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U! 7 IL i I 3 d a i 0 0 0 VIZI � ti 9 � �i35AChn5[tla' DEPARTi1tiENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT with a principal place of business/residence at: 3 l STLt�voe�ip R�f�?G� �(.a u tk, FIA- (phone#)41t (strect/cit?;I�tatrJi�p) do hereby certify, under the pains and penalties of perjury, that: (� I am an employer providing the folloltving worker's compensation coverage for my employees working can this job: "�C-cA S I lac It 0_ (Insurac'<_°e Coa43-2-ry) (PoUcf Number) (rxpuanon Date) ! ) I am a sole proprietor, general cont_r_a_c_toDr r homeowner (cir,le one) z_zd lave hired the contractors listed below who have the following worker's compensation policies: f)MCQ.tciglV s?l rcS (Name of Contractor) (Insurar.C--Comp's /Policy Number) (E-Ypiration Date) _ tlk-5 2-:�15 3059 g-to( ct (0 _ (Name of Contractor) (Insurance Company/Policy Number) Fxpira on Date) i (Name of Contractor) (Insurance Compaay/policy Number) (E.x-piration Date) a i (Name of Contractor) (Insumnc-- Company/Policy Number) (Exmimuon Date) (coach additional sheet ifnoo=xry to inc}ude informiIIoa pertaining to all oodxsctora) '' ( ) I am a sole proprietor and have no one worLng for me. I am a home owner performing( ) p rming all the work myself. NOTE:please b aware tip w�1c hoarvrvncn who employ pasoai to do ma r, cam pion of r,c^ait wvci o a dwcLing o not afore than throe units in which the homoowncr raids cr oa the g gads appurteaurt thereto arc Dot gaxrally oo=ocrcd to be employ=under the%Ym*c's o=pcm4aa Act(GL152,zs 1(5)),application by a homeowner for a Gernsc cc permit may cvidcacx the legal status of an employer under the Workeet Compensation Act_ I understand d)d a copy of this c f mcut may be forwarded to the DV tzn�of Ind.i id Arcidm&OtFoe o:[r auiacn for the coverage verification and that fai u a to&enure coverav under scctioa 25A of MGL 152 can lead to the imposition of cc im=l penalties ooas.L%dng of a fine of up to S1,500.00 anNoc impris�of up to ow year and civil pcnilti a in the form of a Stop W erlc Oeda and a fim of 5100.00 a day against ny- For dcprrtm=1bal use only Permit Number Map;t _---- Signature of LiccnxxJPermittee e -- 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-FORBUILDING 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 I, 0©1 as Owner/A , 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 t e pai7 and penalties of perjury. `( C)A40s�. P 'nt Name qI 2 7 cb Signatu a of Q wne / en ` Date SECTION 12-rrCONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number 12t uJ _ P t� _ Address Expiration Da Sig ature - 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...... ❑ ' Version 1.7 Commercial Building Permit May 15,2000 SECTION 94120FESSIONAL DESIGN:AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTURES .,UW.ECT TO CONSTRUCT 16N';CONTR'OR`PURSUANTTO:780,CMR 116(CONTAINING MORE THAN 35,000'C.F.OF ENCLQ$ED,SPACE) 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): t'JU-t- A PP(Al'A E 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 Telephcne Expiration Date Name Area of Responsibility Address Registration Number Signature Teiephone Expiration Date 9.3 General Contractor A NT d"1 )A-A p-y cG V t,Tky 0(�(Co c k-S Not Applicable ❑ Company Name: v 3 p In arge f Construction 3(on s �` I c coo �t G� I.�� H_ "off✓ E�1 A ress 4( 7 708 signature Telephone ' �'ersionl.7 Commercial Building Permit May 15,2000 7.Water upply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: ( Public Private ❑ I Zone: Outside Flood Zone Municipal On site disposal system ❑ _J 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ,r F)6- 5A ti Frontage 9 C-)' Setbacks Front Side L: R: L: R: Rear Building Height 2- t Bldg. Square Footage (s rJZn % �M� Open Space Footage % (Lot area minus bldg&paved arkin #of Parking Spaces ' AHE Fill: C �- (volume&Location) �� SJ (` 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? :0 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: Version 1.7 Commercial Building Permit May 15,2000 City of Northampton " Building Department SEP 2 9 2000 i ` 212 Main Street DEl'� �lF u�J±��,�� kiSrECTIONS Room 100 orthampton, 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 section to be complex by uffce 1.1 Property Address: ��� ``14 cl (-Yfl N Pb, Map mot wt o e# �,� Zone Overlay District -H . ,. Elm St.District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGEN 2.1 Owner of Re o'rd: 'S t+? ' G Pao --- 3( kUST—( C K008 R- (Q U E Ej i t-t Tc V H ame( t) Current Mailing Address: 761 Signatu Telephone 2.2 Authorized eat: Name t) Current Mai! ng Address: — ---- - --,?q Signatur Telephone SECTION - ES ATED NSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only �_ com leted by permit applicant _ 1. Building (a) Building Permit Fee 0co 2. Electrical -700 (b) Estimated Total Cost of _Construction from 6 3. Plumbing 3� Building Permit Fee V 4. Mechanical (HVAC) 5. Fire Protection ?00 6. Total =(1 + 2 + 3 +4 + 5) U U Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2001-0347 APPLICANT/CONTACT PERSON Roy Giangregorio ADDRESS/PHONE 31 Rustlewood Ridge (413)586-7708 PROPERTY LOCATION 949 RYAN RD MAP 35 PARCEL 058 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid_ DTeof Construction: REMO EL KITCHEN&BATH New Construction Non Structural interior renovations Addition to Existin¢ - _ Accessory Structure Buildiny,Plans Included• — Owner/Statement or License 062571 3 sets of Plans/Plot Plan TLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: pproved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS 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 Conservatio mmission Permit from CB Architecture Co ittee Signature of Bui ding 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. 949 RYAN RD BP-2001-0347 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35-058 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2001-0347 Project# JS-2001-0561 Est.Cost: $21900.00 Fee:$105.00 PERMISSION IS HEREB Y GRANTED TO: Const.Class: Contractor: License: Use Group: Roy Giangregorio 062571 Lot Size(sq.ft.): 17641 .80 Owner: Roy Giangregorio Zoning: SR Applicant: Roy Giangregorio AT. 949 RYAN RD Applicant Address: Phone: Insurance: 31 Rustlewood Ridge (413) 586-7708 Workers Compensation FLORENCEMA01062 ISSUED ON.1014100 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN & BATH POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/4/00 0:00:00 4984 $105.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo