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24D-320 (11)
r R-t i W-r nT r A E 11 3 of �C71" l�ctlll})f011 _ A J f 'al aaaachnsc(la' a DEPARTI .TENT op BUIL-Dr)\,C rNSPEcTjot:s — 212 Main Street ' Municipal Building Northampton, Afass. 01060 «'ORICE IZ'S CO\/LPENSA'z'N, MSURA-NCF- AI TTJMA TIJ- (lccvs:x'Jjlctii>;ttix) " 2 b .1"Vick Ci6- ' —,Y— (t�OAe=) Sr y 'Jt 2-W (5�'�.i/city/Stalct27 p), do hereby certif),, under Lhe.pa.uts and penalties of per7ufy, hal ( am an employer providing fire following �c onccr's comocns-DO, coverage for 1ny eluployecs worming on this job` w 8a-y,?,Py omstirao= Compaq) (PoLic:Nu--abccr) F:."piratior, Dzte) O I am a sole proprietor, general contractor or homeowner(cir cie one) and have hired the cooE actors fisted below vqbo hive the following worker's c000ensanon policies: ;aMc Oi Contnctor) (Insurance CoinDarnwi'ouc; !,!u (Name of Conczcior) (Insurance. ComDanyiPo'je; Numi:rr) (L\Dirmlon Date) (Name of Coturaeto,-) (Insurance Comp2m)-fPolicy Munbe-r) (E.,�airooa Date) I I (Name of Contractor) (Insurance Company/Policy Numb:r) - �T-xpuatioo Date). (ana.cb:-ddr'oorsl rbcct tfnc�c -Y to mcu.d;iafonn,Eoa percauzi.ng to.11 oa=-_-o- ( ) I am a sole proprietor and have no one worldDg for me. ( ) I am.a home owner performing all the work myself. NOTE:plesc be ew�rc L*z ..}�Je 6omrwvm�+bo employ pcsoai u d,r �e��c rc�air orz on.d.•c!L^�or not @Oct Lh--o L-' `-L-)-YJ to laEl3ch tt� bomMO%DG'It i6,O OC cc EbK VvuplJ z p W(�`OCnjtY cc d=7i to be r074pl0yc-3 undo the c=p==I!ea Act(GL152-=1(5)1 aW i=6oc try n bomao-=fcr a lice=or permit try--rd—i-c les;d ctaasc of an uoder dto work e.Compom.dioa Act I UbOdcrtand tha a OoPy of this m.t® m„y ba f6r--xind to tbo Dop_u_.d of jo&l trial Ac dt OM_of tria.raooa for the covease vetiraoo and thet filtae to Lcol L toverase wades loadoa 25A of MoL 152 cao Icad to the oO cdaiminal pc-iW(= oomiaix:g of a fine Of UP to S 1_100.00 ar.6ror isga iyp �orup to ooc yev cad ci ii pm.lue in LSc form Ora Stop Work Ord=and a fim of 5100.00 a day.Fp,inst fix For dcp=nm-'.t use only -------- /� Permit Number / map:: Lot n Signature ofLio=Lscr Pcm-iucc Version 1.7 Commercial Building Permit May 15,2000 I•• SECTION 110 5 RUCTURAL PEER RE IEWI(780 CMR 11011) Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION 11 OWNER AUTHORIZATION-'TO Be COMPLETED`WHEN OWNERS.AGENT OA CONTRACTQRAPPLIES FOR§UILDINGP.ERMIT as Owner of the subject property i hereby authorize `to act on my behalf,in all matters relative to work authorized by this building permit application. i Signature of Owner Date I, as OwnerlAuthorized 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 F I Print Name i i 1 Signature of Owner/Agent Date SECTION",12-CObtSTRUCTION SERVICES , 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:; L1v*VL dl'- License Number Address Expiration Date 27 2,4 Signature Telephone SECTION 13 WORKERS'COMPENSATION INSURANCE"AFFIDAVIT 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 0 r Versionl.7 Commercial Building Permit May 15,2000 SECTION :9-PROFESSIONAL DESIGN AND CONS ii FAR BUILDIIJGS AND STftilGTU, BECT f0 CONSTRUCTION GON7ROL PURSUANT"(0,780 CMR 1'16(CONTAINING,MOi�E THAN_35,000 CF„OE ENCL05ED SPACE) 9.1 Registered Architect Not Applicable ❑ 7 i Name(Registrant): j Registration Number Address 1 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date I � Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i j Name Area of Responsibility Address !!Registration Number Signature Telephone Expiration Date 3 I I Name Area of Responsibility { Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor I Not Applicable❑ Company Name: Responsible In Charge of Construction ' I Address 1 Signature Telephone Version 1;7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This colurrm to be filled in by Building Department Lot Size Frontage ' Setbacks Front Side Li ! R:= L:—J R:= � Rear -Biu-7dmg Heim.._ Bldg.Square Footage I % Open Space Footage r-� % (Lot area minus bldg&paved i + 7-7 parldrig) #of Parkina Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON7 KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book ( I Page; � I and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON7 KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: ;I C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: j 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 Q ` NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION -CO3�STRU TLOI�SERTMC a ©RPROJECTS ESS=THAN,35;000 C1B1CPEET�D)� NCLOSED°SP.�CCE _ Interior Alterations ❑ Existing Wall Signs Demolitio Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description jEnter a brief description here. /`ror� - rJ Al Of Proposed Work: J'N rxvi.,e,ti �{�•.�t,i o n1 pN L.1 d 14.rr*-Yt MN n /�/ T1'I7°i'�f SECTION'S .USE=GROIiP'ANQ CONSITC7ON YPE, M. ,_.. . .... . USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 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 ❑ 1 Institutional ❑ I-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 El Specify COMPLETETHIS SEGTIOI7F EXISTING BU1LDlNG lI�IDEFGOIIG RENOtUATfONS ADDtl'i13NS A1�DfORrCHANGE fN USE Existing Use Group: 1 Proposed Use Group: i r Existing Hazard Index 780 CMR 34):' Proposed Hazard Index 780 CMR 34): — i SECTION 6 BOIL771NG HEIGHT AND:AREA �. x BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) r 4 1 Sty 1St ++ Y 2 nd 2nd 3`d ! 3`' i 4t' I New Construction Total Proposed Ns ni Total Area(sf) I P - I ` .. 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!_-j Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Version 1.7 Commercial Building Penn it-May 15,2000 City of Northampton Building Departme J' 212 Main Stree t Room'100 J�� Northampton, MA 0 T _ r phone 413-587-1240 Fax i. ._ t APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECIION� 4TE_INEORMATI0 N Thrsectrorr tame corrrpeed hyofficeA –^- 11-Proc�etty�tddress . a i (3 Imt Disfrlc ,�__ _ f SECTION 2 PROPERTY OWNERSHIPWLTHORIZED AGENT „R 7 1 110 �11 2.1 Owner of Record: i, _ 1.zn j o L 4-e. r?L 1W Name(Print) Current Mailing Address: ---- Signature Telephone - 9 , 2.2 Authorized Agent: l 1 Name(Print) Current Mailing Address: r Signature Telephone 3.-,EST I,M L Atbj;CO w8T. U&110N COSTS Lj In*^J ON VrI Item Estimated Cost(Dollars)to be �fical.Use Only completed by ermit applicant 1. Building - (a)Bu;lding Pemiit Fee 2. Electrical (b)Estimated Total`Cost of, 4 _ I �Constriaction firoin 6 .° 4 3. Plumbing Btiilding.:PeRr►it Fee 4. Mechanical(HVAC) , I 5.Fire Protection 6. Total=0 +2+3+4+5) -Check Number This Secfin For.OfficiafUse Oni yButld�ig Perm�t`.Alurnbe "Date lssued, r . Signature: 200`' Building.Commissi ner/lnspectorofi'Buildings Date w 88 ROUND HILL RD BP-2005-0467 GIS#: COMMONWEALTH OF MASSACHUSETTS MapBlock:24D-320 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0467 Project# IS-2005-0616 Est.Cost: Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: �1 Use Groin: Oliver Iselin 039073 Lot Size(sa.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 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: 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 Occupant y 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:(413)587-1272 Building Commissioner-Anthony Patillo