18C-048 (17) p. 6
Mat$ 09 05 10z36a
21
0EPA.RTMEN7 01, OUILLFNG i4'rsp t<__
212 Main Strcir. Muoicipa�. D oldinC
Northampton, ?vfnss, 01050
A'()J�J'MIZ'S CONVENSAI—ION
---HENRY HOPKINS
tb a pi' ic paJ plact oiFbusicess/rdside-nce zi
R & H ROOFING, LLP 59 SOUTH �ASTHAMPTON
MA K62 413-527-9378
l7!Z'7ut_jm P)
uro n"'I ptnzl6es 0, ptgu' f,
C"(1 here-by cc_MY), udder 01C P ihar
XA'X';) I am an mr,:Loy,-_r, provid.1m, dic fol;'o%ving ',vorkcr's comon
exploy-ccs wor.ocig uol 011:s job.
AIM MUTUAL INS. CO. 0180097. 10-24-05
( c j c-."N u--akw- DaLc)
s sole proprkmr, gcocraJ, coov-aaor or nomeow-ui.-.- o,)e) and Itizve hired
the cocu'-1:.r0'7 LS-1_1 below 10 111?ve the `DU*nvr�nq worn er`s
(Nam: 4TCO.11—�_11xl
(T.mr 0'-,<C)
b 66'.- 1 ehcv�Lr a v
ku
am a Solt pmpneto, and `aa,,e no o2,: wot,_trig fcT- me.
?m, a home •wrncr performing al! Lbe �vo,-k myseif.
'�orz:pi=s Int--s olp.'L;la Ajbc=play pz_i4�,L.W 6,--U;-
as:note�L!rw=i'.s to ,-b:cb Ll_- r.<'C',co t -k'
-Vl0r-u&-lb---&— —(Gf.1 %M.Lica6co bou= va fors li.=—.or pc-r�l=-_y ulx-
M'Q L 1.'1 cm IM4 or Pm.
oc='6tinc;of.rm d up to 3 1_Scc.00 �priooamc to 'f n Lod civil pamki=
rtw o(s 100 oc& rD,-
5-20-05
15=57 -- �tlr 7-1—
HENRY R 0KINS-RARTNER
May 09 05 10: 36a P. 5
Version 1.7 Commercial 91diding Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Irdependent Structural Engineering Structural Poet Review Required yes 0 No
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERVAT
RICH PERRY
-
...,as Owner ofthes,lbjec t property
heraby authorize. R & H ROOFING, L L P to act on my be tters relative to work authorized by this builftg permit application.
.5-2-0-0-5
Date
—HENRY—HOPK INS
as Owner/Authorized
Agent hereby declare that lhe.5tatemanls and information on the foregoing app!rlation are true and accurate,to the best of my fJowlecge
and belief.
Signed uncles the.p2{ns __pe
LNRY HOPKINS/ PARTNER (R & H ROOFING, LLP)
5
Print N -20-05
s&nature of%Her-PAgert Dar's
SECTION 12-CONSTRUCTION 3
101 LIcansed C =0913-11mrylsor: Not Applicab'le
NoiLlcar,eeHcjdg; .._HENRY HOPKINS 105�948
LicensA Number
-5 _S0-9THAMPTON MA 01027
- .QTH-5TR-E-ET.j, EAS'" 7-21-06
A7ree ------- Exp'ration Date
413-527-9378
Signature Telaphore
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,S 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result
it the denial of the issuance of the builc'.ing permit.
Signed Affidavit Attached Yes AD No ()
May 09 05 10: 34,a P• 4
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9•PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
8.1 Re istered Architect:
BUILDING OWNER Not Applicable
Name(Registra+tt) — —
Registration Number I
Address -
Expiratlon Date
91911 a",ure Telephone _
9.2 Registered Professional Engineer(s):
NO ENGINEERS
Name Areip of Responsibility
. .......
Address Registration Number
I
Teiephone Expiration gate —� --
Area of Responslbi:ity
Addrec-s Fte istrabon Number
F i
S'gnature Telephone Exp ration Date
r.
Name Area of Responsibllibr
Address Registraton Number
II i
Srg nuturo Telephone Expiration Date
1 Name Area of Responsibility
I i
Address Registration Number
e*phone Expiration Date _-
9.3 General Contractor
_R_&&H ROOFING, yLLP Not ApplicableCl
Company Name: —
�_
Responsible In Charge of Comtructlon __-
59 SOUTH STREET, EASTHAMPTON MA 01027
Addres
413 --- --- -
5 2 7_9 5 7 8_ _ -
Signature Telephone 0
Mai 09 05 10:34a P. 2
Version 1.7 Commercial Building Permit May 15,2000
CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE I
Interior Alterations ❑ Existing Wall Slons 0 DomollitionLj Repairs El Additions El Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign[] New$lgimsO Roofln4M Change ofUqeO OtherD
Brief Description jEnter a brief description here.
Of Proposed Work: REMOVE EXISTING ROOF & INSTALL NEW MEMBRANE ROOFING SYSTEM
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 A-3 L7,
A-4 ❑ A-5 ❑ 113
B Business 2A
_E Educatonal ❑ 29
F Factory F-1 ❑ F2 2C ❑
H Hi Hazard 3A ❑
! institutional ❑ 1-1 1-2 ❑ 1-3 L3 3B
1W Mercantile R-3 4
R Residential 13 5A EJ
3 Storage ❑ S-1 ❑ S-2 ❑ 5B El
U Utilitv ❑ Specify:
M Mixed Use ❑ speclfy:;
T-
S Spacial Use
t s
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDJOR CHANCF_IN USE
Existing Use Group: Proposed
Existing Hazard Index 780 CMR 34):'_... Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NaV CONSTRUCTION
Floor Area per Floor(sf)
nj
2"d 2
rd
3 3
4
4th
Tota!Arcia(rf) I Tote l!Proposed New Construction
Total Height(it)
To'A Height f: ----------
7.Water Supply(M.G.L.c.40, 541, 7.1 F! o_0 Zq0q.Information., 7.3 Sewage Disposal System:
1.9_ _ 1 4
.ELblir Private[7 Zone',__;-, i Outside Flood ZcneCj , k4unicipai L Or s:'e disposal system[
May 03 05 1O:33a p• 2
� r
_Version 1.7 Commercial Ritilding Perrnit May 15,2000
8. NORTHAAI T'ON ZHNING
Existing Propowd Required by Zoning
This column to be filled in by
Building Deparhrent
T x size
Frontage
Setbacks wont
Side L' R-- . L:!
Rear
Budding Height
Bldg.Square FootaftK %
Open
(Lot area minus61dG&pavei
of Parking Spaces
i
l
F�,ll•
j ivoiume 6t.Location?
A. Has a Special Perm it"Variance%Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued*' �
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0 YES C)
IF YES: enter Book Page: and/or Document .
K. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a hermit been or need to be obtained from the Conservation Commisslon7
(deeds to be obtained Obtained 0 Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, descrite 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,gradinc,ercava?io i,or<lling)over 1 acre cr is it part of a Common plan
that will disturb over 1 acre? YES C NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
May 09 05 10: 33a P. 1
Versionl.7 Commercial Buildin Permit Ma 15,2000
''
City of Northampton
Building Department
artment
r, 212 Main Street
h 2 Room 100 ete � sva,labfltky�r � .
Northamp}on, MA 01060 'a 't cb S�tructuF
;ph,ne 413 5F37-12 0 Fax 413-587-1272
tip
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
1.1 Property Address: This Se `I016 be COO I*W i y o Ice
NORTHAMPTON NURSING HOME Map Lot Unit
737. BRIDGE ROAD caneaYerlayDlvtrta
NORTHAMPTON MA 01060
.......... _ (4t 3tlfr t CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED ANENT
2.1 Owner of Record:
.RICH PERRY__ .-'737'_"BRIDGE. ROAD-;_NORTHAMPTON -MA 0106
Name(Print) Current Mailing Address:
-- 413-586-3300
Sigrature Telephone
2.2 Authorized Anent:
R & H ROOFING, LLLF ,�g OCJ1`H l`;_ ASTFTAMP7GN__MA__01027
Name(Print) Current Mailing Addrass:
413-527-9378
Signature -- Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by oermit applicant
1. Building i-. i � ---------___-_.._
_.._
(a)Building Permit Fee
2. FlectrIcal I (b)Estimated Total Cost of �_�—
3X ! ! Construction from 6T
" OOF I NG j 220,00 Building Permit Fee
4. Mechanical `iVAC)
5.Fire Protection ...
5. Total-(1+2+3+4+5 220,000 Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
i
Signature:
Building Ccmmissianergnspector or Buildings Date
737 BRIDGE RD BP-2005-1165
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mg:Block: 18C-048 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1165
Project# JS-2005-1569
Est.Cost: $220000.00
Fee: $1100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: R & H ROOFING 042781
Lot Size(sq. ft.): 272685.60 Owner: NORTHAMPTON NURSING HOME INC
Zoning URB Applicant: R & H ROOFING
AT: 737 BRIDGE RD
Applicant Address: Phone: Insurance:
59 SOUTH ST (413) 527-9378 Workers
Compensation
EASTHAMPTONMA01027 ISSUED ON:5123105 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE & INSTALL NEW MEMBRANE ROOF
SYSTEM
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 5/23/05 0:00:00 $1100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo