18D-053 (29) 80 DAMON RD 6305 BP-2020-0440
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-053 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv:renovation BUILDING PERMIT
Permit# BP-2020-0440
Project# JS-2020-000754
Est.Cost: $31000.00
Fee: $217.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MOWRY & SCHMIDT INC 075360
Lot Size(sq. ft.): Owner. TAYLOR TRENT
Zoning:GI(88)/SC(12)/WP(12)/ Applicant: MOWRY & SCHMIDT INC
AT. 80 DAMON RD 6305
Applicant Address: Phone: Insurance:
P O BOX 135 (413) 773-3176 Workers Compensation
GREENFIELDMA01302 ISSUED ON.101912019 0:00:00
TO PERFORM THE FOLLOWING WORK.-BEDROOM/OFFICE RENO
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 Sip_nature:
FeeType: Date Paid: Amount:
Building 10/9/2019 0:00:00 $217.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
� Ca I/ a)hun )fivna�qk 4o p d lip cad -�e-lol(awS
74- W` 3 ` 141 —"ASAI.7 Commercial Building Permit May 15,2000 '7 7-3- S/7
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
ROOM 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PloUSite Plans
Other Specify
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
1.1 Property Address: This section to be completed by office
T56 fj4vv�,o^ 2�yJ. -R`%�- R"-w\ C� �'s . Map / Y Lot 66-3 Unit
(' Zone ! 00 Overlay District
aJr�
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
( 3-Z31 - 2 Q 4(3
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
3\x'� 1. Building t pQ� — (a)Building Permit Fee
2. Electrical pUU _ (b)Estimated Total Cost of
I Construction from 6
3. Plumbing Building Permit Fee 7
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) 2) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
6-5-h
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 ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. ^ ^"c- o IFF,- e
Of Proposed Work: �ct- (2.�.,�,,nS to•, lV�r,�r-k+ D. (��\b tC�,IZ����� .
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ 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 ❑
Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 IS 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 OFFICE USE ONLY
Floor Area per Floor(sf)
1 st 1st
.Ind 2nd
3rd 3rd
4
4m th
Total Area(sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft
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 [0 On site disposal system❑
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 O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 7; loK—' as Owner of the subject property
hereby authorize z>L"\ \� -�-V-\c to
act o my behalf, in all matters relative to work authorized by this building permit application.
G� Ao - 7- 9
Signature of Owner Date
s e- , -V\ \ V,\C 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 o Own /A ent V Date
SECTIO 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: ( Not Applicable ❑ /
Name of License Holder: 1 � �� y u5� C CD - (D S O
License Number
�b wok \ \ 't ' 2-
Address
Address Expiratio Date
-(4 r v2
Signatu a Telephone
SE ION 1 -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 R No O
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, as defined by MGL c 111 , S 150A.
Address of the work: w�o'4� - �i.�( R�'� C�`r` Q 5
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
io 'i t
Date lignature of Permit Applicant
The Commonwealth of Massachusetts
F Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
\\orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information ` Please Print Lecgibh
Name (Business/Organization/Individual): o o t M\ \ T✓\c
Address:
City/State/Zip: vfzzv"&AA MA 0�)Q Phone#:
Are you an employer:'Check the appropriate box: Type of project(required):
I.E&I am a employer with `0 employees(full and/or part-time).* ?. E]New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in K. ZI Remodeling
any capacity.[No workers'comp.insurance required.]
y. El Demolition
OI am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 Q Building addition
t_F-11 am a homeowner and will he hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.F-1 Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t p
0.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. 1
Insurance Company Name: `\'0 C
Policy#or Self-ins.Lic.#: Xw C� 2i� b �{ 35 Z� Expiration Date/: fl
ZO `
Job Site Address: .9-bC AMQ ,c n\ �'30� City/State/Zip: ' IU � V nV^`�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expil tl�te). 6W)400
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form 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.
Ido hereby certi u er the p n and pens 'es of perjury that the information provided above is truce and correct.
Signature: // Date:
Phone#: —)3 Jdo
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Mark O. Gelotte Architect.
70 Elm Street
Hatfield, Massachusetts 01038
413 247-9624 mgelotte@markgelottearchitect.com
June 24,2019
Re: Massachusetts Code Review
Renovations to Two Bedroom Condominium
River Run Condominiums,Unit 6305
80 Damon Rd,Northampton,MA 01060
Renovations to a Two Bedroom Condominium Unit,#3605
The River Run Condominiums were originally constructed as apartment units in 1972 as the Manor Hall
Apartments. There were 8 Buildings constructed, each consisting of 3 stories with a total area of 35,020
sf. per building. The first story of each building is partially below grade. Each building appears to be
separated by vertical fire rated walls of 2 hr ratings,into 4 separate areas. The two center 3 story areas
consist of one-level units,containing 11 units and 12 units respectively, (23 total)with common
hallways on each level serving 2 stairwells for egress. A ground floor area of approximately 1000 sf. is
dedicated to Mechanical and Laundry areas in each building.The two end areas of each building consist
of 2 Townhouse,2-level units each,(4 total)with their own distinct egress stairs and exits.
The Buildings are wood frame construction,with some brick veneer exterior walls and some wood
frame exterior walls. The wood frame is protected with sheetrock and the floors have a 1.5" layer of
lightweight concrete poured over the plywood subfloor,presumably for fire protection reasons. Each
building has a fire alarm control panel located on the lowest floor,connected to detectors in the common
hallways and stairwells. The buildings are unsprinklered.
Unit#6305 is a single level,two-bedroom unit on the third floor of Building#6.
"The scope of work for the present project involves demolition of some non-load bearing interior walls
within the unit and construction of new walls to create a new office space as well as a reconfigured
bedroom. There will be some reconfiguration of electrical outlets, switches and lights and the addition
of hardwired interconnected smoke detectors for bedrooms and hall within the unit. Three new mini-
split heat pump wall units will be added for heat and air conditioning for various rooms. There will be
no alterations to any of the common areas or public areas of the building. See drawing A-1 by Mark O.
Gelotte Architect, dated 6/24/19.
IEBC 2015
Chapter 3: Provisions for All Compliance Methods
Section 301.1.1 Classification of Work, Prescriptive Compliance Method; (Comply with Chapter 4)
Chapter 4: Prescriptive Compliance Method
Section 403 Alterations
Except as provided by Section 401.2 or this section,alterations to any building or structure shall comply
with the requirements of the International Building Code for new construction.Alterations shall be such
that the existing building or structure is no less conformingto o the provisions of the International
Building Code than the existing building or structure was prior to the alteration.
Section 403.3 Existing Structural Elements Carrying Gravity Load
**No alterations to any structural elements are being proposed
Section 406.3 Replacement Window Emergency Escape and Rescue Openings
Where windows are required to provide emergency escape and rescue openings in Group R-2 and R-3
occupancies,replacement windows shall be exempt from the requirements of Sections 1030.2, 1030.3
and 1030.5 of the International Building Code provided the replacement window meets the following
conditions:
1.The replacement window is the manufacturer's largest standard size window that will fit within the
existing frame or existing rough opening. The replacement window shall be permitted to be of the same
operating style as the existing window or a style that provides for an equal or greater window opening
area than the existing window.
2. The replacement of the window is not part of a change of occupancy.
**The present bedroom windows do not meet the code for new construction for emergency escape, but
are allowed under the exception cited above.
See below for IBC Requirements.
IBC 2015
Chapter 3: Use and Occupancy
Section 310.4 Group R-2,Residential,Multiple dwellings,(Condominiums, 12 units per 3 story fire
zone where Unit 3605 is located)
Chapter 5: Building Heights and Areas
Section 504: Building Height and Number of Stories
Section 504.3 Height in Feet
Table 504.3 Allowable Building Height
**25'-6"above grade plane, meets requirement of max. height of 50'for Non sprinklered, Type R-2
use, 5A Construction.
Section 504.4 Number of Stories
Table 504.4 Allowable Number of Stories
**3 stories above grade plane, meets requirement of max. 3 stories for Non sprinklered, Type R-2 use,
5A Construction.
Section 506.2 Allowable Area Determination
First Floor: Second Floor:
R-2 Use: 11,400 sf. R-2 Use: 12,400 sf.
R-2 Accessory Use: R-2 Balconies 200 sf.
Laundry,Mechanical 1,000 sf.
Third Floor:
R-2 Use: 9.820 sf.
R-2 Balconies 200 sf
River Run Condominiums Unit 3605 Renovations 2
Table 506.2 Allowable Area Factor
Section 506.2.3 Single Occupancy,Multistory Buildings(Use equation 5-2) Aa=At+(NS x If) x Sa
Section 506.3 Frontage Increase(Use equation 5-4)
**Allowable area with frontage is 23,315 sf Per stow. Building 6 meets the requirements of Table
506.2 for Non sprinklered, Type R-2 Use, 5A Construction after calculations, largest floor is 12,600sf.
Chapter 6: Types of Construction
Table 601: Fire resistance rating requirements for building elements
For Non Sprinklered, R-2,Type 5A
Primary Structural Frame: 1 Hour
Bearing Walls, Int&Ext: 1 Hour
Non Bearing exterior walls See Table 602
Non Bearing interior walls 0 Hour
Floor Construction 1 Hour
Roof Construction 1 Hour
**No alterations are being made to the primary structural frame
**Alterations to floor will involve patching areas of lightweight gypsum concrete poured over plywood
subfloor where partitions are demolished.
**Alterations to ceilings involve patching of ceiling with Type Xsheetrock and installing new electrical
fixtures which shall have I hour fire rated boxes and fixtures as required.
Section 602 Construction Classification
Table 602: Fire resistance rating for exterior walls based on fire separation distance(X in feet)
X>or=30: Rating required=0 hours
**Fire separation of all exterior walls is greater than 30', no rating required.
Section 602.5 Type 5: Type 5 construction is that type of construction in which the structural elements,
exterior walls and interior walls are of any materials permitted by this code.
Chapter 7: Fire and Smoke Protection Features
Section 714: Penetrations
Section 714.4.2. Membrane Penetrations
Penetrations of membranes that are part of a horizontal assembly shall comply with Section 714.4.1.1 or
714.4.1.2. Where floor/ceiling assemblies are required to have afire-resistance rating,recessed fixtures
shall be installed such that the required fire resistance will not be reduced.
**Alterations to ceilings involve patching of ceiling with Type Xsheetrock and installing new electrical
fixtures which shall have I hour fire rated boxes and fixtures as required.
Chanter 8 Interior Finishes
Section 801.2: Interior Wall and Ceiling Finish: See Section 803
Section 801.3: Interior Floor finish: See section 804
Table 803.11: Interior wall and Ceiling Finish Requirements by Occupancy
R-2 Occupancy will require walls and ceilings to have Class C Flame Spread Rating.
**All altered walls and ceilings will meet Class C Flame Spread
Section 804.4: Interior Floor Finish Requirements
**Requirements are only for materials in enclosures for stairways and ramps, exit passageways,
corridors and rooms or spaces not separated from corridors. Does not apply to this work.
River Run Condominiums Unit 3605 Renovations 3
Chapter 9 Fire Protection Systems
907.2 Where Required—new Buildings and Structures
An approved fire alarm system installed in accordance with the provisions of this code and NFPA 72
shall be provided in new buildings and structures in accordance with Sections 907.2.1 through 907.2.23
and provide occupant notification in accordance with Section 907.5,unless other requirements are
provided by another section of this code.
Not fewer than one manual fire alarm box shall be provided in an approved location to initiate a fire
alarm signal for fire alarm systems employing automatic fire detectors or waterflow detection devices.
Where other sections of this code allow elimination of fire alarm boxes due to sprinklers,a single fire
alarm box shall be installed.
Exceptions:
1. The manual fire alarm box is not required for fire alarm systems dedicated to elevator recall
control and supervisory service.
2. The manual fire alarm box is not required for Group R-2 occupancies unless required by the fire
code official to provide a means for fire watch personnel to initiate an alarm during a sprinkler
system impairment event. Where provided,the manual fire alarm box shall not be located in an
area that is accessible to the public.
Section 907.2.9 Group R-2
Fire alarm systems and smoke alarms shall be installed in Group R-2 occupancies as required in
Sections 907.2.9.1 through 907.2.9.3.
**A Fire Alarm System is installed in the 12 unit zone of Building#6 serving the public corridors and
stairwell areas.
Section 907.2.11 Single-And Multiple-Station Smoke Alarms
Listed single-and multiple station photoelectric type smoke alarms shall be installed in accordance with
the provisions of 780 CMR and the household fire warning equipment provisions of NFPA 72,as
applicable. Section 907.2.8 shall not preclude the installation of a fully addressable fire alarm system
where system detectors and alarm notification devices can perform the functions as required in section
Section 907.2.11.
1. On the ceiling or wall outside of each separate sleeping area in the immediate vicinity of bedrooms.
2. In each room used for sleeping purposes.
3. In each story within a dwelling unit, including basements but not including crawl spaces and
uninhabitable attics. In dwellings or dwelling units with split levels and without an intervening door
between the adjacent levels,a smoke alarm installed on the upper level shall suffice for the adjacent
lower level provided that the lower level is less than one full story below the upper level.
Section 907.2.11.5 Interconnection
Where more than one smoke alarm is required to be installed within an individual dwelling unit or
sleeping unit in Group R or I-1 occupancies,the smoke alarms shall be interconnected in such a manner
that the activation of one alarm will activate all of the alarms in the individual unit. Physical
interconnection of smoke alarms shall not be required where listed wireless alarms are installed and all
alarms sound upon activation of one alarm. The alarm shall be clearly audible in all bedrooms over
background noise levels with all intervening doors closed.
**New hardwired interconnected smoke alarms shall be installed in the two bedrooms and in the qfflce
and in the hall space adjacent to the bedrooms and office, within the unit.
River Run Condominiums Unit 3605 Renovations 4
Commonwealth of Massachusetts
Dwis+on of Professional Licensure
Board of Building Regulations and Standards
Construction Supero sor
,S-0753o0 I`Xpires 01;09/2021
ROBYN S PROVOST
PO BOX 03
HEATH ASIA '01344
Commissioner
Office of Consurn8r A,ffiairS and BusineSs Rsguiation
1000 Washington Street - Suite 710
Boston, Nl;assachusetts 02'118
Home Improvement Contractor Registration
Type: Corporation
MOW RY&SCHMIDT, INC. Registration: 101002
P.O.BOX 135 Expiration: 06/23/2020
GREENFIELD, MA 01301
Updata Address and Raturn Card.
10/4/2019 Northampton,MA:Assessor Database:
Northampton, MA : Assessor Database
Property Search:
Parcel ID: Owner Name: Street Number: Street Name:
Taylor 80 DAMON RD •
Search Reset
Property Detail:
Parcel ID: Card: Street Name: Street Number: Zoning: State Class: Acres: Plot:
1813-053-159 DAMON RD 80 Residential Condominium 0.00
Owner Information: Property Images:
Owner Name: TAYLOR TRENT B Picture:
Owner 2 Name: r `
Owner 3 Name: °
,s.da
Street 1: 80 DAMON RD #6305 `
City: NORTHAMPTON
State: MA
Zip: 01060 }
Valuation:
Appraised Land: $0.00
Appraised Bldg: $100,500.00
Appraised Total: $100,500.00
Sketch:
northampton.ias-cit.com/parcel.detai1.php?id=18D-053-15900 1/2
Version 1.7 Commercial Building Permit May 15,2000
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
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW ® 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 Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® 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 O
IF YES, describe size, type and location: eK c 5h'n' COYN A0 5%SVN 5
D. Are there any proposed changes to or additions of signs intended for the property? YESiO NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.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:
k1- 0 64-/I Not Applicable El
Name(Registrant): � /
Registration Number
Expira on Datqf
igna re Telephone
9.2 Reg' tered 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 .
%Zob y✓1 S , ��ro Q 5�
Responsible Charge of Construction 1
lib
Address
Sign at a 11 Telephone