29-001 (4) • rl I ! i l l i l �.
T o
J-t
a vcr _
0
rl
� rn C
e 71
• � Q
ZS �—
+v
lb
IC)l
D o�
� W
� ► I D
7
N
F
FLORENCE HEIGHTS D APT. 1-B FIRE JOB
1/ Replace light fixture in second floor hall and light-fan fixture in bathroom.
2/ Replace ceilings in first floor bedroom, livingroom, kitchen, second floor hall,
and bathroom.
3/ Replace ceiling of second floor rear bedroom and closet wall.
4/ Replace window in second floor rear bedroom.
5/ Replace door jamb, casings, and sliding doors is second floor rear bedroom closet.
6/ Replace underlayment and resilient floor covering throughout the apartment except
the kitchen and first floor rear bedroom.
7/ Replace walls and insulation on the exterior rear wall of the first floor rear
bedroom and the wall that is common to apartment 1-C in the bedroom and livingroom
8/ Overlay with sheet rock the wall adjacent to kitchen in first floor rear bedroom.
9/ Wash and taint the whole apartment, first and second floors, including sand
and refinish stair treads to second floor.
w w
s
IkAIf
li; ll N.laf NClrtliallipfoil
ac � �aaa HChltSrlta
DLC
m DEPARTMENT OF BUILDING INSPECTIONS
l 2I2,Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S CONIPENSA'ZTON INSURANCE AFFMAVTT
I,
e-C— V ` i C
-----
(UCI: eJPermittec)
with a principal place o bU7n--7 residence at:
honC")
-- (sC�et/city/sea'
do hereby certify, under the pans and penalties of perjury, that
( ) I am an- ever providing the following «,orker's compensation coverage for my
employees working on this job:
�F - /0 116, /0
(La=ce Comp my) (Polio Numbcr) (Expiration Date)
( ) I am a sole proprietor general contractor r homeowner (circle one) iand have hired ""
the contractors listed below o owing worker's compensation policies:
(Name of Contractor) (Insurance Conlpany/P(Aic-�' Numbcr) (Expiration Date)
(Name of Contractor) (Insurance CompanyiPolic,- Nmnt•2r) (Ex-pum,tion Date)
(Name of Contactor) Qnsuranc: Company/Potic} (Expiration Date)
(Name of Contractor) (Insuraace Company/Policy Number) (Expiration Date)
(attach additioasl sheet fnoac�ury to inchsdc informstioa pcxtaunag to all ooatraeon)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing aH the work myself.
NOTE:please be aware dul while homeowners wbo cmplay persons to do m-i*+*r�corstruaioo or repair work on a dwelling of
not rncce than three units is which the homeowner reside or oo the grounds appurtcc thr,t arc not gcoualty ooasidutd to be
cmployen under the worktis o=pcns4ca Act(GL152,ss 1(5)�application by a homcovmNa for a license cc permit may cvidcace the
legal status of an employer under the Workaeg Cornpco at Act
I uadcial.wd thst a copy of this a r�nray be forwarded to the Dcpartnmf of Inclzlrr;al A=dcaii OtB oo of In�for tbn
coverage vrrificstioc and that failure to scarrc coverage under section 25A of MGL 152 can lead to tha imposition of criminal penalties
comtstmg of a fine of up to S1,500.00 and/or=prison real of up to one year and civil peasteics in the form of a Stop Work Order and a
firm of 5 100.00 a day sgainsi me-
. For dr..pvta � use only
Permit Number
/ Z/ 4 Z Maps Lot# _
Signature of Liccnssee-Rcrmitiee e
0 .0
laf 'Nart[jamp toil
...........
DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street * Municipal Building
Northampton, Mass. 01060
WORK-ER'S COMTENSATION MSURANCE ATITIMAWr
with a prmicipal plac,-- of bugmess/residence at:
do hereby certify, under the pa�Ls and penalties of perJUry, tlhat�
I am an employer pro,-nidiris t-he following worker's compensation coverage for my
employees working on this job.
ansi=cc Compmy) (PoLicy Number) (Fxpiration Datz-)
I am a sole propnietor, general contractor or home�owner (Giffcle one) and have hired
the contractors listed below who have the following worker's compensation Plicles*
(Name of Contractor) (Insuranoc Cornparry/PoLicy Numbcr) (E'xp�mdoa Date)
f
(Name of Contractor) jns-urzmce Compairy[PoLicy Number) (Exp�radon Date)
(Name of Contractor) Gmsuraaoc Compa-uyiPoLicy Number) (Expi�ration Date)
(Na-me of Coati-actor) (Insurance Company/PoLicy Number) (Expi�ration Date)
(nfiaz+additloo2l shce if n6cc=w� to ix�informition p<-�to a coatra�)
I am a sole proprietor and have no one worldng for me.
I am a home owner performing all the-work myself.
oa�b�orj cpair rkou dwtUiag
NOTE:picase be aw2re thai vehile homco�who employ pa-som to&mxi,�C cf r wO , & of
not more thm throe uarts ia wfuch the hombowrier r=dc3 or oci 64 Vvjad3 appurtenwi tbado ut not gwaidy ooQndcrtd to be
cayloyers undcr the worker's oompcmdioa Act(GLI 52,ss 1(5)),,appLication by&horacowner for a Liccose cc Pamd maY cvidcnoc 6:
leplo-tu of an employer uoder the Workci�z Compaxatim AcL
Ajc6&c&0ffioo La=vnce orth*
lunderAxnddijdaocypyofthilrutem.ecirnAybefocwwd,adtoth.oDtpmart�ofl��a1 Of f
oover�vaificidioc and thit ad=to so=oov=av undcr soctioa 25A of MGL 152 can Icad to the imP�OQ Of a=�W Polulfics
coasLiting of a fine of up to S 1,500.00 anNor iapriso�of up to ow Y=and civil pCndfic:3 in d)e form of a Stop Work OrKkr and a
f=of 5 100.00 a day tg&insl m
For&PqtaVUW coly
permit Number
Map4-Lot
Signature of Licensec/Permittee
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(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 FOR BUILDING PERMIT
Ae-- off. 1�k ,,L-k5+ A as Owner of the subject property
hereby authorize %AX7_0 C.'riw% to act on
my behalf, in matters relative to work/authorized by this building permit application.
Signature caner Date
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 and belief.
Sig7 under the pains and penalties of perjury.
Print Name
Sign of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : L f.t I "°V v, 0 C, , � 5
"? } License umbXC)
�D J W �'� t G �� �� a Z_ 1
Address Expiration Date
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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...... ❑
• Versionl.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 ENCLOSED SPACE)
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
LtC o-1 G Not Applicable ❑
Co rc any Name
e ( OW {J
Responsible In Charge of Construction (�
pop Address
Signature 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 ❑ Zone: Outside Flood Zone Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existin 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 Y, 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 x 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
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
CA—Gc
SECTION 5 - USE GROUP AND CONS RUCTION TYPE - `
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A 11
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ _ 213 I ❑
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 ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
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): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
. Y OFFIG S N: ° x
BUILDING AREA EXISTING PROPOSED NEW CONS RUCTION w
.a E r "." 1,
124
_
Floor Area per Floor(sf) St Ka s
Y
2nd ��'
1st
c i
$Y
2nd 3rdv�
1 y `3c4
i 4 d15' dY
3rd
4th
a'
4th
ia
Total Area (sf) Total Proposed New Construction (sf) 4 q yM" '
FJ ,0 8 x
.. _. z.. .,s'
Total Height(ft) ,�; yk s
Total Height ft ---------------•---
+ ° Version 1.7 Commercial Building Permit May 15,2000
City of Northampton
Boding Department
212 Main Street R=
Room 100 .
rh :, .'Northampton, MA 01060
phone 413-587.1240 Fax 413.587-1272
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
This;'< on secti to 4e completed by offfoe
1.1 Property Address: r..,,
f slap_ lot Unit.
zone Oife"rtey l)%strict
E!m St- ..-sue. GB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: 9
Tjct
Name(Pr ) U Current Mailing Address:
.Sky - Y()3 U
Signa Telephone
2.2 Authorized A ent: P
✓1 AQa f..1-1 1 1cJ4
Name(Print) Current Mailing Address: —
Si ature Tele6h no
SECTION 3 - ESTIMATED CONSTRUCTION COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Z0 3 U (a) Building Permit Fee `
2. Electricai (b),Estimited Total Cost of
Construction from 6'
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total (1 + 2 + 3 +4 + 5) Check Numbe b
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature: _
Building Commipsioner/Inspector of Buildings Date
4i
File#BP-2003-0548
APPLICANT/CONTACT PERSON SALOOMEY CONSTRUCTION
ADDRESS/PHONE P O BOX 1203 (413)269-4360
PROPERTY LOCATION FLORENCE RD-FLORENCE HEIGHTS APT 1B
MAP 29 PARCEL 001 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid 1,5'x/!0 7
Typeof Construction: REPAIR FIRE&WATER DAMAGE-APT 1B
New Construction
Non Structural interior renovations
Addition to Existing Accessory Structure
Building Plans Included• -
Owner/Statement or License 065275
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INN� 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
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.
( � FLORENCE RD -FLORENCE HEIGHTS APT 1B BP-2003.0548
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-001 CITY OF NORTHAMPTON
Lot: -001
Permit: BuiIdin
Category: BUILDING PERMIT
Permit# BP-2003.0548
Proiect# JS-2003-0900
Est. Cost: $20733.00
Fee: $103.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SALOOMEY CONSTRUCTION 065275
Lot Size(sg. ft.): 255697_20 Owner: NORTHAMPTON CITY OF
Zoning: URA Applicant. Si;L00MEY CONSTRUCTION
AT. FLORENCE RD - FLORENCE HEIGHTS APT 113
Applicant Address: Phone: Insurance:
P O BOX 1203 (413) 269-4360 Workers
Compensation
W ESTF I E L D MA01086 ISSUED ON.1216102 0:00:00
TO PERFORM THE FOLLOWING WORK.REPAIR FI RE & WATER DAMAGE - APT 1 B
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:o
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc c*,
Si nature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 12/6/02 0:00:00 15475/15467 $103.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo