The URL can be used to link to this page

18D-053 (2) BP-2008-0478 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -070 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT BUILDING PERMIT Permit# BP-2008-0478 Project# JS-2008-000715 Est. Cost: $1000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD PALMISANO 89485 Lot Size(sq. ft.): Owner: KELLOGG RICHARD V Zoning: GI Applicant: RICHARD PALMISANO AT: 80 DAMON RD #3205 Applicant Address: Phone: Insurance: 87 SHATTUCK RD (413) 549-6824 HADLEYMA01035 ISSUED ON:11/5/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 4 REPLACEMENT SLIDERS 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: FeeType: Date Paid: Amount: Building 11/5/2007 0:00:00 $50.00596 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo • ''` I r4 , { !i Versionl.7 Commercial Building Permit May 15,2000 �. V ^1� \ '' Depaffrhent use only: r 0 v city of Northampton Status ofPermit: _ B`t�ilding Department CU eway Permit 5 ZQ4l \ 212',Main Street Se rertSe�ptie-Availabdhry NQv a R om 100 LAtater/Well Availability !iStc$ tham on, MA 01060 Two Sets of Structural Plans ' phone 4, -1240 Fax 413-587-1272 Plot/Site Plans � moo:: p�. 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 T._SITEINFORMATION This section to be completed by office__- -1:1-Property-Address: l�r , V 4 e' A t.(t/ e C n d Os / 0 Lot 3 Unit g'O �i q yt1 rid . Gl/V.r f 3 2 0 v j ogre GI, ', Overlay District, I / iet14n�,t,tr 1-16A a/0In ,, .,: I,* , 'Elm St District i,, CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT I 2.1 Owner of Record: W Dc QrA � Name(Print 't1A-2p .'1 I Current 'ling Address: (3) _ loam Signature gie ,c.,,� 'J ` K Telephone / ' pp �� 2.2 Authorized Agent: '•7 SI('�LtC(/� e_a. , C.l. t 04 ,, j + ,:/---' - ---, —=� :i O ib Name(Print) R lC ( J Current Mailing Address: ( N Y lgt4571aVqfFi I Signature vid-i-- Telephone C-S J � �" ' i 5 _ (D$ -SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use-Only completed by permit applicant 1. Building / e/� (a)Building Permit Fee "U 2. Electrical i ' (b)Estimated Tote! Cost of I Construction from(6) i 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ! • 6. Total=(1 +2+3+4+5) 71( ?C4.:), Check Number "%e $67) — - - This-Section'For:Ofileial Use-Only Building Permit.Numlie%` --'Date'- __ -Issued r Signature: Building Commissioner/Inspector of Buildings Date Version1.7 Commercial Building Permit May 15,2000 r.. SECTION COAISTRIJCTION SERVICES.FOR PROJ -LESS ECTS THAN AN 35,000 CUBIC FEET O.F ENCLOSED:SP_ACE'` - Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs 0 Additions ❑ Accessory Building 0 Exterior Alteration El Existing Ground Sign El New Signs El Roofing❑ Change of Use❑ Other 0 Brief Description r a brief descrip 'on here. ( l'/ \ /� _-E-- Ci( 5 Of Proposed Work: to (4 !'+- ,,,. (-(�1/ eJ t V l fir ,64.�r j lv/ tart S SECTION 5-USE GROUP-AND CONSTRUCTION,TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ElA-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1 B 0 B Business ❑ 2A 0 E Educational 0 2B I ❑ F Factory 0 F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ 1-2 0 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ s Storage ❑ S-1 El S-2 ❑ 5B [ ❑ • U Utility ❑ Specify: M Mixed Use ❑ Specify:I i S Special Use 0 Specify: I COMPLETE THIS SECTION IF.EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS:ANDIOR CHANGE IN USE Existing Use Group: ! Proposed Use Group: l I Proposed Hazard Index 780 CMR 34): E i Existing Hazard Index 780 CMR 34):� oP SECTION 6BUILDING HEIGHT-;ANDAREA- -... . FI,' SE oNLv'^4 .t^- a �` , 3 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION �� 4.1' _ -�,� Floor Areaper Floor s ---": T 4., �? ( � s 1st 1st 1 j `r -4 • ..,.t-= 7* 2 u- x - Y , +ram ft, Total Area(sf) I Total Proposed New Construction(sf) ; „',-' 4s Y . "' • ,u,' '- Total Height(ft) ` 'v,?-----4,,e,---jrov i Total Height ft ." ,-,. 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private El Zone I i Outside Flood Zone Municipal 0 On site disposal system El Version1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ' ' Frontage ' Setbacks Front 1 Side L:' i R:I L:1 i R:f 1 1 ___i ' i f Rear s ' . BuSdmg Height I J -- Bldg.Square Footage I ; % I j ; i Open Space Footage ----- (Lot area minus bldg&paved ! I f parking) I #of Parking Spaces Fill: ' ' (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 , IF YES, date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book j Pagel and/or Document# ��` DONT KNOW YES B. Does the site contain a brook, body of water or wetlands? NO �` 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 Q 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: i E. Will the construction activity disturb(clearing,grading, - «svation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® ` NO 04; 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 STRUCTURESSUBJECTTO CONSTRUCTION CONTROL PURSUANTTO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED-SPACE) 9.1 Registered Architect Not Applicable ❑ i Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility I 1 Address Registration Number I Signature Telephone Expiration Date Name Area of Responsibility { I i Address Registration Number I Signature Telephone Expiration Date Name Area of Responsibility I , Address Registration Number I � ! Signature Telephone Expiration Date Name - Area of Responsibility I ! Address Registration Number I I Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction I r i • Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-.STRUCTURAL PEER :(78Q CMR 11011} _ Independent'Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUIL:DINGPERMIT 1 ' ,as Owner of the subject property 1 hereby authorize' ,to act on my behalf,in all matters relative to work authorized by this building permit application. j Signature of Owner Date 1,I I C, 4 ra!d V 1(, 1 ` ,t I c I f ! as Owner/ uthorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the of my knowledge and belief. Signed under e ains and enalties of a 'u . Print Name 61 i 1 / tij I 07 - Signature of Owner/Agent Date SECTION.'12 -CONSTRUCTION SERVICES- _ 10.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder:' �C k4I F-P , 1N�t-lQ."C� l i O f V �S t License Numbe i - 1 1 3/c Dg . Address Expiration Date b-eA-C7yk- )QC(1/61(iii 1=-Y Signatur Telephone eiS SECTION 13 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L_c.152t;§25C(S)) 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 0 (9/. The Commonwealth of Massachusetts Department of Industrial Accidents i 1 .,g Office of Investigations t= 600 Washington Street 0N r•��<e Boston,MA 02111 ' . ' www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 30.4.1 s p 1,1_,Li Address: S cc.�—Zcc , , __,i City/State/Zip: f T5(( tit( '0.35-- Phone#:��/3) 5 YJ - 68-DV Are you an employer?Ch k he appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. modeling ship and have no employees These sub contractors have g. 0 Demolition working for me in any capacity. employees and have workers' co insurance.$ 9. ❑Building addition [No workers' comp.insurance comp. required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions ha ve ave exercised their 3.❑ I am a homeowner doing all work officers11.Ej Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. Na - �� r Insurance Company Name: .I //`�_ ,w„�vl�, Policy#or Self-ins. Lic. #: 3 (�le`'S Expiration Date:- <ge-(7/D-e.) --7 Job Site Address: 0 a ,fitA_ lN`'T 3 ) City/State/Zip; t .)-(-404,0 Tec,. . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 1:i2 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ce coverage verification. I do hereby t a n the ins d penalties of perjury that the information provided above i tru and correct. Signature: tt Date: Phone#: 't"[ `7 3) 3 — 6 F-dY 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#: