right of Way
DATE: November 2,2001
RE: Release of Structures
The following structures are available for demolition:
Parcel No. Address Former Owner Structure
15-1-C 1467 Westhampton Road Lamere, David 1 Stry Wood
15-RTTS-1
15-12-C 76 Chapel Street Nickerson, Nancy 21/2 Stry Wood
15-12-C-UR Station 261 -- 50±
MAW, Jane Swift James H. Scanlan John Cogliano
HIGHWAY
Governor Acting Secretary Acting Commissioner
August 16, 2002
SUBJECT: Northampton
Route 66 Reconstruction, Phase 1
Contract#31351
a
E.T. & L. Corp.
873 Great Road A j r
P.O. Box 2950
Stow, MA 01775 ';;
Attention: Mr. Ken Straney
Project Manager
Dear Mr. Straney:
This is to notify you that the Department hereby releases the following houses for demolition
under the subject contract.
1. 76 Chapel Street, Northampton, MA
2. 1467 West Hampton Road,Northampton, MA
Please contact the Resident Engineer Steven Zych prior to the actual work commencing.
For additional information, please contact Acting Assistant District Construction Engineer
Steven Doyle at(413) 584-1611 Ext 236.
Very truly yours,
jt-G., GO. 0-cf,61) .(ayw1K)
JOHN W. HOEY, JR.
District Highway Director
SJD/sue
C - DMF
SAZ
Massachusetts Highway Department•District 2.811 North King Street, Northampton, MA 01060• (413) 584-1611
INSURER ' S AFFIDAVIT AS TO WORKER' S COMPENSATION INSURANCE
I, Nanc B. Melton Account Mana•e •- . - . ,
5 Neponset St. , Worcester. MA 01110.6
(NAME, ADDRESS AND TITLE) , authorized representative of
Construction Industries Comp Ins
(INSURANCE COMPANY) , do hereby affirm that effective
01L01/02 (DATE) ,
E.T. & L. Corp
(CONTRACTOR) is insured by said Insurance Company with Policy
Number WC0003760
for
WORKER' S COMPENSATION in accordance with Massachusetts General
Laws Chapter 152 , and Subsection 7 . 05A of the Standard
Specifications for Highways and Bridges of the Massachusetts
Highway Department . Any discrepancies between the Massachusetts
General Laws, Chapter 152 and Subsection 7 . 05A of the Standard
Specifications for Highways, Bridges of the Massachusetts Highway
Department shall be resolved in favor of M.G.L.A. c 152 .
(SIGNED) "GAL-re Aght/r ,
Subscribed and Sworn to "gore m this
c72/ Ste_
day of / /221S 204 .1
at (,,l/4Ye es *
+ 3a�t�
Not/67 P '•lic
My Commission expires A77-- c200‘
i
■
S a 1` oo y
•
.
�ti x NortI ant mt =*=t e
CC.J�''A- DEPARTMENT OP BUILDING INSPECTIONS _`;'__�°�-
212 Main Street • Municipal Building —=_
Northampton, Mass. 01060 '" ow
•
WORKER'S COMPENSATION INSURANCE AI FIDAVIT
I,
(licensee/permittee)
with a principal place of business/residence at:
• (phone#)
(street/ci ty/stateiri p)
do hereby certify, under the pains and penalties of perjury, that.
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
- (insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle cne) and have hurl
the contractors listed below who have the following workers compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
,r
(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)
(attach additim,l sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
NOTE:please bc aware that while homeowners who employ per occ to do u,i, `n, cons ruction or repair work on a dwelling of
not more than throe units in which the homeowner resides or oa the Bounds appurtenant thereto arc not generally comidacd to bc
employna under the worker's compensation Act(GL152,33 1(5)),application by a homeowner fora licrase oc permit may evidence the
legal si tat of an employer under the Worker's Compensation Act.
I understand that a copy of this ctatemem may be,forwarded to the Dcpartmcat of I.ocizuhial Accidcntf Ofoo of Iszuninoo for the
coverage veiifieatioo and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
ootnisting of a fax of up to S1,500.00 and/or imprisonment of up to one year and chit penalties in the form of a Stop Wok Order and a
fin,o(5100.00 a day against inc.
For depatmdal use only
Permit Number
Map# Lot 4
: y uLLL,. Signature of Liccn_ser rpermittee Fate
If S 4r3 Sr s3 *° m
8.1 Licensed Construction Supervisor: Not Applicable ❑
•
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
_ .� . . ,: e • ®"i 'af�� .ecf® ;• Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 ;WORKERS' COMPENSAT,1ON INSURANCEEAFFIDAVIT(M:GL. c. 152,§25Q6));
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this afficL
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
9...,! 1 11ri
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act:
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
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
-."y�x yT '�'zy'�:f .,�. si - 3 s fir. 3 i5v x i k {�'+ �
ECT10� �dESCR TION � ` R OSED YI O eheck�a I$applieatile)
d-:_"�'i =..?.' I3TR"`.�"[ .••..�'A em^.'p 1660420 _:s.b ,..,.3.4WW@COM"!k .u..,. S'? M Y3* '`H, M, 5.;-;«:XS": Vg«fra:.Ni4M
;'WV 04F W ".' _W?: a.V°....sue '„ 3_ .t'VM4S ^_.O.;AMo OU . AM, R V*WN?,
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
filtilfitiMBITWOM711 iiil Bt to' e i tiitg firm n rOli p ttiatre fo ralit:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTfO 01 V ERgAt1THt3 21ZATfON TO BE COMPLETED WHEN
,;:0'0ErislAG7FutitifccoltrowasiteAvoti POR`BUILDI NG PERMIT•
, , as Owner of the subject prope
hereby authorize to ac
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, . im ►� _ 01111 • !,;, , as Owner/Authorized Agent
hereby declare that the statements and information on t e foregoin: application are true and accurate, to the best of my
knowledge and belief.
'gned .nder tlrains and penal ie�s,,of,perjury. -;�
l�11! alq J C-1 � (G/1'f1/41€-
Pr' t Nam-
(7.40.) a
Signature of Owner/A:•nt Date
Section 4.
. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE .
DENIED DUE TO LACK OF INFORMATION
Existing 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 ever 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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
r .
-- -I', City of Northampton � �
Building Department � ��_ � ,° 17 4� s
SEP X12 Main Street �S ,r° Ifir'
Room 100 a •�. .kn
ce'-
I �.--------- o rt h a m ton, M A 01060 Two Se :-.
�r; �,pkau413 5 7 1240 Fax 413-58 7 1272 Plo lSite Pa
Ot er Sp 2, 44 ,,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to,be`completed by.office
1.1 Property Address:
z/6 (/l)�L'�l [ .,,�,, IJ 4—O4,I0 Map r l.ot .- �k,U ��
Q_, ( �N ' M A. Zone Overlay District s
Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 00(2 -141q(P-FON-
A V � _ 0 1a 2T6-- (�i 1.1(� j '
Name(Print) ��^ Current Mailing Address: IA
..z-re, vJ l-�—"I J `7`�C3— Shy— /611
(,... 6._-e s Ai- }C 1-I 2(] -- 77rrcj Telephone
Signature
2.2 Authorized Agent:
"rli, doe max 2-g.� cS MA 01713-
Name(Print) E/J/Je� I `�-�Ad�C,/ Current Mailing Address:
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Signature Telephone
-SECTION - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Emt
Construction stiaed Total from Cost(6)of
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) Check Number ien3—
n This Section For Official Use Only
0 Building Permit Number: "2 � Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
• •
File#BP-2003-0257
APPLICANT/CONTACT PERSON E T&L CORP
ADDRESS/PHONE P 0 BOX 295 (978)897-4353
PROPERTY LOCATION 1467 WESTHAMPTON RD
MAP 41 PARCEL 009 001 ZONE RR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid /Do.).3 lt LAS'
Typeof Construction: DEMOLISH HOUSE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 062464
3 sets of Plans/Plot Plan
THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
/ bo
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.
BP-2003-0257
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0257
Project# JS-2003-0452
Est.Cost: $0.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: E T & L CORP 062464
Lot Size(sq. ft.): 14984.64 Owner: MASSACHUSETTS HIGHWAY DEPT
Zoning:RR Applicant: E T & L CORP
AT: 1467 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P 0 BOX 295 (978) 897-4353 WC
STOWMA01775 ISSUED ON:9/13/02 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH HOUSE
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/13/02 0:00:00 10033
10033 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo