29-001 (6) Letter Of Transmittal
Tr+ Teagno Construction Incorporated
V P.O.Box 2054,Amherst,MA 01004-2054
Phone:1-413-549-0803 Fax:1-413-549-2628
To: City Of Northampton Building Inspector Project ID: flor fights 1B ReDate: R 10-Jul-01
Project Name: Florence He
212 Main Street _
Northampton, MA 01060 Location. Florence Road
Northampton,MA 01060-
Attn: Tony Patillo
We are sending you:
Copies FDated I Number Description
1 07/10/01 9313 Check for$200.00 for Building Permit-Application
1 _`07/10/01 Building Permit Application
These are transmitted as checked:
(X For Approval rX For Your Use r7As Requested r For review and comment
Approved as submitted r7Approved as noted Returned for corrections
Remarks
Please find a check and building permit application for the above referenced
job. Please call our office with any questions. Thank you.
i
Signed:
U
File: 37082.5612 Page 1 of 1
Q-CN�MP7.
B• m
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AII"IDAVIT
Donald J. Teagno
(li==&pernuttec)
with a principal place of business/residence at:
228 Triangle Street, Amherst, MA 01002 (phonei#) (413) 549-0803
(str=t 16 ty/slatfJap)
do hereby certify, under the pains and penalties of perjury, that.
I am as employer providing the following workers compensation coverage for my
employees working on this job:
ACE American Insurance Company 043183540 4/1/02
(Insurance Company) (Policy Number) (Expiration Daze)
( ) 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 Number) (HxPiradoa Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/PoLcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (E)Tiration Date)
(anach additioml shed ifneo=suy to iochrde iaformatioa peRaiaing to all 000tri d )
( ) I am a sole proprietor and have no bne working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that While homeowaors who employ pawn:to do mamicnanrx suction or repair work ou a dwelling of
not move than throe unit+in Which the homeowocr mides or on the pfouo zpNdcaant thereto ate not gma-alky comidend to be
employers under the works compensxtioa Act(GL152,sa 1(S)),applicatioa by a homeow=for a Gccme or permit may evidence the
legd status of an employer under the Workees Compeasalion Ad
I undervAnd that a oopy of thin r at=nocit may be focwerdsd to tho DtQatmacoa of lodush id A=W—&Ofoe of toaunnoe for the
coverage v nfie dioa sad that failure to soaue coverage under section 25A of MGL 152 an lad to the iarposi -of criminal peaaltiea
000sisewg of a fine of up to S1,500.00 and/or imprisoumcra of up to one year sad civil peaaltia in the form of a Stop Work order and a
fine of 5100.00 a day against mo.
=NumbZer
.._, Signature of Li Mice Mte
+ Version 1.7 Commercial Building Permit May 15,2000
idependent Structural Engineering Structural Peer Review Required Yes......❑ No.....13C
E
N
UT�HORIZATION TO!,BE COMREIETED, HEN
Jon Hite, Executive Director Northampton Housing Authority as Owner of the subject property
ereby authorize Donald J. Teagno to act on
iy behalf, in 11 matters relat work authorized by this building permit application.
? / o,
ignaturAdf0w ner Date
Jon Hite as Owner/Authorized Agent
ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
nowledge and belief.
signed under the pains and penalties of perjury.
Jon Hite
'rint Nam
>i ure of Owner/Agent Date
;ECTION 12:-CONSTRUCTION SERVICES
.0.1 Licensed Construction Supervisor: Not Applicable ❑
Jame of License Holder: Donald J Teagno CS 03471
License Number
e S re Amherst MA 01002 1/10/02
a Expiration Date
(413) 549-0803
Signature Telephone
SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, §25C(6))
'Norkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
Nill 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
G ,-
I Registered Architect:
Not Applicable ❑
ame(Registrant):
Registration Number
Jdress
Expiration Date
gnature Telephone
2 Registered Professional Engineer(s):
ame Area of Responsibility
Jdress Registration Number
ignature Telephone Expiration Date
ame Area of Responsibility
ddress Registration Number
ignature Telephone Expiration Date
ame Area of Responsibility
ddress Registration Number
ignature Telephone Expiration Date
lame Area of Responsibility
ddress Registration Number
,ignature Telephone Expiration Date
>.3 General Contractor '
Not Applicable ❑
;ompany Name:
responsible In Charge of Construction
address
;ignature Telephone
Version 1.7 Commercial Building Permit May 15,2000
'.Water Supply(M.G.L. c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
'ublic P�C Private ❑ Zone: Outside Flood Zone ❑ 1 Municipal M On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
Ibis 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 X 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 x
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 X
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No X
IF YES, describe size, type and location:
Version 1.7 Commercial Building Permit May 15,2000
R
terior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
cterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
p,Tp-T_- ; Fire Restorati n Job
a a' r .Ax=
ECTION 5- USA GROUP RMR C 5T U,C 1 P
= w
USE GROUP(Check as applicable) CONSTRUCTION TYPE
Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 113 ❑
Business ❑ 2A ❑
Educational ❑ 213 I ❑
Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
High Hazard ❑ 3A ❑
Institutional ❑ 1.1 ❑ 1.2 ❑ 1.3 ❑ 3B ❑
Mercantile ❑ 4 ❑
Residential ❑ R-1 A3 R-2 ❑ R-3 ❑ 5A ❑
Storage ❑ S-1 ❑ S-2 ❑ 5B
Utility ❑ " Specify:
Mixed Use ❑ Specify:
Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
:isting Use Group: Residential al Proposed Use Group: Sn mP
:isting Hazard Index 780 CMR 34): 2 Proposed Hazard Index 780 CMR 34): Same
ECTION 6 BUILDING!HEIGHT AND""AREA '
MAN"
vin
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION t,fin vin
loor Area per Floor(sf) St No Changes
;t 492 2nd
i
nd 492 3rd
rd 4th
th
otal Area(sf) 9&/` Total Proposed New Construction(sf)
_
...................................
otal Height(ft) 24
Total Height ft ------•----••------•
i •'�
...._ r
... .. _.
i. . ., ,.. ..e
{
Versionl.7 Commercial Building Permit May 15,2000
E (r� Q �i Northampton
QDepartment
ain Street
j'6 L 10 2001 om 100
Nort am ton, MA 01060
oEP10fa (�plA 87-1 40 Fax 413-587-1272
NORIHAMPION,MA 01060
4PPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
ECTION 1-SITE INFORMATION
.1 Property Address: _ J3,< 0
Florence Heights Apt. 1BMa o.. '-
zq a :er D s a`
Florence Road, Florence, MA 01060 +
b r ct v
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
:.1 Owner of Record:
Northam ton Housing Authority 49 Old South Street, Northampton, MA 01060
lame(Pri ) Current Mailing Address:
(413) 584-4030
?ig to Telephone
'.2 Authorized Agent:
Jon Hite Executive Director 49 Old South Street, Northampton, MA 01060
lame(Prin Current Mailing Address:
(413) 584-4030
>ig —!'Uxz Telephone
SECTION 3 . ESTIMATED CONSTRUCTION COSTS
tem Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
Building (a) Building Permit Fee
29,100
�. Electrical (b) Estimated Total Cost of
91000 Construction from 6
3. Plumbing Building Permit'Fee
4,800
1. Mechanical (HVAC)
3. Fire Protection 1 .100
S. Total =(1 + 2 + 3 +4+ 5) 44,000 Check Number
This Sec tion For Official Use Only
Building Permit Number: Date Issued:
_ ,% „C.,}.lar. ti,:�a��.7 R-a Uzi,.€„ems. , n• ,. _
fi
Signature:' .
Building Gommissjonerll spe to �o Bulle ir)Ss ,- ` Date o,
•r
File 4 BP-2002-0036
APPLICANT/CONTACT PERSON Teagno Construction Inc
ADDRESS/PHONE P O Box 2054 (413)549-0803
PROPERTY LOCATION FLORENCE HGTS-UNIT 1B- 178 FLORENCE RD
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 `
TWeof Construction: FIRE RESTORATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 034716
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF91CMATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 Co i ion
Signature of Building fficial 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.
ri
r
n
--�
F - .
C)V\
t
.GTS-UNIT IB- 178 FLORENCE RD BP-2002-0036
COMMONWEALTH OF MASSACHUSETTS
)_001 CITY OF NORTHAMPTON
Building
on structural interior renovations BUILDING PERMIT
BP-2002-0036
JS-2002-0052
44000.00
.00 PERMISSION IS HEREBY GRANTED TO
ass: Contractor: License:
aL Teagno Construction Inc 034716
sq.ft.): 255697.20 Owner: NORTHAMPTON CITY OF
URA Applicant: Teagno Construction Inc
AT: FLORENCE HGTS -UNIT 1 B - 178 FLORENCE RD
2
:ant Address: Phone: Insurance:
lox 2054 (413) 549-0803 Workers I
i
pensation
iERSTMA01004-2054 ISSUED ON:71121010:00:00 k
D PERFORM THE FOLLOWING WORK.-FIRE RESTORATION - APT 1 B
ST THIS CARD SO IT IS VISIBLE FROM THE STREET
hector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
derground: Service: Meter:
Footings:
)ugh: Rough: -7p House# Foundation:
inal: Final:
Rqu�gh Frame;
u(+CL�_ vt
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final:
Smoke: Final:L9/( 4114e
THIS PERMIT MAY BE REVOKED BY THE CITY OF NOX HAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receip o• Date Paid: Check No: Amor pit:
Building 7/12/010:Gi11:00 9313 $200.00
212 Main Street,Phone(413)587-1 240,Fax: (413)587-1272
Building Commissioner- Anthony Patillo