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HOBIE ISELIN
GENERAL CONTRACTOR
36 SERVICE CENTER
NORTHAMPTON, MA 01060
(413) 584-1224
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DEPARTME?,T OP DUILDTNC INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOPKER'S CO11'CP} NSA710N MSURA-NCF All=, A�rlj.-
a,fE J-S'E
(l 1pcnnittrx)
Ct*j f6,L- eLo, (phone;:)
— (sa-�tJd ty/sia t r/a p)
do hereby certify, under Lhe pains and penalties of perjury•., -h:i
O I an an employer providing the Following, ,�,orkcrS comoens-nt;o, coverage for Illy
eluplovees worl,Dng on this job.
45,&S-rw ,;ra'✓vw4-*rit6- W c- -C) - b
(Lnsur-� Comas.) (Poiic; l;u-aixr) (Ix-piraor, Dz.cc.)
( ) I am a sole proprietor, general coocmaor or homeowner (ci:Cie oee) and have hired
the contractors listed below vgbo hive the folio%vino worker's cot pelasadon policies:
('141a )e Oi C007 ao.r) (1nR!rwicc. Coin[)a y/POUCi N lumhe- ) (-1-x)IT-a 0n D 1tC)'
(Name of Contractor) (Lns-u2zcc CompanwPol c Numcsr) (E.�Di :lion Date)
(Name of Connamor) (Lnsuranec Compan)-fPoUq- Number) (Expira-doo Dale)
I
(Name of Contractor) (Tasuranc—c Comoai y/PoUcy Numb`r) - (Eapirm6ou Datc).
(nnx3r;d�i�ocal Lice irncct�v in cic!u��aro�aoo pcztaiains to.11
( ) I am a sole proprietor and have no one working for me.
( ) I am.a home owner performing all t-be work myself.
NOTE:plcsc lx cvnrc Lfis .tJn bomoo+ncn vbo ctnplay p,,,to&3 r. cam.—.—o c repair work oa,d"mo=o of
not mote tb--z L'-rw_L-arJ in uhicb the bornoo-v wide or oa the Cry nc, jppurten_r1 tbecW e' ooc C-=-zlty Cv=.-d-frd w be
employe 11 rue cc=�> --+.m Act(GLl XZ a lCS)1 r.ppluatioo try n bomeoeva f,=c bey__o perms r=y e.Idmx t!c
ICI ctzl c of——Ployer uodnr tba Wo,l .C.ocapom.tion Act
[understand the a oopy or thi.=a--.=r may be roe�v to tbo Doportmcat of.r 1..du,t;d At�da&0M—or(rrxu•noo Tor tba
oovei.sc va calioa and aul Ed=to xoou roach ase under soe oa 25A or r.i4L 152 na Ic d to the imp oo of aimi=l pcnilt'=
00x:31 ing of a rsne orup to S1,500.00 arldror i=g+i,oame orup to one ycsr t od CMI pmtlia in Lie roan of n Stop Work Order nod a
frm of S 100.00 a d_y•Vint tnc
For dq>anrn='�)u,c only
Pcrm)t Nu.mbcs
Lot n
Signature of LiccnsufPcn-nittcc J�
y
Versionl.7 Commercial Building Permit May 15,2000
SECTION:1A 53RUCTURAL PEEk2 REVIEW(78D CMR 1-1
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 1'1=OWNER AUTHORIZATION='TO BE-COMPLETED"WHEN
OWNERS AGENT Oil CONTRACTOR APPL[k&FOR BUILDINGT!ERMIT
I 1 674 as Owner of the subject property
hereby authorize a, - I_J'-J Ito
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner { at
1, �� '� �f�W r1 I 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.
Si ned under the vains ape pepalties of Dedurv.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCLION 5ERI/ICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Hold :
i D c.1✓
er
License Number
qd s Expiration Date
Signature Telephone
SECTION 13'-WORKERS''COMPE14SATION'INSURMCE`A1=FIDAV(T(M G L.e::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.
Slgned Affidavit Attached Yes Gr No 0
r
l '
Version 1.7 Commercial Building Permit May 15,2000
SECTION .9--PROFESSIONA 7_DESIGNANDCONSTRUGTIQ t" SERVICES=FOR'4M,,l- NGSAND!ST#2UCTUR S1JB ECT. D
.. ;
CONSTRUCTION CONTROL PURSUANT TO ' CMR-1'1fi tCgf+T- N ING MORE T1l�W_35;D00 C:F,OF EI+tC105ED SPACE)
9.1 Registered Architect
Not Applicable ❑
Name(Registrant): i—
IiRegistration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
a t
Address Registration Number
} � 1
Signature t Telephone Expiration Date
i
f E ,
Name Area of Responsibility
i � 1
Address Registration Number
Signature Telephone Expiration Date
I
Name Area of Responsibility
i
Address {`Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
- t I
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
^1 Not Applicable ❑
Company Name:
Responsible In Charge of Construction
2(, .j JLF!t v/c-i(s AQ
Address
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
� � Q � �Wrl..
Existing Proposed Required by Zoning
/�
3 v 1 L/) !G p 7'W' V� x Jn G' jz.•�o This column to be filled in by
�,-6-E-.r �„ar Building Department
^vd C
_ d sE r3 c
Lot Size {
Frontage II
Setbacks Front r L et
Side L:' I R:= L:I i R:i= — ^T
i
Rear i !
--—-
-Bni tng et
Bldg.Square Footage (-
� i f °
Open Space Footage t-- %
(Lot area minus bldg&paved
azldn )
#of Parking Spaces
Fill:
volume'&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES Q
IF YES, date issued: ; E
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book j Page! f and/or Document#j '
B. Does the site contain a brook, body of water or wetlands? NO ef DONT KNOW 0 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:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
s.
Versionl.7 Commercial Building Permit May 15,2000
1;ECT10N CO STRUCTLOAJ SERd1CFS�FOI PROJ 1-P.WEESS THfiN 35;000
C1161C EEETO ENCLOSED
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other❑
Brief Description 'Enter a brief description here.
Of Proposed Work: l L-. A00 J. 1'N r° /r[. / J! 1 V,.
e
...»..>..� .y ._---• �i:�-r ..-_.+.4 "a*.. k R! 'iF sha-n. c .. ,
SECTION'S USE-GROUP=AT[D :ONS RUCT70N YPE� k „µr
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly AA ❑ A-2 A-3 ❑ 1A
0
_ _A-4 ❑ A-5 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 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 0 Specify.f
i
S Special Use
EJ
Specify i
i
.COMPLETE TEi1S SEG 101#1 FE)CISTING13Ul {)[NG il1�IDERGO1tgG RENOVA-T ONS ADDMONS.AND30R;CHANGE 1N USE
Existing Use Group: i Proposed Use Group:
Existing Hazard Index 780 CMR 34):1 E Proposed Hazard Index 780 CMR 34): i
>-SEC_TJON`�6•'BUIGIIING�iEIGHT�-AN�_AREA:
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
5[
1st
2nd i � •�: <"°�.`�� :��
2nd i
<
a
a..
rd
3`d 3 3 !
4th i 4 m i
Total Area(so s Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone L 1 Outside Flood Zone[] Municipal ❑ On site disposal system❑
Version 1.7 Commercial Buildin Permit May 15,2000
City of Northampton
\*ilding Depaitment
212 Main Street
Room'100 _
Lj
ort mpton, MA 01060
phone `13-58X-1240 Fax 413-587-1272
APPLT6�7 ON T ' 699TRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
,..�EGIION�:SITE'1NFORMi4TlOt�l '' _ __ _ _
-'t;l-Property Addres .� ._ ..... t
OCT -°ft
2 iaP
gUnt
�/r1,51 l r 'J �a'3y
' .; '•.. wou .`Y,Vr,...2. fl=,.PZ'h 3. �s4�i1.'' �vzi.:':=...xs..-.....,,;,r y`' s
i LA rJ
IN ft
SECTION 2 PROPERTY OWNERS1 IPrAUTHORIZED AGENT
2.1 Owner of Record:
'
—114A 41 Z 6-1 r cY"g )2,cvj v 1�� ►moo.
i
Name(Print) Current Mailing Address:
Signature1\6�_ .ter Telephone
2.2 Authorized Agent:
i
ll�E .�SE�►^� i .76
Name(Print) Current Mailing Address:
?
Signature Telephone
SECT1ON.3=ESTIMATED Z,ONSTRUCTION'COSTS
Item Estimated Cost(Dollars)to be Official"Use Oraly
completed by ermit applicant
1. Building l 1 pp, J-- (a)Buildh_ Pemaitfee ✓fld
t
2. Electrical # { (b)Estimated Total,Cost ef°
! -�' I ''Cons'truchoiifrom. 6 �.
3. Plumbing I Biildmg PenrifFeep,�b
i
1
4. Mechanical(HVAC) /00, p d
5.Fire Protection
6. Total l=(1 +2+3+4+5) 6 �/ -Chedk;Number 1-71 ay
.This Section.For,Official'tlse Ohl
Buildtt g Perm f Na m er: D"a,#
Issued=
r
Signature:
Building Commissiorierlinsp6c t—,Of-Bdildings
Date
File#BP-2006-1219
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 88 ROUND HILL RD-UNIT 3
MAP 24D PARCEL 320 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out _
Fee Paid
TyTeof Construction: CONSTRUCT 3 FLR 10 X 14 DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 039073
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IPJ90RMATION PRESENTED:
NN 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 El eet ommission
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.
BP-2006-1219
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1219
Project# JS-2006-1809
Est. Cost: $6450.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sg. ft.): 24219.36 Owner: GHAZEY THALIA
Zoning:URC Applicant: Oliver Iselin
AT. 88 ROUND HILL RD - UNIT 3
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTON MA01060 ISSUED ON:511812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 3RD FLR 10 X 14 DECK
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 5/18/2006 0:00:00 $100.001713
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
88 ROUND HILL RD-UNIT 3 BP-2006-1219
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-320 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1219
Proiect# JS-2006-1809
Est. Cost: $6450.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sa. ft.): 24219.36 Owner: GHAZEY THALIA
Zonis: URC Applicant: Oliver Iselin
Applicant Address: Phone: � Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:511812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 3RD FLR 10 X 14 DECK
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:-l t,I-e?.
l )11-7— Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Insulation:
Final: Smoke: Final: OK D4S-A y d-'3 {S
THIS PERMIT MAY BE REVOKED BY TH ITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONyS
f Occupancy Signature:
Certificat e o p y nature:—. �
FeeType: Date Paid: Amount:
Building 5/18/2006 0:00:00 $100.001713
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Comtnissioner-Anthony Patillo