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35-040 33 SYLVESTER RD (SEE ALSO 35-304 1015 RYAN RD) Jan 13 09 03:-53p ' Water 4135871576 P. 1 JAM-13-2009 07:59 From: 4137346224 7o:413 587 1576 P.1,2 i L�Lf-11� 352 Albany St.,Springfield,MA 01105 Tel; (413)732-31791(800)448-2822 Fax:(413)734-6224 i( DATE: January 13, 2009 TO: DAVE SPARKS (LYNN) FAX# 413-587--1576 OF: NVATER DEPT. PHONE # 413-387-1098 (1570) PLEASE CUT ALL SERVICES AT THE LOCATION OF 3 3 SYLVESTER ROAD AND 1015 RYAN ROAD,FLORENCE,MA, AS IT IS BEING SCHEDULED FOR DEMOLITION. ONCE DISCONNECTION HAS BEEN COMPLETED,YOU MAY EITHER SIGN BELOW AND FAX IT TO ME AT 413--734-6224 OR YOU MAY FAX ME NOTIFICATION ON YOUR COMPANY LETTERHEAD. THANK YOU VERY MUCH FOR YOUR ASSISTANCE. SINCERELY, ASSOCIATED BUILDING WRECKERS,INC. JOANIE SAVAGE DEMOLITION COORDINATOR SERVICES AT: 33 SYLVESTER ROAD AND 1015 RYAN ROAD, FLORENCE,MA HAVE BEEAt.H15CONN OF PRINT NAME: SIGNATURE: f REMARKS, IF ANY:. I i Jan 09 2009 8: 59AN HP LASERJET FAX 3105892519 page 1 nationalgrid January 9,2009 Carol Erickson 1015 Ryan Road Florence, MA 01062 TO Whom It May Concern, This is to verify that National Grid has removed the electric service and meter at 1 Ol 5 Ryan Rd. aid 33 Sylvester Rd Florence, Manaachusetts, effective Januwy 9,2009, and is safe for Building Demolition. Sincr.rcly, Jim Nichols Supervisor Distribution Design JN[ekp 548 Hayden011s Road,Leeds,MA 01063 ■ mmrationalgrac= Wb SZ:95:9 600Z/6tL:9M3 L1C :essd MLZ:wad Bay stets Gas Company January 13, 2009 Associated Building 252 Albany St Springfield, Ma 01101 Dear Associated, The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS - 1015 Ryan Rd TOWN - Florence STATE : Massachusetts Sincerely, ]ew Illy Ferri Miner Workforce Planning 2025 ROOSevelt Avenue P0.Box 2025 Soringfield,MA 01102.2025 4'3.781,9260 Fax:413-781-9222 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / [[ Please Print Lep-ibly Name(Business/Organization/Individual): �{J j�`/('l 'Cf�G/f!� Address: City/State/Zip: Phone #: Aon an employer?Check the appropriate box: Type of project(required): 1.iy am a employer with yj 3 t 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. E] Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: -41 I/l(t'I 1! y j)(, /�/V/ Policy#or Self-ins.Lic.#: 4 � / d/•� Expiration Date: V/2J���� Job Site Address: ^�'u!��� / kd, City/State/Zip: r'Cf�'�)!�L}Uh Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: A At /fr,, Date: ��J/ � Phone#: � - / tl Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction/ Supervisor:: Not Applicable ❑ Name of License Holder: >11 11-(h1 V1/✓PP AJ`/ //A License Number VA tll l G'f�l Ot � ddr s Expiration Date Signature Telephone 9.Registered Nome Improvement Contractor: Not Applicable Mz Company Name Registration Number Address Expiration Date Telephone SECTION 10-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 buildi g permit. Signed Affidavit Attached Yes....... No...... ❑ 11 - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts 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(s) 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 r , SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ED Accessory Bldg. ❑ Demolition New Signs [0] Decks [0 Siding[p] Other(p] Brief De cri tion.of�I pose f� Work: , R /i7 G /- C7/?(1C�(sp df Cy// �hSfL%/7/�i`C'(�l�%J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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. Masscheck 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 No 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, C(Yf016 rUl i✓4 02061 60/hirc; 4065,M as Ownerof the subject property hereby authorize to act on my behalf,in all matters relative to work autPr6rized by this building permit application. Signature of Owner Date I, A—�5,oCl*ft)CI All/*6,�# Mr(Mil.J,kC. as-evtter/Authorized Agent hereby declare that the statetrknts 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. Prin Na e 1, Signature of 0%6r/Agent Date f Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 0 DON'T KNOW 0 YES IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES IF YES: enter Book Page: and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 11* YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 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: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb CoDriveway Permit �"A `212 Main Street Sewer/Septl6Availability a oom 100 Water/Well.Availability Northampton, MA 01060 Twa Sets of Structural:Plans phone 41.3-SW-1240 Fax 413-587-1272 Piof/Slte flans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: I- f ru! Klobd j1�no Cfiu/�,Q. This section to be completed by office m J,[/VIS J E r /�(/, Map Lot Unit Fc/yAepj k9A Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: bi?7/Z1�I�ISGJ1 Name(Print) Current Mailing Address: Telephone Signature G 4,; 2.2 Authorized Aaent: c t)t.&A l A4a tifi-f( eo roc V 1411 u:sf �r?%//1y&/I , qq / Nam (Pr' t) Current Mailing A dres � tin L'//G� sr Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Nd7WI A-1 \li qt ba v (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2 +3+-4+5) e,G'�� Check Number ' � 00 This Section For Official Use Only Building Permit Number: Date Issued: \ Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0642 APPLICANT/CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413)732-3179 PROPERTY LOCATION 33 SYLVESTER RD MAP 35 PARCEL 040 001 ZONE SRO 00)//WP/WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: DEMOLISH 1 STORY STRUCTURE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• - Owner/Statement or License 062382 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF99MATION 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 Permit DPW Storm Water Management Demolition Delay I 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. S BP-2009-0642 GIs#: COMMONWEALTH OF MASSACHUSETTS k•35--040 rv° CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2009-0642 Project# JS-2009-000911 Est.Cost: $3000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Gro : ASSOCIATED BUILDING WRECKERS INC 062382 up Lot Size(sq. ft.): 538837.20 Owner: MIELKE ROY D C/O CAROL ERICKSON Zoning: SR(100)//WP/WSP II Applicant: ASSOCIATED BUILDING WRECKERS INC AT. 33 SYLVESTER RD Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON:111412009 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMOLISH 1 STORY STRUCTURE 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 1/14/2009 0:00:00 $35.00303006 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street IV Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:.)i)///);6{/.�'�&/, Phone Are on an employer?Check the appropriate box: Type of project(required): 1.7I am a employer wither 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /1/n4,% Policy#or Self-ins.Lic.#: (s���D (�°�l�/ Expiration Date: �tllb' 5�c rte./lcnl� h'c 1 , Job Site Address: � �1� � 1. City/State/Zip: `tl� l�/!(i; A14 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: I 11/u' A" Date: l D L . Phone#: /l5 � )`_ .�l 1 vl r Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DIG SAFE SYSTEM, INC. - Create New Quick Ticket Page 1 of I Request Number: 20090201422 Date 01/06/2009 Time 07:43 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address/Intersection: 1015 RYAN RD Nearest Cross Street 1: SYLVESTER RD Nearest Cross Street 2: Additional Information: DEMOLITION OF ALL STRUCTURE ON PROPERTY-MARK ENTIRE LOT TO STREET Nature Of Work: DEMOLITION OF ALL STRUCTURES ON PROPERTY Area Of Work: PRIVATE PROPERTY Area Is Premarked: Y Start Date:01/12/2009 Start Time: 08:00 Caller: JOANIE SAVAGE Title: DEMO CO ORDIN Return Call: BEF 430PM Phone#: 413-732-3179 Fax#: 413-734-6224 Alt.Phone#: Email Address: ABW_INC @COMCAST.NET Contractor: ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip:01105 Excavator Doing Work: ASSOCIATED BUILDING WRECKERS,INC. Member Utility List Code Abbreviation Name MC MASSEL MASS ELECTRIC COMPANY SP �—VERIZN VERIZON DCOMCAS COMCAST WG BSTGAS BAY STATE GAS ON ONTARG ON TARGET LOCATING E=1 IDM = INNOVATIVE DATA MANAGEMENT . There may be non-member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. Create New j Create From Existing Print Ticket Return To Menu Return To Home http://digsafefonn.digsafe.com/cgi-bin/dlcgi.exe 01/06/2009 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: f Not Applicable ❑ Name of License Holder: License Number Q s Expiration Date X�y ture Telephone 9.Reallstered Home Improvement Contractor: Not Applicable Company Name Registration Number Address Expiration Date Telephone SECTION 10-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...... ❑ 11. - Home,Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 1083.5.1. 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 buildine 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(s) 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable t New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors l] Accessory Bldg. ❑ Demolition New Signs [O] Decks [p Siding[❑] Other[p] Brief De'scriptiort o#�Propos 7 Work: .tlt�il'�I;�!%J7017 //(/C/i(( claooejr t)ll[libib /P J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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. Masscheck 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 No 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property / hereby authorize �� ��� /[)f(9�1�C/)/��/l�Gl GULC iy�r iin to act on my behalf, in all matters relative to work ethorized by this building permit application. Signature of Owner Date I, 4, S VC ����('ii1��)��i �1�'[ f��;�/�(. as Gwnw/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. P`nt m Signa ure ofewrw/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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? Afflh NO 0 DON'T KNOW IV YES Q IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book _ Page; and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q Date Issued C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r , �$ entxl#e � City of Northampton ;Building Department y " �r y QO9 ° 212 Main Street Sege a oom 100 w! " Y 3 �hOrthatrhpton, MA 01060 phorfe:411240 Fax 413-587-1272 Pik#► try Utyr•x1 )fy '� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office; 0 ,J h,nC s Map Lot Unit �Gr�'f�� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cron,/����i��c-r� �.' �✓r ��r,��Cc�i �>r� ;?�;�� "�c�c:_>e �'��., �1c�i���ri ��i� �i��� �� Name(Print) Current Mailing Address: , ohs Telephone_ Signature 2.2 Authorized Agent: A, cC vd r fA(111 i2" Na a(Pr t) Current Mailing Ad ess: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ) ) (a)Building Permit Fee (k mO'll- G'o ,j) .UGC-. GC, 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) ) Check Number 0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2009-0635 APPLICANT/CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413)732-3179 PROPERTY LOCATION 33 SYLVESTER RD MAP 35 PARCEL 040 001 ZONE SR(100)//WP/WSP II THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid BuildinIZ Permit Filled out Fee Paid T_ypeof Construction: DEMOLISH 2 SHEDS-1015 RYAN RD New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 062382 3 sets of Plans/Plot Plan THEpproved OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INTION PRESENTED: 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 Permit DPW Storm Water Management Demolition Delay � Z D 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-2009-0635 Y GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2009-0635 Protect# JS-2009-000911 Est. Cost: $1500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 062382 Lot Size(sq. ft.): 538837.20 Owner: MIELKE ROY D C/O CAROL ERICKSON Zoning: SR(100)//WP/WSP II Applicant: ASSOCIATED BUILDING WRECKERS INC AT: 33 SYLVESTER RD Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 SPRINGFIELDMA01105 ISSUED ON:111212009 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMOLISH 2 SHEDS-1015 RYAN RD 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 Si nature: FeeType• Date Paid: Amount: Building 1/12/2009 0:00:00 $40.00302973 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo