Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
32C-149 (24)
4.�HAAfP2Q Re Crzt-� naf wart Ijaillp foil z � � �asaactlnsctta m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 wozICER'S COMPENSATION INSURANCE ' ' A'L'IT with a principal place of business/residence at: ISAA V=)�ea do hereby cc under t. p211s and penalties of perjury, that: am an employer pre•.•ding the follo`virlg wor'rier's compens non cove mge 10. ]ny employees worlhing on th S lob: f( LLJF .140? � 1 ®V J==cc Co ) (Policy Number) (E pih on D ) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Numbcr) (Expiration Date) �f (Name of Contactor) Omsurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoLicy Number) (Expuation Date) (Name of Contractor) (Lnsuraace Conlpany/PoLicy Number) (Expiration Date) (attach additioml shod if near xx-y to i chudc inform ajoo p,=tn fining to av 000t"a ) ( ) I am a dole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be a*wt thr2 whilc homcoKV=who employ paww w do r iyTtm%= ovctioo or rrpair work on a dwelling of W ntoeo than throe unity in Winch the bomeowncr r,=d=or oo the grvands appurtenant tha do an not sencany 000sidcrcd to be entploytn under the work.c z oompctzr.:ioa Act(GL152,sa 1(5))�appticabon by a homeow=for a liccnsa or p=nit may cvidcnoe Lk legal dstus of an employer under the Worir.oee C.ompematioo.Act.. I un&rstaad that a copy of this rhttmcnt may be forty rded to the DVwtn m of lndautrial AC6&CI&Offroe of Imruwoe for the covmge vcnficalion and that failure to&scare coverage undcr ScMon 25A of MGL 152 can lead to tho imposstion of criminal PcnaW- eomisiing of a fine of up to S 1,500.00 or' of up to one ycar and civil penalties in the form of a Stop Work Ord--and a floc of S 100.001 y against mc. L C7.2 For dqurtmertal uao caly Permit Number Map'# —Lot# Si o i l�sr, ._.... ...... .ter.... - (f its oficl tljanl}�tDlt _ C J •. ,31X3 0 Arhnrc llb' L _0 1 Q DEPARTMENT OP DUILD0\JG INSPECTIONS _ 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORJa;R'S COiVTZNSA'nON >NSURANCE AI , AVIT (li ccnscrJ permi ttcl=) 10"Ith z pri,-lcipal place of business./residence at: (phone.-, (str�Uci ty/sta tclz�p) do hereby certify, under the pangs and penalties of perjwy, :hat O I am an employer providing the following worker's comncnscDon covemgc For !n), etuployecs worUng on Lilis job: (bnnlr_n= Comra=Y) (Polio: l\u_mbcr) -- (z :pir rior, Dai:) ( ) I am a sole proprietor, general contractor or homeowner (c cie one) and hzve hired the coots actors listed below rgbo h.zve the following workers coc-jtnsa6on pc!icies: (Nam-, of Contmaor) Onssu zicc Cornoany/PoUcj N4unl-Cr) C-?;)IiJL3Q ��llC) (Name of Contractor) _ (insurance. ComoanyiPolim, Nlunccr) (Expir,oon Dale) (N2me of Con>:raetor) (tnsuranc;, Compao)-fPoUq- Ntrmb�r) (Expirrrioo Datc) (Namc of Contractor) (I-n_suranct Company/Policy Numbcr) (Lspifa ioo Date) . (aalcb 6-6,co=J rbcct ifnco=s--y informanoa gercaiaing to..it ( ) I am a sole proprietor and 'have no one wot-L-J-og for me. ( ) I am.a home owner perfortni_ag all the work myself. NOTE:plcsc be aw^tre t}a.at u'lv]o 6emeawrom cmploy pc-wm to do r--t -,+..,.- ccr,—.=oc r rcn work oa a dx--LL:g of not mote thco `roc=ru in xvb c the bocn45ow r=d=or CO the Vou06 zp�tbczen L:c ox gam---22Y oecrid=d to be eavlo)—-)?--the ketch o=r=<-t'oa Am(GL152=1(5))�,apptintioo by a bomeo-Da for c Gam cc perma ray c�46cooc the Ic J r=.0 of en c=ployx uoda tl o Worlcafa Compomaiioa Ad 1 yob--d lb,a>oopy of thia m11-pmt m..y be fot-xotd.sd a tbo Dcpertmca¢of loa`cuia!Acndaat3'ollioa or trr�ror the ' cove-L&e v eiresioa aad thel L-J1Xc to A0=M`cove under waioa 25 A of MGL 152=ted to the impoli ioa of eimival pcwl6cs 000sizing of a fine of up to S 1 500.00 andlor im{sriyo�of up to oroc ycsr and a%il pcaatio in c5c form of a Stop Wort Ord,=and a rim of z 100.00 a d--y 1pA=EX- F,dcp.rta-",t u,c C.-Ay Numbcr - - hfap" Lot ." Si�natu�of Li�lPcrmiuct �e . .� �= Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 S-T UCTURAL PEE-WREUIfYY(780 CMR 110 lI) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11,y OWNER AUTHORIZATION ;,TO BE�COMPLETED WHEN OWNERS AGENT OR CONTftACTfJR APPL°1ES f0R BUILDING"PERMIT':, e as Owner of the subject property hereby authorize 1 o act on my behalf, in aljln)�tters r"elatFk to work authorized by t i building ermit application Signature of Owner Date Nm_n as Owne _ +hnAao-P„nt hereby declare th t e tatements and information on t e foregoing application are true and accurate, to the best of my knowledge and be Sign IT under the pains and penal of perjury. Print ame/ q� v - V Signature of ner/Agent 7T I Date 3 SECTION i2 -CONSTRUCTION SER1'ICES ..z 10.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder License Number A dress Expi to Signature Telep one SECTION 13 �fl(ORKERS iCDMPENSATION tNSk LANCE AfFiDAVIT{MSG L c ].52,§,25C(6). .R s Workers Compensation Insurance affidavit m e completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of e building permit. Signed Affidavit Attached Yes....... No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION 9:` PROFESSIONAL DESIGN AND CQNSTRUCTION SERVICES -F.OR BUILDINGS AND STRUCTl1RES.SUBJEGT TO CO;NST,RUCTION C,OI�TROL PURSUANT`TQ 780 CMR`1161'(CQNTAINING MORE TL AN 35'OpO C f :OF 1=INCLOSED RiACE) , 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 En Not Applicable ❑ R (2`j6 Name: Responsible In Charge of Con uction Address Signature Telephone H Versionl.7 Commercial Building Permit May 15,2000 w 7.Water Supply(M.G.L.c.40,§ 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ I 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 parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/ 'riding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Regis ry of Deeds? NO DONT KNOW YES IF YES: enter Book P e and/or Document# B. Does the site contain a brook, body of water or wed ds? NO DONT KNOW YES IF YES, has a permit been or need to be obtained fro 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 in ed for the property?YES No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 ' t .tES+7-TflA1,f3"00E� t CI�BiR FOFI�CLSE® 1C1 . 5k Y s .b ti t..:T y f Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ K— ❑ ❑ Exterior Alterations Demolitio New Signs [ ] Change of Use [ ] Other [ ] ❑ I sory Building [ ] Repairs [ ] BRIEF DESCRIPTION: SECTION 15 USE jGROI ,ANII'CtNSI RCI30N 1fI�E USE 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 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ -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 ❑ pecify: M Mixed Use ❑ S ify: S Special Use ❑ Sped C®MPLEf 3 $EL. I�NFIG I1GDG;LIIIG ?FIO�, O1V5, 3DIO NSA N©JDR`'CHi4NGE;IN 17SE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTIONrv6 iBUILDING I I ElGIiT:ANII J11REit1 BUILDING AREA EXISTING PROPO D NEW CONSTRUCTION WHIM,_ 1 �* Floor Area per Floor(sf) ist nd 1st 2 2 nd 3`d w 3rd th 1* vua 4 4t' � �� Total Area (sf) Total Proposed New Construction sf) v. ', h.. rr Total Height(ft) amp E Total Height ft--------------- .� � Versionl.7 Commercial Building Permit May 15,2000 c Git�c hampton DE l� u VgBt�di partment D Street 100 SEP - 5 Ma , MA 01060 phone 413-587 124 Fax 413-587-1272 prEl QE DING INSPECTIONS APPLI TION T , NOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 1L(q SECTION- 51T fDRIN111'I ©N 1.1 Prog)ertv Address: n mple c+e IOUT�' p SECI ION,2 IPROP..ERTY L�111ilERSFIIPAiF10RIZE©AGENT 2.1 Owner of Record. The Hampshire Property [Management Group,Inc. _jd'QQ)4kS6, -1 P.O.Box 686_ Name(Print) , Current Mailing Address: ° mp ° 051-0686 2 Signature Te ephone T4,8 gi,mpshire Pro erty 2.2 Authorized A ent: Mianagement Group, n' — — P.O.Box 686 �� • Northampton,NIA 01061-0686 N (Prin r Current Mailin Address: C"7 AO Signature Telephone z :SECTION ,ryEST NIA U iCONSTItUCTION CO5T5 Item Estimated Cost(Dollars)to be Offcia7�lss nnl completed by ermit applicant 1. Building O Building;Permit Fee 2. Electrical Esbr�ated Total Cost of` Consir pct 66ft-m"t6`- A. 3. Plumbing Bu ldmg3Pefrnli Fee 4. Mechanical(HVAC) 5. Fire Protection S v 6. Total = (1 +2+ 3+4+ 5) -CheckoNurnber, * :afiIs,Section For Officral`-else Onl Butldtng:Perm�t Number " - �3ate issued Signature: Building Commissioner/Inspector of Buildings Date 163J!"LEASANT ST BP-2004-0260 GIs#: COMMONWEALTH OF MASSACHUSETTS 140:13lock: 32C- 149„ CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: ALTERATION BUILDING PERMIT Permit# BP-2004-0260 Project# 35-2004-0382 Est. Cost: $5000.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RUSSELL JOPSON Lot Size(sq. ft.): 10715.76 Owner: MCCARTHY PROPERTIES INC. Zoning: GB Applicant: MCCARTHY PROPERTIES INC. AT: 263 PLEASANT ST Applicant Address: Phone: Insurance: 64 LYMAN RD. NORTHAMPTON MAO 1060 ISSUED ON.919103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE AND REPLACE EXISTING WALL AND FLOOR COVERINGS 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• Receipt No: Date Paid: Check No: Amount: Building 9/9/03 0:00:00 1811 $0.00 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo