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29-029 s ti d 9 eo 0 N 13'4" 2'-6" n 0 m p (D CL Q OD p o CD O= CD. 0 CD (Q �: DAN A 1 � g � N N N 0 3 o o m cn 0 W— CD CD m c� o v o p C o o i - CD 3 3 do CD go 0 T o14... 101. 3 p °o c cu m n � 0 no _ N W N_ � W p� O T 3 01 a 42 r t J Tony Patillo Northampton Building Commissioner 212 Main Street Northampton MA 01060 January 15, 2004 Dear Mr. Patillo, Thank you for taking the time to speak with me this morning. I submitted an application for a building permit for my residence of 258 Ryan Rd., Apt.2 in Florence on January 12'h. This permit is being held pending receipt of a Workers Compensation form. The contractor named on the application is George Kicza. Please be advised that I am no longer authorizing Mr. Kicza to act as my agent to secure the permit. I have met with a new contractor and will be in shortly to name this person as my agent to secure the permit. I appreciate your assistance in answering my questions regarding this permit process. Please feel free to call me with any questions. I look forward to meeting you once this project gets under way. Sincerely, Stephanie Velez 258 Ryan Rd., Apt. 2 Florence MA 01062 587-3969 (H) 549-3918 (W: M-Thurs. days) t t (S} f}l i• R to 4.0 to lx U7 M, �. O '�' ; G FIT:; Oo It CD 4 CD � zv N n• � O't3 ° 'r G y t CD C n � CD CD Sal O (D n rr ^ O � aq O O (D x O cn -r O Ste. 0 O lD O OQ . 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O V-10" 3 i Rz �ira:f a))>.pfo„ r ----- Af .61 z3sechnr:clie' _ DEPARTMENT OP BUILDING INSPECTIONS 212 Main Strect ' Municipal Building Northampton, Mass. 010GO �NIOJ CCIZ'S COwEPENSA770N C SURA-NCE A I7' (li ce aserJ perm)acc) wlLh a prMcIpa.! place of business residence at: 75 ��.> S�� c� felt f!—L -YFr ,�.' 'ez (phone•') Z4 > 'S S 3 (sv-c--UcitY1S=L1zbp)Gry f'', 3 do hereby certify, under the pains aod penalties of penury., !hat O I am an employer providing the followine workcr✓s comocnsa or Iny etuptovccs wor�2t,g on"tills job. (Lzlsur,a Comrzny) (Pciic; ?:u_-hoer) --- (r:--,•pir-do r, D2t:) ( ) I am a sole proprietor, general contractor or homeowner (ci'cie or_e) and Dave hired the cones actors listed below vgbo have the fotlowi�g worker's coO:)ensation policies: ('Namc Of COD—17nC'Or) (In-urancc Company/71obci Numh---) ` xpinw,:Qn Datc) (Name of Coua2clor) (1nSw-anc ComDaa`-/PO1cl' Num6cr) (i emir Lion Date) (Name of CO=CIO ) (I»Iranc; Comp w)-[PoUicy Numb j) Date) QN'ame of Contactor) (Iasuranct- Comp2zy/PaEcy Numb r) (Expn6on Date) (an.zab sdd=oca!SbcG ifnco=^ -ry to cn vct=mforcujoc pczta.iai.ns w all oo,=,on) ( I am a sole proprietor and have no one wcr4d.ng for me. ( ) I am.a home owner perfon=*,O, all the work myself. NOTE:plesc be ew-ut Li-z'wtjjl bom owvm v bo=play persons t.o di ma rw—= or rcaair-ork oo.d%,e! -g of not most kL:n urm=rj in wt ieh the boiD o ranch(x oo ehe 9--d3 zppurtec=tbcceo oee:d-rod io be —)Ploy--ua' t5c..airh lion Acs(GLIS2-sI(5)).=ppG=000 by n bomcowvc fv-lice.or Parma rr y nid=cc tt`c Ic�,J n 9^„of an-=ployo under dro Woke,Coe alioa AeC. t ux dcstnnd dv2 a copy of a,;,caI—may be Cor__%j d to tbo Dcpenmeoa of Inoayzricl I�=&—lY OM_of Ir-_for the oova-X&c vtyjt'alioa mad lh:t f ilt7e to socurc`aovcza&,vAder sxtion 25 A of 1.SoL 151 an lad to the i , i6cc of==in-tt pcw.16cs oomini g of n Sine of up to S I,S00.00 uzditx ms�� oCup to aec y=r od a%il pasnhia in tx form or n Stop W oA Order nod a ring Or 5100.00 n d-,y Lp=tnc For dry.rsa�31 u.c Doty Parma)`IttrnbCl Z ��y T apv, Lot —' .' Versionl.7 Commercial Building Permit May 15,2000 SECTION 30-.STRUCTURAL PEER REVIEW(780'CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 3.1— AUTHORIZATION;-TO BE COMPLETED' WHEN OWNERS AGENT.OR CONTRACTOR APPLIES'FOR"BUILDING PERMIT' 1, 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 declar 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 N me Signature of 0 er/Agent Date SECTION 12-CONSTRUCTION SERVICES: 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :�, ��� S ST/: 'Z�- 5 a cri ; n n oS5`Sr License Number �Sr G+IA-,C4 Geis Address Expiration Date 3 3 3 2 Signature Telephone SECTION 13-WORKERS'COMPENSATION 1NSURANCEAFFIDAVIT(M.,G.L -c. 152, §25C(5)). 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....... 2d No...... ❑ �-� �` ( � � � P a Version 1.7 Commercial Building Permit May 15,2000 SECTION 9`'PROFESSIONAL DESIGN AND CONSTRUCTION SER,ICES FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRIJC710N-,CQNTROL PURSUANT TO 780}CMR 116t.ONTAINING MORE THAN 3 ;OOO T 'OF E JCLOSED SPACE] 9.1 Registered Architect: Not Applicable �( Name(Registrant): Registration Number Address 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 j Versionl.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L.�.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private I Zone: Outside Flood Zone Municipal ®On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning All 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_ < DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO X 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 ; SEt N -' ONS 3i� � R R03EG ?S .ESS7HAN"Xs 0 Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ ❑ ❑ Exterior Alterations Demolition[] New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: UN V e-I -f111 -7-0 13 f- SEMT ON ='USE CROUP ANi3 USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ 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 It R-1 ❑ R-2 Ca R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: U7S7 ISE llDf�iNGVflNS4D13iIflNS A1Q�OR CHANGE I'N`17SE a�t Existing Use Group: TZ-2- A c- fR '"' � Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECT ION 6:S�ILDI :I�EiGHT�AND,A � BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION t Floor Area per Floor(sf) ist r 2nd 1st 2"d rd 3rd th 4 4t' a. xi p gas (sfl � Total Area 1�v,.rto� S �-�— Total Proposed New Construction (sf) MIN � �� Total Height(ft) Total Height ft--------____ -�C E r Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 Northampton, 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 SECTIONS ,SITE Iit1RM TION4 1.1 Property Address: y i it• i. , .�s�.,� '`. SECTIOl�l2,'PROPERTY©1I11NERSFIIP/AUTHOIEDf1GElNf 2.1 Owner of Record: Name(Print) Current Mailing Addr . SLIq-��G.B �w� Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone =SECTION -ESTIMATED CON STRUCTION'COSTS Item Estimated Cost(Dollars)to be Official else Only completed by rmit applicant ;<, 1. Buildings Building Permit Fee IScoO _ 2. Electrical 1i Estimated Total CoAt „ r O � Ccir�sh�ctionsfrom�,� -- 3. Plumbing 'Bujildmg Perm�tFee 4. Mechanical(HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3+4+ 5) 3 3 3 5 wvFeccl [xilief, l E , _,; T�sSec ton'T�r",�(Ilfcia�lsllse�nl , Eiudd�rig.Perm�t=Number.* w.. N. =_ ©ate issued Signature: Building Commissioner/Inspeztor-:ofBuildings Date File#BP-2004-0728 APPLICANT/CONTACT PERSON GEORGE KICZA ADDRESS/PHONE 129 MIDDLE ST HADLEY (413)586-6672 PROPERTY LOCATION 258 RYAN RD-#2 MAP 29 PARCEL 029 001 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 D Typeof Construction:_CONVERT ATTIC INTO BEDROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 084268 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOKMATION 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 Co ion Zd LOD� 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. } d ,�U ` too t pz Arlo has gsxw (70 TAX,744 AN x y s i was Ann a Q111-ST shop,Un ,, aka*� �` r r { r CA 41 gd ,c- },:.,k' r :'NINT MENU TOWN r)F r.,. r'` x � E«3" °- 4 # .. "x"r` 'r`r•E a REIN fo to Sub, ilk S �r . r �Y�a �. ����5�g+,�; �`" � r, � y a° ...� ,k � a�� �•+k x � ay,�. a,'u?E F d t i .a' Dot 8 S r" " .vBoom #bk- 1111A k�t A �#r r equ No "N, roquo x �lfi rein u f s n+, `' '°t¢-." ,s x s 6 xx" ,c`` �'a.,r.� ep. x' a�* �.*x _ '✓. tyn,4 p4ak,£r.•a.; : a t3 � �'iwp{ Te' ib *z Y \. {Yi ✓i ,dG k�Yy,..z, 4[ 4 �xx°x'�.T p*`, , n a'°C v"d' d KF' S y r•+ V WK k VV, { a now x�' � p g� «4.. � F,�.N { ��� 4t ^�� � a�-a '` �.•'����a"j} .�, �a `^�Za��?'��34�„ '` x XENIX�s ?� a%k�a a s utx b r t ��, °x'- �' ..-- � Y, as '� ¢ a• } �', t � 'aka,. C n� � � y„. x� 258 RYAN RD-#2 BP-2004-0728 GIS#: COMMONWEALTH OF MASSACHUSETTS Maj:Block: 29-029 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0728 Project# JS-2004-1053 Est.Cost: $3335.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LEON STRZEGOWSKI 000555 Lot Size(sq. ft.): 21170.16 Owner: VELEZ STEPHANIE A& Zoning:URA Applicant: LEON S1 ZEGOWSKI AT. 258 RYAN RD - #2 Applicant Address: Phone: Insurance: 75 LINSEED RD (413) 247-5532 WEST HATFIELDMA01088 ISSUED ON:1120104 0.00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT ATTIC INTO BEDROOM 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: G► Driveway Final: Final: Final: Rough Frame: ei< 3—fo -d A/..� Gas: Fire Department Fireplace/Chimney: Rough: Oil: Ipsulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY E CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGU ATI S. Certificate of Occu all Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 1/20/04 0:00:00 418 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo