38-050 (22) RTE 66,HOSPITAL HILL BP-2005-1310
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38-050 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1310
Project# IS-2005-1759
Est.Cost: $4845.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Wright Builders 068185
Lot Size(sq_ft.): 226512.00 Owner: VILLAGE HOSPITAL HILL LLC
Zoning:PV Applicant: Wright Builders
AT. RTE 66, HOSPITAL HILL
Applicant Address: Phone: Insurance:
48 Bates St (413) 586-8287 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON.6/28/05 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPAIR BUS STOP
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:
FeeType: Date Paid: Amount:
Building 6/28/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2005-1310
APPLICANT/CONTACT PERSON Wright Builders
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287
PROPERTY LOCATION RTE 66,HOSPITAL HILL
MAP 38 PARCEL 050 001 ZONE PV
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: REPAIR BUS STOP IF r
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 068185
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 ommission
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.
Version 1.7 Commercial Building Permit May 15,2000
' DelJaCtCIJ2nt oe on[
� }} 4
C's C: 7f Northamptcn Status of Permit-
0,
LuiiCi Department Te 4
s �g p W�Wib Cut/Dnve fcxn
X212 �ain Street Sewer/Septa i a I
Room 100 Vi/ater/We�lx.Va tai
Lit-6rthampton, MA 01060 Tw�oSetsof rat °a�rr` .� a
4 phone"413-587-1240 Fax 413-587,1272ans: 4
Oth�e�Spec�f�
APPLICATION TO CONSTRUCT, REPAIR. RENOVATE. CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A.ONE,O''R TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: g V$ 1 This section to be completed by office
Hui, Map Lot ,Unit
I �Q Zone Overlay District
Elm St District C8 District
I SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Wfl(flf►' BttL92L5.1 *r PiCAC ITE 41?) gXT_US ST- 14EM11MVIDE L,/IA-
Name(Print) Current ;Mailing Address:
AK a -7
Signature Teiephcne
2.2 Authorized Agent:
Olt, j c Z
L; C62PCk A
AU t"1 o
Name(Print) � �I`G k..t � tic i}c�►�I� (1C_Current MailingAddress:
.
LIf3-- 7 3 'T-�: &u'7
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTSj0 NtIrtIM�M �b�Ml r r G+�`
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit aeolicant
1. Building /1 [� i (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) Check Number
T Official Use Only
This Section For 0
Bu ldmg Permit Number Date'Issued:
;.
Signature i,
.s
".. .;'Building Commissioner/Inspector of Buildings ': Date "':�
Versionl.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 0 Roofing 0
0 0 1
Exterior Iterations DernolitionO New Signs Change of Use Other
Accessory Building Repairs
I 6M
-Tlblp 0- *" n-os
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly 1tv A-1 11 A-2 0 A-3 C 41A 13
A-4 CI A-5 0 I 1B 11
B Business 171 2A C
E Educational 0 I 2B C:
F Factory 0 F-1 0 F-2 0 I 2C c
H High Hazard 0 3A El
I Institutional C3 1-1 11 1.2 0 1-3 C1 I 38 11
M Mercantile 10 4 CI
R Residential 11:1 R-1 CI R-2 0 R-3 C2 I 5A C1
S Storage C1 S-1 1:1 S-2 ❑ 5a
U utility 13 Specify: &r Win
M Mixed Use 0 Specify:
S Special Use 0 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
-ii–w,'0FFICEjJS&ONLY
BUILDING AREA EXISTING NPROPOSED NEW CONSTRUCTION t -
k
Floor Area per Floor(so St g
am
2 nd
1st
3'
2nd
1h
3`d 4
4th - ----
Total Area(sf) Total Proposed New Construction (sf)
...................................
Total Height(ft)
Total Height ft--------------------
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: NI�
Public ❑ Private ❑ Zone: Outside Flood Zone I Municical ❑ On site discosal system ❑
8. NORTHAMPTON ZO YL`c. L Wow Tt gf *t)ONS m1T"-M S'T' Nb- 1"FF-INT
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Fronmae
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
9 of Parkinsz 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: 6kN -Th ., S4�NC
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 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
9.1 Registered Architect:
Not Appiicable 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
zz
Name Ar 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 Number
Xnature Telephone Expiration Date
or
lo 9.3 General Contractor
Uv 'd- 1 r+C,
ffl a P Not Applicable 0
Company Name:
Responsible In Charge of Construction
Y'r AAT15S
Address
rxg
D(*
Signature Telephone
r
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
i SECTION 11-OWNER AUTHORIZATION -TO BE COMPLETEO WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
jI, V!`1L��
mit ! C as Cwner of the subjec` pr;certy
hereby authorizer �lC �fE ) (�j�.�(�{i' �+�ER$ to act on
my be. If, in all matters relative to •Ncrk a thonzed by this building permit application.
y d
Signature of Owner Dat
f, T I GtiT6 J �/U�I t� l- 3u t LpS as Cwner/ .uthorir-_d Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the cest of my
knowledge and belief.
Signed under the pains and penalties of perjury.
PdL-r �ICf-rte
Print Name
/4,le�r "al 64rm G bl/ a
Signature of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor; Not Applicable ❑
pp,,�� p
Name of License Holder: rpt I If-1���� CS 6fp2>1 ES
License Number
MA
AddressExpiration Date
-7
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFID VR(M.G.L-c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed al d 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...... ❑
I
cis P,o
ya Lr� of W c1#a11t:7t12IT
9� ti1(° ��R:ssacascl2s �-
v t�
•Vie,-..-ti•r -
DE?a LME.Vi' OF BUIL* WG INS?ECTICNS
2I2 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WOR=R'S CONfPENSATION INSURANCE A=A'YTT
(Iic-as. cc-=tt---)
with a principal place of bum-ts- residence a_r:
(s�2/ci tri s,.i:lzr p)
do hereby ce H=y, under the pains and penaltes of pe-7ury, that:
O I as a_ eWployer providiaz &.e follow•inz :vor'de s coverage fer my
employees worming o this]Cb:
(Irszu-Lc� Carr-�) (t'ci ;Number) (=.�rdon D=-)
( ) I ain a sale proprietor, gene:zl contractor or homeowner(cycle one)' and Piave hired
the contras tors listed below who have the foto:grog workers cotlpPe cation policies:
(Name of C0a=car) (Ln_suran=Co=7-azy(PoLicf Numbcr) (—;:-cp�Edon Date)
�eor� r 'et :im:� o Dare)
(Namc of Contr (Lzssran�ComJa�.,/Poucr Nunc ) CF• .
(Name of Coni sc or) (Inszuanct-Co=paa /Palicf Number) (E.Yir dozy Date) .
(Name of Contraccr) (Iasuran=ComranyiPolicf Number) (Emiration Date)
(aa-ch adtl dc*&i:s'ect if neoc=ry to 6--hide iaiocrosrioa;pro` a.0 oocwwtom)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the wort myself
NOTE pica=be agate thatwhil4 hcmeow=%who c=plcy pm-==to do ,,,,^•Y =SftUC:en cr s;aawc&ca a dwelling of
tint mote thaw thine unit:is wbzch the hou owoe T=ida a m tha erg spptuta 1bacto=ax gma ay oaasidasd to be
cwpicym under the wociterls*==p=zati=Act(GW2,ss1(5)),zwr===by a hm=w=far a Gc=c cc permitmay evidence the
legit axw of=empioyw undwt ze waricaes Cation Act
I uodaAand thac a a*"of thin c=an sd may be faavraniad to the D epacmmw of l.&Lzb ai Aa:ida Cffioe of imu—fat t6a
average vaifics w a sd that filum to waste awaago under z Mi.ZA of MOL 132 as lead to the'imposition of ctiminsi paaaltia
comiscng of a fine aCup to 51.300.00 and ar iasp<aottment of up to one year and dva p=aNcs is the to=d■Stcq wilt tDsdw and a
fine 4(3100.00 salty against me
For drat uae ady
Permit Number
-- - _Loth
Date
; ... . s1gsL3tlmC of Liceasrrj?ermitt=
W R I G H T/_ B U I L D E RS
I ` C O R P cj R A T f_ D
43 13ATESSTREET
NORTHA&IPTON, NIA$SACHUSETTS 01060
I
Mr. Tom Kegelman
The Community Builders
322 Main St.
Springfield, MA 01105
RE: Hospital Hill Bus Stop Repairs
Dear Tom:
Thank you for your confidence in Wright Builders',:and for the opportunity to work together and
be of assistance. Our quote is based on the scope of work outlined below.
The Scope of the Project: The scope of the work',,is as outlined as follows:
1. Remove overgrown vegetation
2. Remove and replace rolled roofing with rubbed roofing flash as needed
3. Scrape and repaint wood and trim on face of building structure
4. Replace trim and facial wood on front of building structure
5. Replace rotted framing n right side corner of building structure
6. Remove and replace ceiling of the bus stop and replace trim
7. Prep and paint wood sections of bus stop (old & new)
8. Chemically strip paint from brownstone
9. Scrape and paint steel railing
10. Condition of brownstone after paint removal u0mown (no lead paint on brownstone, lead
paint on wood sections only)
11. Any unforeseen wood damage other than listed above is not included in the Scope of Work
Costs: Costs for the project are as shown on the attached estimate summary.
Optional Work: Options for material or costs savings, if applicable, are included in a separate
Options Summary page. They may be selected at time of original contract, and will then be
incorporated as a Change Order.
Site Work conditions: All costs presented for sits work items are estimates assuming conditions
are as they appear on documents provided and ascertained during site inspection. Anv site
conditions that occur that require alteration of site'plans, site engineering, septic engineering,
cope of construction work or related work will result in cost changes to the owner.
Unforeseen Conditions: Reasonable care is taken by us to inspect field conditions and existing
TELEPHONE 41 ,- 3n „7 & FAX 4I1 37 Ak !-Lf_C T,:�),vl�' ��IUL. inl���n���righ;-, u,Id01S.cum