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35-055 (2) OR-(ttlJ-! (`ifs of �ortl�a))t}�ton B~ E ,3las�+crhncrtla' _ — 4 = DEPARTMENT OP DU1LDr-,10 INSPEC7101.'S —' 212 Main Strect ' Municipal Building Northampton, Mass. 03060 \V(D RIC':R'S COMPENSATION LN S UR ALN CE A FF D):k`rI-I' (li cCnscrlpertni floc) 11),Ith a plincipay place of business residence all (svrrt/c�ty/Seale f2i p) do hereby cer-i ,, under dic p?ins and penalties of perjury•., :hat O I an a-n employer providing tyre Following worker's colnncns-nDorl covera,c or my etnplovices worydng on tills job: (I>zsur_a Corer ) (Polio: (1 ;piratior Da1c) O I,am a sole proprietor, general contractor or homeowner (ci cie one) aid have hired the cones actors hsted below r,,bo h-ave the follo%YU" g worker's caooensadon pc!icies: (N,91D-, of Con-.runic (IRR f3nh Corntmm•/ioUc-,- NUSILrT) (Name of CODII3c00 (Rsurancz ComoanyiPolim, Nwm6zo (—ti�ir,uon Date) (Name of Cotu(aelo7) (zswancc Compao)•/PoLicy Numbzr) (Expil- do0 Date) (Name of Contractor) Rcsuranc-- Comp2 ry/Poucy Numbu) (ENpuatioo Date) (aaaCb oeal erect if aocsiry to n-,e�ud=infor=m,:j oe pertaiain&to.11 oo=-c_o:-,) ( I am a sole proprietor and bave no one wor�dng for me. ( ) I am.a home owner performing all the work myself. NOTE:pl=s be ewzrt th,..tile bomeowvc,wbo cmplvy pczow to do cG—jcC oo r rt,air-ork ao.d,,,-U .e of ant mot Lb ` _ s m u-ticb the baa�rmda or oo t6e Qoune:,zppurica.:r,.tbeev c c ooe�_--j oecz drej to be cmploy�ubGc the ca Acl(GL1521s1(5))�apptisaDoa by a bomcoa-oa fca a tip.a Perms=y nidca the legal m-^-of m-cPloy.c uoder dw Workoet Com9amiUOa ArL I uodvaind dl t a copy of this msz:maos m,.y be fo--,id to tbo pop,,,,ca¢of lnm,asri�l Amd.3&ofsoo of trca,r,aou for th. coveter v nBcmioo vzW a%--'f-L=to t'00 r `oovR1,Cc under soaioa 25A of 1.(QL 152 c=lad to tlx impositioa ofaiminal pca wl= coasizri of a rmc of up to 51_500.00&nN r impR of up to ooc year tad ov-il peaatio is tx form of a Stop Work Ordcr and■ fim 015100.00,d--y tpj=me For d �— u,c only ------� PC7III1t t`lt1IDt)CS Si�natztrr of Li crmi(ic� �� .:�; Versionl.7 Commercial Building Permit May 15,2000 ,SECT OI+1 10 STRUCTURAL PEER REVIfIY(7$OQCMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11� OWNER AUTHORIZATION=TO BE COMPLETED: WHEN OWNERS AGENT OR CONTtACTQR APPLIES Ff3R BUILDING PERMIT" I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner 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. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 121 CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number (�(/ ' Addres Expiration Date .--7165- Signtlure Telephone SECTION 13 WORKERSg COMPENSATION JNSllli2ANCE AFFIDAVIT -M G .,..... �.._...0 "g n -M _ 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...... ❑ rwrw — Version 1.7 Commercial Building Permit May 15,2000 r' SECTION 9 PROFESSIONAL DESIGN AND CONST>Rl1CTI0N;5ERUICES -FOR SUILDINGSHAND STRUC7 URES SUBJECT TO` CONSTRUCTION GONTRQL RU'UANT T01780 Cw 116{CONTAINING MORE'THAN 35; 0©C:F :0"f;ENCLOSEfl RACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address I 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 Company Name: Not Applicable ❑ Responsible In Charge of Construction Address Signature Telephone r Versionl.7 Commercial Building Permit May 15,2000 ' Y 17.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 parking) #of Parking Spaces Fill: (volume&LAcation A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 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 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 SEON � �yYp�y ��' TTAa7IY1T 2 Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: 1/ SECTION=S .IiSEZROI :"AND�COJ+IS1lUCI3ON''3 ( 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 ❑ 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: S fi 'f f!�P„LETS` T I�1G i1�1G I3 Gt�llalG�10 7 i1 0Y31 ONS "CHANGE IN-USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): 4'- SEG730N;6.BUILDiNG,fiIEI"GH�AND�`REA� BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTIONi. , IN Floor Area per Floor(sf) 1st � x z � 1st 2nd � w a 3 , h 3rd 4t' �-00= Total Area(sf) Total Proposed New Construction (sf) M ` r Total Height(ft) Total Height ft Versionl.7 Commercial Building Permit May 15,2000 City of Northampton 60ilding Department -212 Main Street Room 100 —_;,,,-North*pton, MA 01060 R �-124Q 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 =;SECfiON 1 ;SITE1!IEOIiIATI0 N 1.1 Property Address. s SECTION 2 xPROP.ER7Y Oafa1NERStIP]AUT#110R�F�AGENT _k ;. 2.1 Owner of Record: w Name(Print) Current,MM50iing Addr f Sig re Telephone 2.2 Authorized Agent: 000f 11 — Name(Print) Current Mailing Address: Signature Telephone SEGT3+DN 3=`IESTII+�IATED CONSfftUCTION COSTS �UF ... .. . Item Estimated Cost(Dollars)to be Official--Use Oily completed by rmit applicant 1. Building �Peftmil +ee 2. Electrical Estimated Total --0 ��=��"�istructlon.frsim'b ,:. 3. Plumbing Builsllon, g�Pefm�t Fee s<` 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3+4+ 5) � - r � rF �.._ .,� .. . Th�s:Sectioi�:For OfFcia�Use Ont ; to Issuetl _ Building Pernait Number ,. Da Signature: Building Commissioner/Inspector af-:Buildings Date 952 RYAN RD BP-2004-0570 GIS#: COMMONWEALTH OF MASSACHUSETTS 3 ;F" CITY OF NORTHAMPTON Lot: -001 Permit: Buildina Category: BUILDING PERMIT Permit# BP-2004-0570 Project# IS-2004-0800 Est.Cost: $5000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Edward T Corbett 119488 Lot Size(sq. ft.): 15246.00 Owner: LAPAN LEO E&THERESA M Zoning: SR Applicant: Edward T Corbett AT: 952 RYAN RD Applicant Address: Phone: Insurance: 1 TERRACE VIEW (413) 584-2546 EASTHAMPTONMA01027 ISSUED ON.•1117103 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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 Sienature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 11/7/03 0:00:00 MO $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo