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32C-131 (11) ✓1ze 1oo�rvrrao�re.�Jea,C�� o��-�cussac�iCCaedZa BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 050230 B i rthdate: 07(2111952 Expires: 07/21/2006 Tr.no: 26922 Restricted: 00 JAN N DRDE R 44 LAKESIDE DR MONSON, MA 01057 Commissioner OR(t - 1' N 9 y E }�asaar}Intrtta' ..._ w+` i o DEPnRTME14T OP BU1LOP\10 fNSPPCTIOI.S 212 Main Strect ' Municipal Building Northampton, Afass. 01060 WORiaiz'S CONTENSATION LNSURA-NCE A=1 AVIT I _A A .DEC (liccvsaJPcrmittcc) with a prZncipal place of business/residence at: P HA 011 t1 (phone:') l� 3' obU' (M-r-- City =jx-'aP) do hereby certify, under Lhe pains a0d penalties of perJLUry, :hat ( ) I am an employer providing the following wor-kcr's coinocnsz on coverage for lm etuplovecs \voriLing on'tllis job: (Insure Conr:_c.') (Policy Nu-mgr) (r:pirarior, Due) O I am a sole proprietor, general conuraeuor or horneowmer (c cie one) and have hired the cone actors fisted below wbo have the following workers coroensadon policies: (Name or Contmcior) Ons-u wi -- CornpanyiPoGc- ?�t1Q1�<T) �•':itti�l3Q ��4tC) (Name of Contractor) Rasurz.nce ComoaxaPolim, Numcrr) (LxDi-r-,;on Date) (Na.me of Conuaeto,) (aswrancc Company/PoOcy N.tstkr) (ExpL-Mdon Date) (Name of Contractor) (Insurancc Comp' > /Pobcy Number) (Expiration Date), (atls cb+A{;;oea.l zbca Jn�r v to atdtxk tnfor-=•'hoa perm' to ku coao-a.c_4.-3) ( ) I am a sole proprietor and have no one woridng for me. ( ) I am.a home owner performing all the work myself. N07 E:pl=sc be awuc LfIc t:ijo tX�-O AMT]wix,cmptoy perLom Lo eo mx r-tr.A= =,—.c oo cr rc au work on of not more then Ll ec in wtn6 the botnoouvcr r id=or oa the p-outartr zppurtcnsr:them at oot C D=ally o d-rd to be employes untie the�.aScr�-=p.=,sica Art(GL152s1(5))�aWU=600 by a bomcoava far:Gam_or Pamir r=y ctiidmcc tl`e IcgaJ naaac of an cx?loyo uodar dso WoAkc e.Co¢gaoaoaiion Act 1 uodcrstaad'b-a oopy of thi,-"=o-=m.ay ba f---,id w tbo Dcgnrtmcaa of lnmurial Acnd.&office or trriu.oao for tba ' oove,.gt v=Zc=too aad th.1 L-iltac to soetrrt`covary&tmdcr s,,i m 25A of MOL 152 an Ia-d to the i=V=iiiow of aimiasl peaaWl= 0OO=.-- 8 of a Gac of up In 00-00 arWr aapr6 of up to ooc yev=d a,-i1 pc zurio in 6c roan or a Slop Wort order and a Gm of S t OO.QO a tP1031 COL For u. ooty PcTIntt)`rwmbcr tv(ap° Lot n 't�turt of Lia=uaclPCrTrt.iucc e J :' _._ Version 1.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEER RE1/lEW(780 CMR 110.11.) Independent Structural Engineering Structural Peer Review Required Yes......❑ No.... . SECTION 11; OWNER AUTHORIZATION--TO BE COMPLETED! WHEN OWNERS AGENT OR CONTRACTOR APPLIES ivPDR BUILDMG PERMIT" ,. I, '��✓ L L as Owner of the subject property hereby a thorize - _ to act on my behalf, in all matters relative t6o work authorized by this building permit application. Signature of Owner Date I, lAt") DIw l L' 1\\VC (� l-l�, , as Oyster/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 and penalties of perjury. Print Name (, V Signature of Age Date SECTION-i2 CONS7'RUCTION,:S'ERI�ICES 10.1 Licensed Construction Supervisor: ��/ Not Applicable ❑ Name of License Holder : �1 !� l �J U So a3 b License Nu ber 1� IV� Iv l Address Expiration Date Sign r Telephone SECTION 13 y WORKERS'COMPENSATION INSURATICE AFFIDAVIT(M G L -,c 152,; 25C(6)) . r. ... . 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 SECTION - PROFESSIONAL DESIGN,AND CONSTRUCTaON.SERVICE$ - fOR,BUILDINGSAND STRUCTURES CT TO _ CONSTRUCTION CONTROL PU,RS VAN TiT03 CMR 116{CONTAINING MORE THAN.35;,0D0,C"F: OF.E JCLOSED S'FACE) 9.1 Registered Architect: Not Applicable ❑ Name(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 Signature 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 rr oo - -T� ®' ",��� W- �'"� Not Applicable ❑ Company Name: j n o�y1Z- Responsible In Charge of Construction A Address i Si e ` Telephone Versionl.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ 1 Zone: Outside Flood Zone ❑ Municipal ❑On site disposal system ❑ 8. NORTHAMPTON ZONING 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 arlin #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW_�� YES IF YES, date issued: IF YES: Was the permit recorded at the Registry f Deeds? NO DONT 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: Versionl.7 Commercial Building Permit May 15,2000 SECTflN 4-CONUGI1�1°SfCfSOR=IPR07ECII.fSS IHA1V35,`DOYt CU$IC FEET`OF;�NCL�SEIIt,�5P,I1Cl 3� '` `" s s a. .ea Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing 1 ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building ] Repairs [ ] BRIEF DESCRIPTION: is v Q q e. -� ( fit 1 Fi FUM M .�►ND COI�IS�Rl1CTIt�N:�Y1PE' -I-t.J U 5f- 1 IY�elQ W�e S►NCre-I C1 '.SECTION 5-USE]GROUPUSE tlF�I�G GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ 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: ©MPLETE iIS�SEiION 3FDQ5IUG B17AD3NG 1lAfiDERG©iNG'12fN01Y�1TIC�NS, 1�D?TIONS`AN©FOR CHANGE IN 11SE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION`6:SUItDING:HEIGHT AND ACREA " BUILDING AREAEXISTING PROPOSED NEW MSEONLY Floor Area per Floor(sf) , 1st 2nd nd 3 M. x 3ro _ 4�' � y r q ri 4t' �r fl � � Total Area (sf) Total Proposed New Construction (sf) r Total Height(ft) Total Height ft ' Versionl.7 Commercial Building Permit May 15,2000 y p r1 City of Northampton Building Department 212 Main Street _J Room 100 �' orthampton, MA 01060 phne 41 -587-1240 Fax 413-587-1272 P&PLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 5EC7�O.N 1=,SITE.IMiF�ORMATION 1.1 Property Address: ..Jef`V tc1.. cfA:41A` ,-v f'o SECT'iON�.-PROPERTY OWNERStIIIPJAUTHORiZEDRGENT 2.1 Owner of Record: 3U FOa��� . sg&ft( Name(Print) � J Current Mailing Address: 1 I f CJ Signature Telephone 2.2 Autho med A ent: 3� LA&=-- 9&0-kq Name(Print) Current Mailing Address: 1,3- '-�l3-s��� � Signa Telephone SEC ETON°3'ES' MATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be bfficiaFuse only completed by rmit applicant 1. Building t��/1 (a) Building Permit Fee 000FI06' V 2. Electrica (#)f-stimated Fotal Costof °w:� -Gorastruction from 6.` 3. PlumbingBwldmg�Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 +4+ 5) Cfaeck;�lurx3ber :.Tlhis-Section For OfFc al Usw n Building perrriit''Nurn ber ='` Date Issued.::: Signature: Building Commissioner/Inspector of Buildings Date 75 SERVICE CTR-82 CONZ ST BP-2005-1300 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C- 131 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2005-1300 Project# JS-2005-1736 Est.Cost: $52000.00 Fee:$260.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J.D. RIVET & CO. Inc. 050230 Lot Size(sq.ft.): 137649.60 Owner: SERVICE PROPERTIES INC Zoning_SI Applicant. J.D. RIVET & CO. Inc. AT. 75 SERVICE CTR - 82 CONZ ST Applicant Address: Phone: Insurance: P O BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:6123105 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALLNEW MEMBRANE SINGLE PLY ROOF 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 6/23/05 0:00:00 $260.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo