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17C-213 (26) R E ( ifs cf 'Nicz:tljalliptoil �� E ��asfnrhncrlta' Q DEPARTMEI-T OP DUILD0\0 INSPEC7101.'s 212 Alain Strect ' Municipal Building Northampton, Mass. 01060 W O RICER'S C O'NM EN S A'M NM S URAN CE A FFM A VIT (li crnscrl(x-rmi ttcc) v,rith a principal plat,- of busines)slresidence at: Q, ��S C'. .1 J't Jf' �•� L—e�r� , ✓�+� e'er aiyf� (phone') 7 (su�.Uci ty/stalcla p) do hereby cert f).-, under tic pa-ins and penalties o't penury:, :hat am an employer providing die iollowine vvorkcr's coinncnsanJon covemae 'or my etuployccs \vorlang on'uiis job: 41-je! AwAwt MIr. Ci� -6003 Ig3ofaov_� (LE=--o= Comr,::.nv) (Polio: Nu-•ter) (T:pirrior Dace) ( ) I am a sole proprietor, geaeral contractor or homeow-aer (c cie one) and have hired the con-actors listed 'below rgbo have the follo�'Niag worker's combensadon policies: (N`SIDc Oi Con- Tnc,o-) (In2rancc Coinoart)-/t'oUc-, NuII1hG) (—Expl'-oon Datc) (Name of Contractor) Rasuranc-- ComoazyRolim, Numcrr) (Lxpir Lion Date) (Name of Contractor) (Las ra.nc: Compa-o)•/Pobc�- Nambu) (Expirarion Datc) (Name of Contractor) ansuranc—c Compa.rry/Po6cy Numb:..r) (Expivatioa Date) (aasch zd'--o-j r!3oG ifnco---v to crdud=inform.-,ioa Pst to all oo=ra rz) O I am a sole proprietor and have no one wori;3ag for me. ( ) I am.a home owner perforraing all the work myself. NOTE:plesc be aw^zrc tS.e utik homy von w'bo employ pc-Low w cla•-•6=,-,• r ec—,w—'0�r rv?zjr��'orir on.d.•c11^Z of not more th a t'ry tmrj in u3ieb ttx bocnoowner raido a m the p-ou�zppurten:n thus a ox C-a.-r-2y oecrd_-Ird to be employe-u---the.«S clz gym Act(GLI52a 1(5)�awil=000 by a homcow=rer s lice^c or prrmrt ra:y ecide ibc 1cg ctsau of as-=;Aoyx under dl o Wock e,Cocszpomatioa Act t —a---d tb-a oopy of a,:.mt n xd may bo for'vv.ded to ao pops,,or 1.&,rricl Acod.&om—or 4avr.00e for tS. ' oovQj.&c vvif atioe&:W dLt r-iliac to swot toverase trodct soerioa 25A of 1 t4L i 51 nn IcLd to the=Posilion oreT=M3I P-16- ooa:is of a fiat of up to S 1300.00 and/or bmprjyo�of up w ooc year and civil pCM.tuo in be form ora SIoP Wort Ord,-and■ f=of S 104.00 a day ap-i=arc _ For anty � Pcrmit NLLmb cr ).01 R iPlzwrc of Li0=--,cc/Pcrmittcc 2 + Versionl.7 Commercial Building Permit May 15,2000 7777777F777777 77 SECTION 10 STIR, URALREER REVIEW(780 CMR'110.11) .77771 Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ 'SECTION 11 OWNER AUTHORIZATIONF TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR AP.PLtES FOR BU DING PERMIT as Owner of the subject property hereby authorize �o-tC o CU:� .ry J�a+, to act on my behalf, in all m ers relative to work authorized by this building permit application. v 6 Sign re of Owner Date l 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 32 CONSTRUCTtflN SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder 4 2 y i r 0611 -2 License Number S U /� .-e.. ^ n...e e7�+, ., fry /�.+► / /a -)' /0 y Address p G�`�f� Expiration Date ,f Signature Telephone SECTION 13 WORKER 'TION INSURANCE AFFit)AVI7(1171 G 1 :c 152; 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...... ❑ Version 1.7 Commercial Building Permit May 15,2000 J SECTION 9 ;PROFESSIONAL DESIGN ANN CONSTRUCTION SERVfCES FOR SUItDINGS AND STRUCTURES SUBJECT TO' CONSTRUCTION t QNTR01 PURSUANT T0780-CMR, '16{GO"NTAINlNG MbRE.THAN 35,x,00 C1 i.OF:ENCLOSED SPADE) 9.1 Registered Architect: Not Applicable 0 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: /410-,I L .'- C. 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) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ 1 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (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 DONT 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 . , SON - fl�1L'1t3{�1I1 t E "R it"mam, �.IESS HA1�1` 10t1 > iti�iCE#7NCiLOS © ►CE � b� ; Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofin Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] (M Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: SECiIMS--USE�,GROU AND°CONS R CTIflN E a.r' rr 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 ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use 1127 Specify: S Special Use ❑ Specify: COMPI -I °E)r it G i iL{ 1G I #tGC 1G i0VA QA1S GE,}TU133 fIf31�1S',7�IflDD OR CHAN IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION.`:fiUILDI�IG tilElGfl � AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) ist wr x rp g rid E 1st 2nd � 3 3rd 4d, � ~ € Total Area (sf) Total Proposed New Construction (sf) mi _ Total Height(ft) Total Height ft---------- s Versionl.7 Commercial Building Permit May 15,2000 of Northampton ing Department Main Street .-- �— r3 = oom 100 No ha ton, MA 01060 X587-1 40 Fax 413-587-1272 � \� .rCi � APPLICATI I'hSTRUCT,REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING i OTHER THAN A ONE OR TWO FAMILY DWELLING .L ;1 "`SE�ON�.'t �ITfFUR�ilA7IflN Lek 1.1 Property Address: .� - 9 3 REi J- n e r f 5 ' Knee Alt �SECTION.3 `Pl�flP4ER�'Y'O�At�IfRSI�IP��lUT�lOR�©AGENT„ 2.1 Owner of Record: (?"f/ yo /3c.z fi.f 1 d wA'r/1%'s CMet 00�� Name(Print) Current Mailing Address: !1 fl- d 3 S- - ?-50 0 Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3ST[ 1 ? DCONSTRl1CTION COSTS Item Estimated Cost(Dollars)to be OftiaFu se On'ly completed by rmit applicant 1. Building (2,,(;,,-, � � Q�d — a)Btnlding Perm Vie_ 2. Electrical 6) n a'ted Total CosFof �onstrctiori.from; 6 . 3. PlumbingBuilding Permitee 4. Mechanical (HVAC) 5. Fire Protection =. 6. Total = (1 + 2+ 3 +4+ 5) dumber, . Tis.Sec4ori'Far Officiaise flnl r: Buildfig,Penn �Nt�rer {3ate Issued Signature: ' Building'Commissioner/Inspector of Buildings Date r � 93 MAIN S BP-2004-0382 GIs#: COMMONWEALTH OF MASSACHUSETTS yTapalock: l7C- i3 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0382 Project# JS-2004-0562 Est. Cost: $42000.00 Fee: $210.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ROSCO CORPORATION 064782 Lot Size(sq. ft.): 20691.00 Owner: ROBERTS BILL Zoning: GB Applicant: ROSCO CORPORATION AT. 89 - 93 MAIN ST Applicant Address: Phone: Insurance: 285 CENTRAL ST SUITE 201 (978) 543-3307 WC LEOMINSTERMA01453 i ISSUED ON.1017103 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 SiLynature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 10/7/03 0:00:00 3382 $210.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo