25C-085 (5) -T' UNIT D
d�Cf
UILITY EA%WW
MOM Cpl-W Fl?MNG
U N IT A (2'-0"HOM WMWA OWN)
UNIT G
Pro r)n�opj
LmO"
a591 .8 S.F.
1 T
nod - _
��asnauco�
r-ort
caws
1
F 1 k5f F L.00�
JL
w www�
OA -- OM&L
S'0
g g Gxt� iaf 'Wart 11ail1pfoil
BMis%a c4nsett5
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building 'o
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AF MAVIT
OL- i ✓ � /'s'�L)..J
(li censee/permi flee)
with a principal place of business/residence at:
V-) e� Gtr . �2•� (phone#) S`/
(street/city/st atrJa p)
do hereby certify, under the pains and penalties of perjury, that:
(-rfam an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following workers compensation policies_
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (IDsttranc-- Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioal shoot ifn<ccaury to include mfixmition pertaining to all 000tmd r3)
O I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who employ pcsioas to do rnainrr,,.acr,cortsirucdoe or rcpa r work on a dwelling of
not atom than throe units in which the hoznbowncr r t=dcs a oa the grounds appurtcnnrst thatito art not wally oomidaed to be
employers under the wackc oompc:sation Act(GLI 52,=1(5)) application by a homcowncr for a liaane or permit may evidence the
legal datua of an omployer under the Workeet ConVensalion Act
I understand that a copy olthia ctatcmmt maybe fodwnrded to tho Dcpartnxcxt of Indautrial Acadmt> Office of Iastuincro for tha
co-mge vcrif cation and that failure to azure cove n under section 25A of MGL 152 can lead to the impositku of criminal prnaltics
oomisring of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil peaalt c3 in the form of a Stop Work Ord--and a
Eno of 5100.00 a day Carol toe.
Foe dep�uae only
Permit Number
Map# Lot#
Signa me of LiccxtseclPetmittce
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)'
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS'AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
re(Z-7 G tAL as Owner of the subject property
hereby authorize O�'1 �� �J ��'J to act on
my half, in all matters relative to work authorized by this building permit application.
ignature of Owner Date
0 L J ✓L-J` 1'E �IJ 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.
�li I ✓tr'L v f�t-l''J
Print Name /)
Signature of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : L I ✓ &rt_ t) 33 O 7-2
License Number
Address Expiration Date
Jay - 2 L
Signature Telephone
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....... 91-' No...... ❑
Version 1.7 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)
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 Nam
Responsi e In Charge of Construction
Address
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L. c.40, §54) 7.1 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
N,l C ,+A--. This column to be filled in by
rT"�� Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
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 YES
IF YES: enter Book Page and/or Document #
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 here 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 [ ]
L•� fNT — v-M-d e4,-..r& -T,J l'rv-t- - boo-c- /..1 13k
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE S' t�Twrt 14-6y) f4.4 i[
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 111 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 1B ❑
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 ❑ 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 r;, OFFICE USE ONLY -.
Floor Area per Floor(sf) C��' St
2nd
1st
3rd
2nd
4th
3rd
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)_/-"°
Total Height ft
Versionl.7 Commercial Building Permit May 15,2000
Northampton
E l� E Q U [J3 i ng Department
1 Main Street
oom 100
AUG 2 2 200&or pton, MA 01060
phone 413-$87-1240 Fax 413-587-1272
DEPT Of BUILDING INSPECTIONS
Wo
A , R, 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:
' ThW!section to a conn pletett b of#very
Z 3 �2,/�G k !`T' Maps Lot s ; nt �f
r
;ion Overlay
r /f
Elm.St:;Dlstricf N i �, ,CB D,sir�cG �:•
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
7'C-MO-7 Ct�L�44-,j, - l A ,►�a� �►o,a �� fro /J �5' ��2P ^�rbr!
Name(Print) Current Mailing Address:
>L !�r &&LL., S-Y y - 6 `f
Signature Telephone
2.2 Authorized Agent:
Name(Pr' Current Mailing Address:
Si re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from' 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) '0 Check Number ma
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date'
File#BP-2003-0200
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center (413) 584-1224
PROPERTY LOCATION 238 BRIDGE ST-TRIPOD AUDIO
MAP 25C PARCEL 085 001 ZONE URB
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: CONSTRUCT INTERIOR NON-BEARING PARTITIONS&INSTALL DOOR IN BATH
-UNIT B
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF aMATION PRESENTED:
t 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 Elm Street Commission
'466
Signature of Build 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.
,: " VKF,sT.TapAUloF` BP-2003-0200
GIs#: COMMONWEALTH OF MASSACHUSETTS
. �k zsc_c�s5 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0200
Project# JS-2003-0365
Est. Cost: $8000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Oliver Iselin 039073
Lot Size(sq. ft.): 13764.96 Owner: MOGGIO ANN-MARIE
Zoning: URB Applicant: Oliver Iselin
AT. 238 BRIDGE ST - TRIPOD AUDIO
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:8128102 0:00:00
TOPERFORM THE FOLLOWING WORK.-CONSTRUCT INTERIOR NON-BEARING
PARTITIONS & INSTALL DOOR IN BATH - UNIT B
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 Sienature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/28/02 0:00:00 1156 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo