32C-346 (8) RANDOLPH PLACE-2-14 BP-2018-1257
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:32C- 163 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory. Stab BUILDING PERMIT
Permit# BP-2018-1257
Proiect# JS-2018-002238
Est.Cost,$4000.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO.
Const Class: Contractor: License:
Use Group: RONALD DECK 102688
Lot Size(sp.ft.): Owner: GEORGE SPENCE
Zoninw URC(105)/WP(53)/ Aaolicant: RONALD DECK
AT: RANDOLPH PLACE - 2-14
AaniicantAddress: Phone: Insurance:
P O BOX 4002 (413) 628-3384 WC
ASHFIELDMA01330 ISSUED ON.5/29/2078 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR 3 BACKSTAIRS AND INSTALL
SUPPORT POSTS
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:
FeeTvoe: Date Paid: Amount:
Building 5/29/20180:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2018-1257
APPLICANT/CONTACT PERSON RONALD DECK
ADDRESS/PHONE P O BOX 4002 ASHFIELD (413)628-3384
PROPERTY LOCATION RANDOLPH PLACE-2-14
MAP 32C PARCEL 163 000 ZONE URCO 051/WP(53)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
NCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction- REPAIR 3 BACKSTA AND INSTALL SUPPORT POSTS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102688
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
_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 Permit DPW Storm Water Management
__Demolition Delay
Signature of Buil it £ficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all caning
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.
(� V.ion1.7 Commemisl Huildin Pemut May 15,2000
R EC_E I City ohs Northampton Status of Permit Dapa nialid use Only
Building Department Curb CuttDriveway Pamn
MAY 2 4 '118 212 an Street SawenSepm Avs labiiy
Room 100 WaterMeft AvailelNBty
Northampton, MA 01060 Two Sem of Sbuctiasl Piens
pogrs,41,1,587- 240 Fax 413-587-1272 PIOVSite Plane
Oyler Specify
APPLICATION TO CONSTRUCT,REPAIR RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR THIO FAMILY DWEW NG
SECTION 1-SITE INFORMATION
1.1 ProoeM Address: This seeyon to be completed by office
Map 3-2 r- Lot 13 Unit
. ` Zone Overlay District
I�LFYY'��CILLr�' EIm St Diebict CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIMO AGENT
2.1 Owner of Record:
,C-,E0(r6t A, '5poec 0.4r /G W4ffl A dmx,
Nam t) /1 r.� /I` �YJFnI�{ Cunem MCYi,Add...
SgnaWm SGV (, r Talaplwaepr X 9898 C-01 (0JG9d3
2.2 A A eM'
1
Name(Pdm) Cuna`N��..++aa Ong Address:
e,.S , VQa.
signature T-60. f 3 S3"1 f)'ZA & seg 7
SECTION 3- T 5/D CONSTRUCTION COSTS 5-11-7
Item Estimated Cast(Dollars)to be Official Use Only
completed by permit a licant
1. Building (a)Building Permit Fee
2. Elec0ical (b)Estimated Total Cost of
Constmction hos 6
3. Plumbing Building Penny Fae
4. Mechanical(HVAC) ot
,1/YL
5.Fire Pmledion
6. Total=(1 +2+3+4+5) Check Numbs
This Section For Official Use On
mg a itNu be, Date
Issued
auiMirg Commrssiasrnnspecl«of auiH'vgs nate
Vclsionl.7 Commercial Building Pcrmit May 15,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Intenor Alterations ❑ Existing WaIlSigns ❑ Demolition[] Rapal-10 Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Chargee 0f Use❑ Other❑
Brief Description Enter a brief description here. 11 DI y� y;� — I(?cA R o)11SPN& 57AW, 671--
Or Proposed
71--O/Proposed work: a.>• �4r..JG-'�"r0.�S tw5��l Sv CA -k S'16
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly171A-1 13A-2 ❑ A-3 11 IA
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A Cl
E Educational ❑ 2B ❑
F Factory, ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Harard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 4 ❑
R Residential 19R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Speck
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)
1° 1°
2n° 2"r
3w 3.
4e be
Total Area(sf) Total Proposed New Construction(at)
Total Height(h)
Total Height If
7.Water Supply(M.G.L.C.40,§54) 7.1 Flood Zone Irdormation: 7.3 Sewage Disposal System:
F'I,Wjn Pm,aw 0 Z. Outside Flood 7011,❑ WaicipalV On site disposal systemE]
Veraonl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Inning
Thisc uauiobefilled Inby
B.1ding rx r—nt
I.t Size
Frontage
Setbacks Front
Side L: R: L: R:
Rem
Building Height
Bldg Square Footage
Open Space Footage
(La vra minus bldy&un el
azki
4.[Parking Spaces
Fill:
volume&Lacnion
A. Has ar�Special Permit/Variance/Finding ever been issued for/on the site?
NO (E DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Docunnee}yrdytt...#
B. Does the site contain a brook, body of water or wetlands? NO O DONT J
KNOW 1 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES,describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the properly? YES O NOO N/r l
IF YES, describe size, type and location:
E. Will the contraction activity disturb(cleamg,grading,,eation,or filling)over 1 acre or is S part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Slam Water Management Permit from the DPW is required.
Verslon1.7 Commercial Building Perini(May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO T99 CMR 116(CONTAINING MORE TWIN 35,990 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect
Not Applicable 0
Name(Registrant):
Regis uon Number
Md.
Evimtion Data
Sgnalue TWephwre
9.2 Registered Professional Engineer(s):
Name Area of Responaibility
Address Regstr n Nunber
Signature TelW=e Eapirelion Date
Name Area of ResponsiWldy
Md . Regkaa on Number
Sigiaaue Telephone Enion Date
Name Area of Responsibility
Address Registration Number
Signature Te ,,Wne 6Piration Date
Name Nes of Responsib119y
Mdl.s RegstiaWn Number
Signature Tek. I rq llan Date
9.3 Generel Co��*actor I
z--p ,p1� ! � Not Applicable ❑
Com yName: !!
ft�ssp)o'rta We In ChaW of ConsLguctbn
� porni d. tV� 1/Vca �- &-r
k)3 334 0 `�
Si Telephone
Vcnsion1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Sbuounal Engineering Stmctual Peer Review Required Yea O No O
SECTIONII -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPPUES FOR BUILDING PERMIT
I, 66R6.6 ! `�" ,as Owner of the subject property
h etherize cNA�D D� to
behalf,in all matters relative to work authorized by this building permit application,
SigraW r /� Date
Owner/Au"Kz_.�d
Agent hereby declare that the statements and i formation on the foregoing application are true and actuate,to the best of my knowledge
and belief.
Signed user the pains and penalties of perjury.
Pnnt Noma
�a�wl
SECTION 12-CONSTRUCTION SERVICES
104 Lfc need COnstrppB Su ervisor. Not Applicable `❑
Nuof LI H M tT T\ t. `S i V Z. lo`6�S
U.Number
Az.5 qty
ger Expiration Date
�Y J K!'S 33s D2G`�
Sgnar 6� Tekplaie
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 F No O
�\ The Comnronwealth ofMassoehuseas
Department oflndustrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www nu scgorldia
Wrokers'Comperounfilm Insurance Affidavit.Builders/Contractors/Electricians/Plumbers.
TO BE FILED WI IH THE PERMITTING AUTHORITY.
A leant Information Please Print Leldbl
Name(Busiroas/orgmvnioNmdiYlauap:
Address: ,i C
City/State/Zipv ,�q phme a: ?f 13 33g f
Are you an ampmred cb«k the appropriate a. Type of project(required):
I❑I am a emplorcr with _ en,0ma (full uWm mn-fisc)' 7. E]New construction
2.�Iam amok pmpietsorpnmrshipaM haves enplmaa woain6 for-in 8. El Remodeling
ax,wryco, INo workers'comp.mwwxs no tome l
❑lamalmmeo.,doing ill work myself INo wmhe%rump.in.mgnma.l l 9. ❑Demolition
3
❑I amaInreov� and win Is, m mmi«it all wvrk on my papery. I will 10❑Building addition
4
arc lM1a all mnhacmrsctharhave worker:em�gensaam immaae or are sole II.❑Electrical repairs or additions
po,mus,with-employees. 12.E]Plumbing repairs or additions
5❑1ama gmeml oontramr act l have and as subcmtrauon lisud on one amsNxi sheet 134—]Roof airs
rlw,eaal,conlxsrshave emplor� na�e wnd:ea W,,,p imamnrt.:
h.❑Weare acoryosrionaM its oRces haveoaoo N'oxnp ntunowepaonper MGL c.
14.[Iher t
152,§I(4),atl xe haves aWlmss.INo xmrkers'm�.immarcc required) F �•Q4l
`Am applinratlxa loxhl muAaksofllmn N,e Mnanelow slwwing)Lev»wkers'mmpenswon polilry^inf 4ae
'Ilommxaan wM sadnit IhisamdmniMiraan6 days &Losa]l wph andIMn krt onside cpnuu:lws mmIsubwlasaw etiidavit indiwfing sucM1.
:ConbesmslM1a cMck rnis boxm tatlnctrd an atli4onalskashowing lM reme of NesubsowactarsaM sba wetXrww dxwc0#mM1 leve
empkyem. If Ne subsosncmrs five emploYeu,awy mull psvidc Heir xorkas'comp.pnim camber.
I am an employer that is pronINng workers'conpemation imus m for my enpioyees Below h the policy and job site
information.
Insurance Company Name:
Policy k or Sclf-ins.Lic.p: Expiration Dale:
Job Site Address: City/Slate/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGI.c. 152,#25A is a criminal violation punishable by a fine up W$1,500.00
and/or one-year imprisonment,as well as civil penalties in the fast of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereb thethe)pdns dpenadles ofpedury that the dformdionprovided ar/'///������u'ayeannddmmea
S' al r y � Dale x�/ a'_�(/l l D
Phone
Official we o*. Do not write in this area;to be comylned by city or town official
City or Town: Permit/License a
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cilyffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 0:
City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, asdefined by MGL c 111, S 150A.
Address of the work: �� �h/ Nl �g
The debris will be transported by: , O'A617C �n ,
The debris will be received by:
Building permit number:
Name of Permit Applic /%Sh e
4---�lf
Date Sign NTre of Permit Applicant
7 7
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2
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