32C-133 HOBIE ISELIN
Hobie Iselin, General Contractor
Construction Supvr. Lic. #039073
May 23, 2013
Northampton Building Inspector
212 Main St.
Northampton, MA 101060
Dear Sirs,
This letter is to request that you grant a modification to waive the requirement for
controlled construction for the project at 59 Service Center Rd, Northampton. The
work is of a minor nature , will not affect health, accessibility, life and fire safety, or
structural requirements , and is impractical in that the cost of controlled construction
is considerable when compared with the cost of the proposed work.
Thank you for your consideration.
Respe tfully,
Hobie Iselin
General Contractor
36 SERVICE CENTER, NORTHAMPTON,MASSACHUSETTS 01060 413/584-1224 QUALITY DESIGN&CONSTRUCTION
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F I of Northampton _ �)s yy , •
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• DEPARTMENT GP BUILDING INSPECTIONS
212 Main Strcct Municipal Building •
to
Northampton, Mass. 01060
WORKER'S COMTENSA'iiON 1NSURANCII, AFFIDAVIT
.L�-e
(li ccuscc/perrni ttcc)
N.ifith a principal place of business/residence at:
ry c . Ce..44 r i none:=)_ ytj -.fey -,zzy
(sa ty(staic rip)
do hereby certify, under the parrs and penalties of-per-jury, that
( ) I aro an employer providing the following worker's coinc5ensanon coverage for Illy
employees worinng on this job
(.ri itran Comp= ) (Policy Number) (r;-pinion Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) 2nd have hired
the contractors listed below who have- the following worker's coonensanon policies:
�n
ljvC;cto 444...I
j)M t" $.whys fl 120 z-- —
(Name of Contmcror) (Innlranc Colnp9ny/?obc; Numb_;) f x pirat.on Date)
(Name of Contractor) (thsiirauc Comoany/Policy Nu her) (EXDtf tion Date)
(Name of Coneracto,) (Insurance Company/Policy Namber) (Expiration Date)
(Name of Contractor) (Tnsuraoce CompznyfPolicy Numbss) (Expiration Date)
(aO ZI)xddi;:ocaJ r'xci if occ ary to mcu<kt info-in,n oo partraa_ns to a1J ooa'r_r_o:--)
( ) I ari=a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plcsc tx awa.rc Lh4 wt^Jc bomcowvm who cmplay pc-'sacs c ic,...iu Boric 03 r d' I of
not more th-a tb'cc.gaits in which the hotn, oa- oo the Qoupc;t zppurtctir txt o LT co(Ec c -y oecs:ck-cd o ho
cmploycl or the wi d cfz dice Act(O LI 52_3=11(5)) ppli Z=ion t y n ho r,r w s for t t:rry oc pernrrt t>_:5 cvidcnoc the
I cg.xl run.r of a.a o r loyor under tit.Wort~.ola Contpoosatio.o Act-
- undcrstxnd the a copy of this aitcma¢t may bo focwYVCied to kb-a Dop<.nmait of l "raid (XL oo or to,octoca,for tlm
cove- gc vmGc iioo and trt-t&ilo=to gocurc cn i a o under so icon 25A of MOL 152 coo!cad totbc impasilioa of cnmiaA pcuittics
000ii.riag of a floc of up to S 1.500.00 and/or iiomprisonmen of up to ooc year end c,ail pcnatuo n be form of n Shp Work Order Ind a
frtn o(S 109.00 a day appinn tID4.
.�J L ) rot dcp�sn l o,only ---------
PcmitNambcr
Signature of LiccnsccJPcnniucc list
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 C No er
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , " fN'!/G"ft._ as Owner of the subject property
hereby authorize 14 G/�'e 'r
4412
"� to
act on my beh- all ma, - - . e to work authorized by this building permit application.
ii
ab. ....,,y
--Lt. / .3-1R1
Signature . Owner ate
41,'A ,3 Gt + 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 underr
ih
a pains and penalties of perjury.
•
Print Name
f iii ) /,
Signature of Own r/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Q )6V cr cLI f 4 J To 7-)
License Number
.1, /,'c.i £2, Jv IL I1/41 , !1'-.47 .3 d'- ova - to t,i
Address p Expiration Date
Signature Telephone
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 b ding permit.
Signed Affidavit Attached Yes No 0
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:
Not Applicable ❑
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
I
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
7,v, Not Applicable ❑
Company Name:
fµfe.—
Responsible In Charge of Construction
Address ii_
L.---• (iI,J •i3'y '/t.i y
Signature Telephone
Version1.7 Commercial Building Permit May 15,2000
S. 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 Q DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
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 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.
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 Yi Roofin• ■ Change of Use❑ Other❑
Brief Description Enter a brief description here. ZQr,f c � �t, �1c, G ct u IQ
Of Proposed Work: t
tv, i4rC G''1 kiln," 1° ,t,.o v.c A-4,4—
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) f—CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑
3A ❑
I Institutional ❑ _ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 El 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)
1St 1St
2nd
2nd
3rd 3rd
4th
4th
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 ❑ On site disposal system
• til - Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
111 2 �' Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
.oF o 1 axo+' ' Room 100 Water/Well Availability
►+oR Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site 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
e..
j 47 St,.lVi c:,a._ (_t..••{ /Z-�° Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
;C34# 4 04zr4fS /1/ /C4r/41-7
Name(Print) Current Mailing Address:
' 2 t� - 63S,T
Signature IIIIPAik,fir .>r ete,�d1V'"' Telephone
2.2 . ■thorized A,ent:
lip 404).... a.0 4 ' .340 .194-v1'0— CeA.4-v- X-d•
Name Print) Current Mailing Address:
J ..cry- /LT Y
Qj
Signature • Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building // rC7 (a) Building Permit Fee
2. Electrical Z (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection �(l
6. Total=(1 +2+3+4+5) /2 O-O-' Check Number a4 C,(' �I 7
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-1136
APPLICANT/CONTACT PERSON OLIVER ISELIN
ADDRESS/PHONE 36 Service Center NORTHAMPTON (413)584-1224
PROPERTY LOCATION 59 SERVICE CTR RD
MAP 32C PARCEL 133 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ,y��
Fee Paid OL A�9� St
Typeof Construction: REPLACE ROOF,FASCIA&SOFFIT,NEW DECKING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 039073
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO3MATION PRESENTED:
4/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
• . o, Dela
're of Building •fficial 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.
59 SERVICE CTR RD BP-2013-1136
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 133 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2013-1136
Project# JS-2013-001865
Est.Cost: $13000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLIVER ISELIN 039073
Lot Size(sq. ft.): 21170.16 Owner: DIMENSION REALTY LLC
Zoning: GB(100)/ Applicant: OLIVER ISELIN
AT: 59 SERVICE CTR RD
Applicant Address: Phone: Insurance:
36 Service Center (413) 584-1224 Liability
NORTHAMPTONMA01060 ISSUED ON:5/24/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE ROOF,FASCIA & SOFFIT, NEW
DECKING
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 5/24/2013 0:00:00 $78.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner