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d DEPARTME14T OP ➢UILDrNG INSPECTION'S
212 Main Strcct ' Municipal Building
Northampton, Mass. 01000
NVORTC;R'S CON'MENSA"ITON C'iSURA-NCE AFFMAVII'
(li ccvsec/permi ttce) -
vVith a principal place- of business/residence at:
(phone')
(Sur--t/ci ty1=r_'a p)
do hereby certif);, under the p?-ins and penalties of pe>7ury., -.hat
O I am an employer providing die following workcr's colnDCns�Jon covervgc iof Illy
etuployccs woraing on't-ins job:
(lnsi=_,n= Corer.-_m') (Folic: Nu--zbcr) --- (E:pirz or Dar.:)
O I am a sole proprietor, general contractor or homeowner (circ;e one) and have hired
the cones aCors Usted below who have the foilo%vinQ workers cocoensztion policies:
(Namc of Conrmctor) Onnrranc:: Cornoany/-PGbc; ?gLuxt.rr) �?:DIiJ Q1 t�1lC)
(N:mc of Conramor) (Las-wanes Company/?obm, Number) (E.vpi uon Date)
(Name of Connaeto,) (prance- Company/PoUc}- Numbcs) (Exairadon Date)
(Name of Contractor) (Insurance Company/PoLicy Number) (E��irdon Date).
(aniGh-'6'--oczr s!eG irooccsiry w fortna:1.a pervuaing to all
O I am a sole proprietor and bave no one wor4dog for me.
( ) I am.a home owner performing all the work myself.
NOTE:pl=sc be ewwr Q1,1 hallo bem-ov,-r,v.tc cmploy pcnow w do r zclei cm--,x—oo c repay—ark oa.d.. U_-Z or
ON most than t'J-oe tmfu io the bocaoaw•na'rssdo or oo the Qouac:a zppuricar_t tbarw i�oo( a.oid=nd to be
ca3)loyc^1 unc'c L---kcrs m Act(GLI5L=1(3)).npplicz.6oro try a bomoowva far s Gam or pcmit rosy n-id=cc the
IcgrJ-of as�loyer under dso Wock-0-,Co¢�cmztion Act _
I uodcszaod dh a oopy orthii entcmo=may be rory grdsd w ebe Moe or usurz000 for the '
dove Sc vrriGatioa n_�sd t2u Lihae to P=='oovccase undo soetioa 25A nr MOL 132 cza Ind to the impositioa of a-imin_+r pca4.Wcs
corm=s m8 or,rme of up to S 1-5oo.00 and/or imprison o(up to doe yesr cud avit pcaLr,a is d.form or:stop wwt ordc and
r1m o(SI00.00 a dy tpinst me
For dcp.rcaaT.�1 u,c only
Pcrmit Ntumbcr
1%42 P.,—_ Lot n r
Si�at�of Litzry5cc/Pcnniucc ��_ . .� .::
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10 STRUCTURAL PEER REVIfW'(780 CMR 110 11j
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11 OWNER AUTHORIZATION TO BE„COMPLETED WHEN
RS RA
OWNE AGrENT OR CONTCTOR APPLIES FOR BUILDING PERMIT”
I, 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
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.
i
Signed under the pains and penalties of perjury.
I
Print Name
i
t
Signature of Owner/Agent Date
I
SECTION 12 -CONSTR TION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
r
License Number
Address Expiration Date
Signature Telephone
SECTION 13 YY[fYRKERSy COMREI+ISATIONIV50RAt�CE AFFIDAVIT
t•
0
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....... 13 No...... ❑
or
Version 1.7 Commercial Building Permit May 15,2000
SECTION"9 PROFESSIONAL DESIGN AND CC3NSTRUCTaON SERVICES F:"OR BUfLDINGS i�ND STRUCTURES.SUBJECT TO
_. _._
CONSTR"11GTION"b6NTROL P"URSUANT TO"780"CMR'116{CO"NTAINING MORE THAN- 5930 C F.OF"ENCL"0"SED 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
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L.c.40,§ 54) 17.1 Flood Zone Information: ( 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This colurrm to be filled in by
�— n Building Department
Lot Size J �l ACke-
Fronta e
Setbacks Front
�/
Side L: R: L: 7 1 R: G
Rear 2 20 /
Building Height ! _ Z 17 /
Bldg. Square Footage 29 % 288 d
Open Space Footage %
(Lot area minus bldg&paved
parking) M ^
#of Parkin ,V Spaces �0 A
Fill: p /VA
(volume&Location) /V,VA
A. kas 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 DONT KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT 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
SECTION 4-CONSTRUCTION SERVICES FOR PR03ECTS 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 BuildingyK] Repairs [ ]
BRIEF DESCRIPTION: (Z Y Z LI ?L
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
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 10 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility SpecifyS'QQ�C n F S"1 c�lx}F;k-c e H1 �,(�i n; C LLl:1T-+ati;S
L.�.,u rt;r��;�►�n� , E-tLl Ll i .��.i���.t. :�:�LS �a�� 'F►rrv�t,-c,-
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: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf) f-
t
nd
F
2 rd x
3rd — r
°o
}-N
Total Area (sf) I Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department G:
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
eC y
APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THE 6S0�OR OCCUkkNCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
APR - 6 2004
SECTION 1-SITE INFORMATION
This section to be completed by office
1.1 Property Address:
I' i LL 1 = C C t- I k� Map_ Lot Unit
Z�� "N YJ��S z►21��_ ML eS 1 Zone_ Overlay District
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �� k; (�'� S i
Na (P ) Current Mailing Address:'Ml� / j LA +�J -
Signa e �Telephone
2.2 Authorize A ent:
J C"A 2 ,A �wil oC tixj 0 �6
Name( rint 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 f'SC (a) Building Permit Fee
2. Electrical r ` (b) Estimated Total Cost of
N Construction from 6
3. Plumbing h n Building Permit Fee
4. Mechanical (HVAC) j �.
5. Fire Protection
6. Total = (1 + 2 + 3 +4+ 5) cl c) a Check Number
This Section For Official Use Only
Building Permit Number:__. Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2004-0968
APPLICANT/CONTACT PERSON ODE LIMITED PARTNERSHIP II
ADDRESS/PHONE 140 UINION ST SUITE 203 LYNN
PROPERTY LOCATION 29 INDUSTRIAL DR
MAP 25A PARCEL 179 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid /YV 1-r 11 VPO L11
Typeof Construction: ERECT 12 X 24 SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INYORMATION 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
s
Other Permits Required:
3
Curb Cut from DPW Water Availability Sewer Availability
i
s
Septic Approval Board of Health Well Water Potability Board of Health j
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
Z 00
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.
r
�9 INDUSTRIAL DR BP-2004-0968
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A- 179 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Bulldin4 DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2004-0968
Project# 3S-2004-1441
Est. Cost: $3900.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 240015.60 Owner: ODE LIMITED PARTNERSHIP II
Zoning: GI Applicant: ODE LIMITED PARTNERSHIP II
AT. 29 INDUSTRIAL DR
Applicant Address: Phone: Insurance:
140 UINION ST SUITE 203
LYNNMA01901 ISSUED ON.
TO PERFORM THE FOLLOWING WORK.-ERECT 12 X 24 SHED
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 4/9/04 0:00:00 14047 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo