18D-026 (48) * ° ' BP-2002-0346
GIS#: COMMONWEALTH OF MASSACHUSETTS
fitozgiwk: 18D-026 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0346
Project ti JS-2002-0524
Est. Cost: $3000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Hac_giggp.L Roy Omasta 006763
Lot Size(sn.ft.): 6141 9.60 Owner: THOMAS ROBERT S
Zoning:01 Applicant: Roy Omasta
AT: 55 DAMON RD
Applicant Address: Phone: Insurance:
21 North St (413) 247-5666 Workers Compensation
HATFI ELDMA01038 ISSUED ON:10/2/01 0:00:00
TO PERFORM THE FOLLOWING WOR%CONSTRUCT PARTITION WALL FOR OFFICE
SPACE
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 10/2/01 0:00:00 12651 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2002-0346
APPLICANT/CONTACT PERSON Roy Omasta
ADDRESS/PHONE 21 North St (413)247-5666
PROPERTY LOCATION 55 DAMON RD
MAP 18D PARCEL 026 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out -49-6
Fee Paid gee, I
Typeof Construction: CONSTRUCT PARTITION WALL FOR OFFICE SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 006763
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFATION PRESENTED:
✓✓Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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 C ission ///
igs
Signature of Building 0' cial 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 • Versionl.7 Commercial Building Permit May 15,2000
p
SE BECEod -
B .r Northampton ` r 5 -
Bpi di g Department t r 6
SEP 2 5 2001 Main Streeta �r�� ,31
R)om 100 re ra iii n�
ry r acrthamoton, MA 01060 IAll �),�
DFNOAi A� , Itux ase-u87-1240 Fax 413.587.1272 1 F�'f4 irf=s g
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE
OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION'S?, ,
P-0., ro 7"This e'i `iii ..
1.1 Property Address: /�
S 9Ma✓
/C/o.c li/J...,oF„ „,----/,r an'2b e4 . Y .....;if§P,, ."
m St istrick 44._ _ _ _ x",',
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED-AGENT
2.1 Owner of Record: 1-k
/ ea
Name(Print) _ Current Mailing Address:
7 . A7 tt. 0 ser—oeyGJ
Signature Telephone
2.2 Authorized Agent:
to/ 797-7lf5/7 �/ /1/n/5/ S1- /..dcf//14e e/43e
Name(Print)/97A,..: Current Mailing Address:
sic_
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ,3FY>o, (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. FireProtection !
6. Total = (1 + 2 + 3 +4 + 5) 3�r'. `6 Check Number /0245
This Section For Official Use Only
Building Permit Number: `' j)? fl4' `Date Issued:
Signature:
Building Commissioner/Inspector of Buildings' Date
r Versiont.7 Commercial Building Permit May 15,2000
SE r CONSTRUCTIO £R`V " .FORPF(,OJE -r ,d `T}A'Ni]411,
Interior Alterations Existing Wall Signs Existing Ground Signs Additions 0 1 Roofing 0
0 0
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
0
t_ Cst-^ i- Accessory Building O Repairs [ ]
GSE iCapir643: c 144.4
SECTION 5•USE-GROUP mD CONSTRUCTfON TYPE-4.
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly l❑ A-1 0 A-2 0 A-3 0 1A 0
A-4 0 A-5 0 18 0
B Business 0 2A 0
E Educational 0 2B ❑
F Factory 0 F-1 ❑ P2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional 0 Fi ❑ 1-2 0 1-3 ❑ 38 ❑
M Mercantile 0 4 0
R Residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage 0 54 0 5.2 0 5B I ❑
U Utility 0 Specify:
M Mixed Use 0 Specify:
S Special Use 0 Specify:
COMPLETE THIS SECTION.. 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 .,
'', a,e ... st- aSk9N to ,
BUB DING AREA EXISTING PROPOSED NEW CONSTRUCTION
w'
Floor Area per Floor(sf) 1" / YX dY ^; +r
as 2"a �" 5a ., Fin
2nd 3m ... EH+ „ ,.
3`d
4m s
s :.N,a
..... Tr� s,. � a;
4
__ ',
Total Area(sf) Total Proposed New Construction (sf} r.,„-:,
41°C, Sit Ft , " a �.^. ,.2r
Total Height(ft) ( ^
Total Height ft
Versionl.7 Commercial Building Permit May 15,2000
7. Water pply(M.G.L.C.40, §54) 7.1 Flood Zone Information: - 7.3 Sewage sposal System:
Public S Private 0 Zone: Outside Flood Zone 0 Municipal On site disposal system ci
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
c This column to be filled in by
/A^I. .Sjfria Building Department
Lot Sin ( "AL".c_
Frontage 5.4--'-e—
Setbacks Front
Side L: ( R: L: R.
I
Rear
Building Height
Bldg. Square Footage t/o
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 L----"- YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO f' 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 d NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
Not/
IF YES, describe size, type and location:
gVersion!.7 Commercial Building Permit May 15,2000
`� & > P A wti.v or a .ei „em1i14}
TYMiffUl r1;;; .ta;". difingflini OidEg lo ...ILA,
aB 0 1 .b k Aktli 8 tsi. vAc33
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 0
Company Name:
a
J� y ktiSTH
Responsible In Charge of Construction
dl N LrS Sr
Adtlress
�� ,�YJ-5-666
Signature Telephone
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Versionl.7 Commercial Building Permit May 15,2000
WC/30M°''c4'
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
•
SECTION 11.OWNERAUTHORIZATION QBE COMPLETED WHEN
OWNERS AGENT_;OR,Cs0NTRACTOR AP?LIES:FOR BUILDING PERMIT
I, g o G F1C J� • Jou t4 X41 N , as Owner of the subject property
hereby authorize /pp o'i O P1 457-4 to act on
my behalf, in all ma ters relative to work authorized by this building permit applic tion.
Nbten,4A1,70A Ag co 9j2r/0/
Signature of 0 Date
fay 0A7gn4i , as Owner/Peatlwyad 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.
lax 0i4soYy
Print Name
Signature of Owner/Agent Date
SECTION 12*GONSTRUCTIO(fl! SSVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: f 'Y GAttS? OO 6,76 J
License Number
d oiv /c/ioA /
Address Expiration Date
� zvr d V?— ,r—we
Signature Telephone
SECTION 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GL 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 ofofthe building permit.
Signed Affidavit Attached Yes LY No 0
!t & f urfjau } fml *_=eger
9rici " 7
aiazaachnaRle'
deDEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Municipal Holding =_
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AI71JAVIT
L it
Gip )
with a principal plan of business/residence/rat:
d Si l7ci4/ /(/zec 4-deC, /-e-, w<3F(phone#) A al7—S 4s
(street/city/state/zip)
do hereby certify, under the pains and penalties of perjury, that.
(<I am an employer providing the following worker's compensation coverage for my
employees working on this job:
lit ate..., 4,1,...,4:2r tdc- ?9G era y) 745/o,Z
(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 worker's compensation policies:
a
(Name of Contractor) (Insurance Company/Pofiry Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(.n,N added mg gam Ina-masa ta in*We information perlaiciag to all ms.nnm)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please ba aware that while hamroxma who employ paaom to do®S.o.na warrurtim Of repair work ova etwtTng o1
an more than throe wits in which the homeocrocr rtssdm cc co the gro y appurtenant thereto are na twang conidatd to be
mployaa W d.t e waken cvmpmatim Art(GLl52ta1(5)),application by a homeowm fora Name m pant may evidence the
legal antis ofm employer undartha WohaM1 Compensation.let
I undoatand the a copy of this gaic ect may be fnordad to the Depaam.,,of inthsth.1 Accidocter OHiee of Mamma,for 4m
coverage vaitaum cod that L.ihae to stain coaetago tmdc sootion25A of MOL 152 an lead to the impmrtim ofcriminal pcmWe
comirtmg of a fiat afup to S1,500,00 ancVor imprecoonazt of op W oa year and aril paaltin w the form oft Stop Weak Ocala and a
fine at-3E00.00 a day ageim1 me
5;7/1" FehpuurzIncm
tal y
Li' �"l 745 / emit Number Lot C
_rL; _
Signature of LicvnsceJpennittet Date
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