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18D-058 (10) OCT 3 DE7 OF Bv !ri c ii 3e MIT u; L . 0,f Q'J?�c r j. r •�� (�� f it V M � ti i OQ-�n�pTO .- �� a of wart 1jaillptoll B6lasaachasctts' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORIER'S COMPENSATION INSURANCE A e e AVIT Odod&�' - tnpr ru K-�(, )D 13/4 K e (li censee/permi flee) with a principal place of business/residence at: 201 I-OC'Uc t 5T tS K I'( (phone#) (strcet/ci ty/s�airin p) do hereby certify, under the pains and penalties of pegury, that: I am an employer providing the following workers compensation coverage for my Inployees working on this job: (Insurance Company) (Policy Number) (Expiration ate) O 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) (Expiration Date) r. (Name of Contractor) (Insurance Compairy/PoLcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shore ifn6otniry to inchule information patn;nins to all coatrnc rs) O I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware[fist while homeowners who employ paioas to do=icd�=sbidioo or repair work ou a dwelling of not atone I]=throe units is Which the homeowner mides a oa the gounils apps rUmani thereto are not wally oonndcrcd to be employee under the workcez oompc=&ioa Ad(GL152,s3 l(5)},application by a homoowna for a license oc permit may evideuoe the legal datna of an employ«under the Workeet Compensation Ad. I undcntaad that a copy of this zu t cmeai maybe fbrwwr W to the Departm�of Indus d Aa=dee&Off oe of limwince for the Coverage verification and that failure to sec=covetngo under section 25A of MGL 152 can Iced to the imposition of a=nal pcnallia oonsisting of a fine of up to 51,500.00 and/of fine isomncut of up to one year and civil penalties in the form of a StoP Work order and a fins of 5100.00 a day against me -�J For dgrutm4&L&l wo oaty / J V ��_ !1 Permit Number j ! Map# Lot# Sipab=of Licenser/Permittee e Version 1.7 Commercial Building Permit May 15,2000 SECTION,10�STRUCT�JRALPEER2E�/I,EW; 780 CMR1I0 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION 11 OWNER AUTHORIZATION TO:BE COMPLETED WHEN!; OWNERS AGENT NTRACTOR APPLIES FO ORCO R BUILDING PERMIT 2 I Y1 1)Q �) l r as Owner of the subject property hereby authorize D e r G I tc 0(3 i✓t to act on my be l I , in all matters rela a to work a horized by this building permit application. G to a Voll Signature of Owner Date l ` DDJ!�3100 \,2{'fe 1 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. Op 51 f r C'Print Name Sig 4t o Owner/ gent L Date SECTION 12-CONSTRUCTION",SERVICES 10.1 Licensed Construction Supervisor: Not Applicable El Name of License Holder: �_ r9 } IlaS 1 e rw!A� 00 2'7_>_2— License Numb r Addr�p Expira ion Date ", Signatur 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 P tOFESSIONAt DESIGN AND GONSfiRUCT10N SERVICES F0,R BUILDINGS AND STRl1CTllilES 5lI`BJEGT TO GONSTRUGTI�,.N GONTROL''PURSUANT TO, 80:CMRY16(CONTAINING MbRE TAAN'.35;0,00, 'F, OF:ENC OSER S`PACE�'„ 9.1 Registered Architect: r Not Applicable Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): -t5 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 Telephom; Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor ,5t-,v I )>55,a)�, Not Applicable ❑ Company Name: l)Duc�(o.> 7--Prrxn: e Responsib In Charge of Construction zoy Lde-�sr `� l=��FP Acz Addy; Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L. c. 40, §54) 17.1 Flood Zone Information: ( 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning Caw✓'�Q This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: `i Rear ; Building Height i 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 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�C_ IF YES, describe size, type and location: Version 1.7 Commercial Building Permit May 15,2000 SECTION 4 CONS RUCTMIS�ERVICES3FOR PROJECTS LESS THAN 35 000' 'GUBIC 'LF ENCLOSEI}SPACE� 3' °iFSLR. Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] 1�,/'g Accessory Building[ ] Repairs [ ] ]" 1JfW 40 Cr L`.�+t1,trlr ��.(�� C' t-P(t.;Z SECTION 5 3C1SE GROUP AND CONSTRUCTION}tYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 213 I ❑ F Factory ❑ F-1 ❑ F-2 -btf 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 THI8'^;SEC7f0N IF=EXISTING.BUIL©ING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: —vi d t'S-t ` Proposed Use Group: 5CA-"Vl -e Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION flN(r 1�d f �► C f��� ' t�c) iR Floor Area per Floor(sf) St a — 1 m k 2nd 1st f 3rd 0 F 2nd z z s a r rd 4th , y 4 th a v i ik y�f M Total Area (sf) Total Proposed New Construction (sf) � ---------------------------------- Total Height(ft) Total Height ft -------------------- nei Version 1.7 Commercial Building Permit May 15,2000 E L� l� Q V Lg It orthampton i Department { ain Street CvCT 2 3 fL,n GI o n m 100 i Northam ton, MA 01060 : DEPT OF BU! f113 87 240 Fax 413-587-1272 ` NnPT.R"Mi'TGN,MA 01060 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#o be completed by'office 1.1 Property Address: T ` �. ` J 2 Map Unit ! 1 n)ysi t r �� * r Zone ove lay District ; ` r. r x Elm,St District „ . w''• CB,District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: _ Name(Print) Current Mailing Address: '�G 1��� s-�� - �t& 7 Signature Telephone 2.2 Authorized Agent: 00j t 2 d R L c7CvS-r Sfi � t 2 QLj(4 5 1— ?crct-ii e 5"Lh� � � ��� �=tc)fe-2c Nam Priryt3 —r Telephone Current Mailing Address:Cl Signat SECTIOR3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �j� � (a) Building Permit Fee 2. Electrical �( (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) Q 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) QJ O Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Comm issioner/lnspector,of Buildings pate' File#BP-2002-0431 APPLICANT/CONTACT PERSON Skyline Design ADDRESS/PHONE P O Box 142 (413)586-8491 PROPERTY LOCATION 175 INDUSTRIAL DR- ST GOBAIN MAP 18D PARCEL 058 001 ZONE GI THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiny,Permit Filled ou Fee Paid Typeof Construction•_POUR 18 X 12 REINFORCED CEMENT SLAB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 002722 3 sets of Plans/Plot Plan THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF MATION 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 Commissi 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. ' aa�� r<° BP-2002-0431 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0431 Project# JS-2002-0656 Est.Cost: $8000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Skyline Design 002722 Lot Size. ft.): 160300.80 Owner: OLDON LIMITED PARTNERSHIP zoning: GI Applicant: Skyline Design AT. 175 INDUSTRIAL DR - ST GOBAIN Applicant Address: Phone: Insurance: P O Box 142 (413) 586-8491 Workers Compensation FLORENCEMA01062 ISSUED ON.10/24/01 0:00:00 TO PERFORM THE FOLLOWING WORK:POUR 18 X 12 REINFORCED CEMENT SLAB 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/24/010:00:00 8201 $50.00 212 Main Street, Phone(413) 587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo