24D-320 (9) 20 G.-:T3:a
A rE Ciii� nf' �in�:tl�alll}�to)I - �_
A 8 ;ltra�nrllnrrlta _
c� DEPARTMU4-r Uf' DUILOrNG INSPECr101:5
212 Main Strect ' Mumcipal Buildin0
Northampton, Ham 01060
woiuCLIt'S CONTPENSA'MN tNSURANCF AFFIDAVIT
J~
v � � �1 � L)�
— ------- (liccuscrJpcnnittcc)
wnth a principal place of busiuess/residence zl:
-76 .(�� �, c �( � � xs,L f2 r". Uhoncr) �/,� ��H � z�y
- -- - (sLTcc4Jcity/stazc1bp)
do hereby certify, under the pa,--jIs and penalties of perjury, .11.11
am an employer providing the following workcr-'s coinpensr:uon cove ale for Iny
eluployccs tti ot�;ing on ulis job
(R.sun-0= Comma-0y) - (Pobc-, Nw-abCT) -- (rlpiration Dafc)
( ) I am a sole proprietor, general cocuactor or homeowner (circic one) and hzve hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contmcto-) (Insunncc Cornpany0i oGc,- N''umt�:r) (I:xptrauon 1111c)
(Name of Contractor) -- (lnsurzncc Comoa:uy/Pobq, Numbu) (-xpiration Date)
(Name of Com-actor) (Insurajacc CompanyfPolicy Ntunbu) (Expilrtioo Date)
(N2-me of Contractor) (lnsuranc-- Company/PoUcy Numlrir) (L-\piratioo Dale)
(aULAcir i;i a:rl tbt,I it ncocvey to inr-ucl;inform. ion pctainirtg to.L ooa:n.C.o:•s)
( ) I ant a sole proprietor and have no one working for rite.
( ) I am a hooic owner pcifor>tlirio all the work myself.
NOM pl=x be acme t2u K{rrc hecY-,rn+zr•-n�ttto ctnploy pcsom to ti)e-•r-A-+a= -gym c repair%vufk oo t d.•cUi�9 of
or>(mat tl=t jr ..tmi',j in%lixich trac borwo+mcr raid=or oo Lbc g vv..Odi 3ppurtcnun tbaan LT n7f c=Kr91ly OC-w::a�•d to tY
cutploya3 ucX'r Lla «wkds oca:passtion Act(GLI54-izi(5)),zpplicx600 try a botnooQna fm c UCz:r :or perroit r=y c.id.-Zoc the
IcSA ctnhu of an employer uadcr d=Workcet Componsation rtct.
I undart.t.nd dw a oopy of thin rt:tcmcrn m.y be forty rtW to tbo Dcpn tuu,r of Inhrvid Amdmd Offiw of 6---W ror tlw
oovmgc vnlfimboo aM th1 L-Jum to toauc coverage tmd..f sociioa 2 5 A of MOL 154 can Icsd to 01,i'19 a oa of cri-"pcaaluc+
000iist of.fit),-of up to S 1,500.00 snd/ex of up to otx year rod CiIil pcuthio io arc forth of a Stop Work Order and a
rim o(S 100.00 t day Lpuast mac//
/ For dcptrtnr=J u.c drily -°---------
�C7 Pcnz>JI Nunabcr
Sil;nature of ,ioc»_scxJYcrntitrcc —� -iT5]te
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.....0-
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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 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.
Print Name
Signature of Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : oLI V<'� IS
License Number
3 TC ✓,�,t C!r' k d . V3 S 0 1�-3
Address Expiration Date
Signature telephone
z y
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....... E7 No...... ❑
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£MR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED 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 /
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address i
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: 17.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 2-9 7-(70 Z`1 � O
Frontage /9s- / 7'Y-
Setbacks Front r S 7-0
Side L: IS.-�`R: 6 b L. f R:
Rear
Building Height
310
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved �J
parking) V 7
#of Parking Spaces fl
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 `� q YE,S,
IF YES: enter Book 0��✓ ! Page .-C 3..." and/or Document #/f
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
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
� Accessory Building[ ] Repairs [ ]
4 U,J IT cA 0o Cr00%0,16OL9r 4 t
SECTION 5 - USE 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 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑
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 THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: / — Z Proposed Use Group: ' 3
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
�) FICE USE O l
., � r . .
Floor Area per Floor(sf) St
`m" im,
t� v
Kk
1st 2nd -,^`
r i
S "
rdY v'
2 n 3 � a
S $
3rd 4 th �'� � =�s
9 b h of fra
F �'9. F 3 d US14' 3
4th a"
Total Area (sf) Total Proposed New Construction (sf) � �
Total Height(ft) 0, �a
Total Height ft --- -------- --
2
Version].7 Commercial Building Permit May 15,2000
` efart eta e� t1�� '
City of Northampton eta �so� ermit a °
Buildin g Department
De
P
212 Main Street Sewe peptic lAuailab it �� �� y , '
Room 100 1Nattle�Av ll�al� f�wk '"
Northampton, MA 01060 Two Setsf,t�` # �f'1a�s` t� G`
phone 413-587-1240 Fax 413-587-1272 Plot/Site P1ans �
VAN
_... ... .__
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OEOISH�A T AIL
OTHER THAN A ONE OR TWO FAMILY DWELLING i r �• -i f;
i
1G1 2 1 2"01
SECTION 1 -SITE INFORMATION
1.1 Property Address: .This section to be coltile`fecf'by,° ,Wrl
�� �7o✓N� �� L Map � t of _Unit .
Zone Overlay District
,Elm St;District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
ISignature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED'CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building Z ,� cT� (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
I �°4 Construction from b
3. Plumbing J� Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection z
6. Total =(1 + 2 + 3 +4 + 5) Check Number Q
This Section For Official Use Onl
BuildingPermit'Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2005-0475
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 88 ROUND HILL RD
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
Typeof Construction: INTERIOR RENOVATION TO CONVERT TO 4 CONDO UNITS
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License 039073
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
--J—Approved Additional permits required(see below) ��(p
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 Commissi
Z c�
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.
88 ROUND HILL RD BP-2005-0475
GIS#: COMMONWEALTH OF MASSACHUSETTS
:Block:24D-320 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2005-0475
Project# JS-2005-0616
Est.Cost: $384000.00
Fee: $1580.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: 5A Contractor: License:
Use Groin R3 Oliver Iselin 039073
Lot Size(sg. ft.): 24219.36 Owner: Oliver Iselin
Zoning_URC Applicant: Oliver Iselin
AT. 88 ROUND HILL RD
Applicant Address: Phone: Insurance:
36 Service Center (413)584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:11124104 0:00:00
TO PERFORM THE FOLLOWING WORK.INTERIOR RENOVATION TO CONVERT TO 4
CONDO UNITS (SECTION 116)
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: Receipt No: Date Paid: Check No: Amount:
Building 11/24/04 0:00:00 503 $1580.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
88 ROUND HILL RD BP-2005-0475
GIs#: COMM4 N EALTH OF MASSACHUSETTS
Map:Block:24D-320 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTIRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2005-0475
Project# JS-2005-0616
Est.Cost: $384000.00
,Fee: $1580.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class:5A Contractor: License:
Use Group: R3 Oliver Iselin 039073
Lot Size(sq. ft.): 24219.36 Owner: Oliver Iselin
Zoning: UtW. Applicant: Oliver !seen
AT. 88 ROUND HILL RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTON MAO 1060 ISSUED ON.11124104 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR RENOVATION TO CONVERT TO 4
CONDO UNITS (SECTION 116)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service J,��/JY4� Meter:
Footings:
Rough: '� Roughz f X66 House# Foundation: 1404L=5 C l7Feh) Ofc
Driveway Final:
Final ( � �"A!rfA�Final: `�/�B/os'
Cuz Rough Frame:
Gas: Fire.Ppnartms-gt ', .. �.:,�re; ;;;•�;n.o_
Rough: Oil: Insulation:
14
Final: ' Z'7.�y woke: �J H✓�`� Final:
Certificate of Occupancy for UN T 1 & 3
THIS PERMIT MAY BE REVOKED BY THE C V OF NORTHAMPTON UPON VIOLATIQTJ OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu _-- -- _ si nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
TEMPORARY FOR UNITS 2 & 4 pending low voltage EXPIRES 8/28/05
Building 11/24/010:00:00 503 $1580.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Connnissioner-Anthony Patillo
88 ROUND HILL RD BP-2005-0467
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-320 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Bundling DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category_ BUILDING PERMIT
Permit# BP-2005-0467
Project# JS-2005-0616
Est. Cost:
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sq. ft.): 24219.36 Owner: Oliver Iselin
Zoning: UKl
AT. 88 ROUND HILL RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTON MAO 1060 ISSUED ON.10119104 0:00:00
TO PERFORM THE FOLLOWING WORK.INTERIOR DEMOLITION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: I?-j 7'/(;7 /Qff'?Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: i,isulation:
Final: Smoke: Final: QK t -6 v
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. _ - '
Certificate of Occupancy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 10%19/04 0:00:00 501 $50.00
212 Main Street,Phone(413)587-1240,Fax: (4:3)587-1272
Building Commissioner-Anthony Pai;llo