18D-053 (20) 11011111111111/1/1 BP-2008-0572
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0572
Project# JS-2008-000865
Est. Cost: $2000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT ARDIZZONI 051547
Lot Size(sq. ft.): Owner: RIVER RUN CONDO ASSOC
Zoning: GI Applicant: ROBERT ARDIZZONI
AT: 80 DAMON RD - BLDG 4
Applicant Address: Phone: Insurance:
7 LAKESHORE DR (413) 531-4841 WC
HOLLANDMA01521 ISSUED ON:12/12/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:BLDG #4 - SISTER 2 FLOOR JOIST FROM
WATER DAMAGE COMMON HALL AREA
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 12/12/2007 0:00:00 $50.002283
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0572
APPLICANT/CONTACT PERSON ROBERT ARDIZZONI
ADDRESS/PHONE 7 LAKESHORE DR HOLLAND (413)531-4841
PROPERTY LOCATION 80 DAMON RD-BLDG 4
MAP 18D PARCEL 053 001 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out aa2 3 C �v
Fee Paid
Typeof Construction: BLDG#4-SISTER 2 FLOOR JOIST FROM WATER DAMAGE COMMON HALL
AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051547
3 sets of Plans/Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
/2 z44:27
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 Conunission,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.
•
,____' _,...-..1 :5 sO
Versionl.7 Commercial Building Permit May 15.2000
Department use only
City of Northampton Status of Permit:
\,, '., Building Department c' 2(1 , Curb Cut/Driveway Permit -
�,n `� U \ 212 Main Street a ' Jv- I•) hewer/SepticAvailability
Room 100 Water/Well Availability
o 259 Northampton, MA 01060 Two Sets of Structural Plans
SEC phone413-587-1240 Fax 413-587-1272 Plot/Site Plans
- S \ 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
This section to be completed by office
1.1 Property Address: ,
j. Map 0 Lot-53 Unit
(�ti���wMO-0. m(� Zone 6..,. .„ Overlay District
Elm St.District CB District
' SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
' 2.1 Owner of Record: _
V`OQC C �c>c.. tii vol-Tri. -4- ` _fn ,rc - 144044
(uO- of iz I
Name(Print) Current Mailing ress:
Signatu mac_. Telephone
2.2 Authorized Agent
. kr-.2s0a.,....626. tcxx DivArziFcd< (ec( __I-koNt-Ac-4 ii(c--
Name(Print) Current Mailing Address: ‘S"---4,j
j--- -
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
co leted by permit applicant
(a) BuildingPermit
1. Building � Fee •
4 2. Electrical (b) Estimated Total ost of
Construction from (6)
( 3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection �7 ,g�111�y
6. Total=(1 +2+3+4+5) p�(j GQQ , Check Number i pa-
This Section For Official Use Only
Building Permit Number Date
Issued
r
Signature:
Building Commissioner/Inspector of Buildings Date
��-�-
•
Version1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
1
Interior Alterations ❑ Existing Wall Signs 0 Demolition❑ Repairs til Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs❑ Roofing 0 Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work: ( � RCM-
p SIj. C - P - °15 ✓t�(�-t_P.C C .._., 1-C , .
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 1A I 0
A-4 0 A-5 ❑ . 1 B 0
B Business 0 2A ❑
E Educational 0 2B I 0
F Factory ❑ F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
I Institutional 0 I-1 0 1-2 ❑ 1-3 0 3B ❑
M Mercantile 0 • 4 ❑
R Residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 0 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): „_w_ ____ : ...__..._„,____ 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 _ _._ .__..
1"
.._ _ .__.__ _; 2nd _
2nd
.... - ,..........,.
3rd
..._._ 4m
Total Area(sf) Total Proposed Naw 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 •
Version1.7 Commercial Building Permit May 5,2000
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 0 DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES _..__
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained tQ Obtained Q Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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 SPACE)
9.1 Registered Architect:
Not Applicable CI
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 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 ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version1.7 Commercial Building Permit May:5,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,-"Ta_roSet L ` I.SSck-c,_,►<cpr C /Ng:A- k as Owner of the subject property
hereby authorize IR40,42,57 _ c _,"Z2c_ - .. ______ .___ to
act my behalf, in all matters pip ti to work a horized by thi building ermit ap lication. _ _ ,
\. (`1 O. l..,0_il ,,a,41. ,.___j.._____ I 1 1' )t-6--
1.
signature of Owner Date
Date
l _.. ,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 of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction upervisor: I Not Applicable El
Name of License Holder: ` {� � �J-1-—I __- _�✓... ..i_ ....__ _ .M_....
License Numb r
Address Expiration Date
H 4\ 0 01541 -1113S,53-1-Vit ' .
Signature Telephone
i
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 O No ++1,
The Commonwealth of Massachusetts
Department oflndustrialAccidents
Q 0 Office of Investigations '
M 600 Washington Street
"74� ` Boston,MA 02111
- • www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Orgaaiiati or/Individuat): ri��J1 AR,-) ,-,--,0)\ "
Address: F <E S l(N<<, Oft
City/State/Zip: d\1 f11VO I o Sir\ Phone . ` (13 531 - t Z5�i j
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 4. I am a general contractor pad I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
These sub-contractors have.
2. I am a sole proprietor or partner- listed on the attached sheet 7.
ship and have.no employees 8. ❑Demolition
working for me in any capacity. employees and have workers'
9. 0 Building addition
[No workers'comp.insurance comp insurance.:
required] 5. We are a corporation and its 10.Q Electrical repairs or additions
officers have exercised their
3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions
myself [No workers'comp. right of exemption per MGL 120 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.
IC-ant-actors that chrrk 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.
lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. (_Insurance Company Name: P �.L C 44--C-C)�-C-Ik ,(-\' 1(-1. y Ct Po g ( c c.
....
Polity or Self ins.Lic.#: U..)C-- O O Expiration Date:- t a b
Job Site Address: City/State/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 Section 25A of MGL c_ 152 can lead to the imposition of crin in41 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�'*�i+.e
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 insurance coverage verification. .
I do hereby certify e its an notes of perjrcry that the information provided above ( and correct
Signature: Date: /, / i7d
Phone#: 4/13'..531 - I S`L/ 1
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 CIerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
------k-- --4)______
• Q i ,______
I () I
1 , 1
, i
ocl 1
L)<1 hif.4 1111 MI r\L CoNT,
pi
I 1.F/RE 6.u< ic5, - ..:- --- 1
- - 1 1
• --- 1.
nisrs •sk 1 - _.jj-sre. :_,Rxia.:
f,-,--- c -` i•>. ---, _____— --___A--,_,-____
1 _ p -JCpc - 11E7E/S5' 1 A l '- --‹ 11•„. — , 1- 6
L 510-ch-X/5:7-11vc, - x 0 V-045-7._2.-.16,..4 64c-i-- 1
&s7J'ri N , AX/0TT e RfZ eiz43 --
• •-• Z4.1E'il.-- Pi-X'•E ..i ..• . ,
• - I . (pari-ity)
_ - • _ _ _ ,
.....TYP:tott_f__-______ _., , i , , /-ivaw.,z, x"--.4 0'- i 2_.4 uAlf.:z2Ry., tk ... 1
VEYV.....ONE HOW?
,..‘Q, -- - P0- --T ! Pi 13 E -I?-4 Tra-p••::7 -.:--..
*. - -- •- ,;---
•_ , _.. _ • - 1 . . ._,i•
•'A/, riiv 2... la_ -*:-.- • .. aiar.......
., . 1111P . ..7 ,i • 1 • EX/57f N C7 ,,• . _____ ---7 1 • 5:4:7: C.E7LIN( ; -
' . . ' ,5'77Ut.. 14/4.1_t.. - Eq
Ai.51/V -;27-X7Q 4 ' j A . k)1,1 R-X-C-; -5iLL- 1. • . .- ()_4111v,57/colvc 21Kg.1
isa -, ------ w.g4-70 nif,43‘...i - -- ---- I'. 74. C-ePTECj 4 2.4t-- w/
' k PLRTif it//
zx 9_,t, ,57,4011,ERE 1 1 . . PRE.Z.(4PE. RI.W 1:-...-_-- -.-.
, 3,21 . 7 • , wiz -
8.0 7 4) 1;;1 7C:)0 M 1 NEktr. .4-0,-/R. f/RE. R4-7-6,c) 1.
. ..-• , fv.1., . . , __ . 0 g Q. 4,,i.c...- i_7--_-_-.--,::: - -I- ---qvxp ).-. qRio. SYs1),
it .,. % - . • -• 2 ZAYEV.5/sel - -- - I o---0.61;,-._7.- -..6:,*AS: :-
; .. .....1 . _ . . -
- ' ti
V pt.' --- - ----
. .
/1q) j .1 •
• RE-11-i-ovfr---1-RV.)iiic.4"..._ rl _ , ,-. .
W4.7-E.A?• Av4A-q4-o--_- :::... ; Q I< AL6-iv • ---• - ' ' " :A/4-14/ 14/Agit 4CCF5'.5d
iN Q> ktit-•- . f057 , P/4'AILS'1,- C.Willif' ._
,577- 0 WAI- i OZ-2-777-11-- ; - (A/074 ' EX/577(ireas/C, NEE-40. .).-___772__B_E-1:-.-
, isLil..7".e"' _ . - --.--- . f4!, . - n_R, 1.4.6 I17N i .
IL I I /Y-; .17#?_.-. .Aae..--
-ll.x, 7-, ,ck) ii 1 ../.°341774V
. . • . . .... . .. .
1
,.,<_
k , ..
t. I
I i • 1
it % t k,3 1
--,--‘------ • . ... •)
1i tW:__ 1 5 --I .....,__
. 4.,R., SL.
sr aTci- 7--iav ---=-.-------
..... .
. ..._ .. . •ScALE: I/4-' =/-(le; • 1
-, tf_ fi- t---., --) i * 4 !
. WA--...CfL-- -,/._- .8.P. A /R 3 a'' CORP/DOR 11"` C .:(3LL75, 4 itco /.. A- utfvf coN005)
. , •:, •
-7---- 1 Arri4? i7A-1AMP-TriV ivi,4 i A..„,,,,41t;rge7,10. "Air-, /-,4 /,-77)-7-, 'C .17; A/ORTA-iAle I P.779A4 11,1 4-4--•• -e!, if/A/ITA1,6M---------n-c-r---/-e,----,---2-1--,57,-- ------------------..