44-014 (27) 254 OLD WILSON RD BP-2007-0140
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 44-014 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: shed BUILDING PERMIT
Permit# BP-2007-0140
Project# JS-2006-001922
Est. Cost: $50000.00
Fee: $250.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GREEN MOUNTAIN COMMUNICATIONS INC 070051
Lot Size(sq.ft.): 43560.00 Owner: VERRILLO GIL F
Zoning: SR Applicant: GREEN MOUNTAIN COMMUNICATIONS INC
AT• 'grid. C 1 Or!
Applicant Address: Phone: Insurance:
P 0 BOX 356 (603) 569-8601
WOLFEBORO FALLSNH03896 ISSUED ON:9/1/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:CO-LOCATION OF ANTENNAS ON EXISTING
TOWER & EQUIPMENT SHELTER 12 X 30
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: /#b4%
% � Rough Frame:
//3 /6 7
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
1' 10i; Uot!5 (el
Final: Smoke: Final: OK 0130(0 6 d-otAi S
THIS PERMIT MAY BE REVOKED BY THE,CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS
3
Certificate of Occupanc a, - #` - Signature:
FeeType: Date Paid: Amount:
Building 9/1/2006 0:00:00 $250.002 3545
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2007-0140
APPLICANT/CONTACT PERSON GREEN MOUNTAIN COMMUNICATIONS INC
ADDRESS/PHONE P 0 BOX 356 WOLFEBORO FALLS (603)569-8601
PROPERTY LOCATION 254 OLD WILSON RD
MAP 44 PARCEL 014 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out J
Fee Paid o'1�7 5 q✓— 45a5
Typeof Construction: CO-LOCATION OF ANTENNAS ON EXISTING TOWER&EQUIPMENT SHELTER 12
X 30
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 070051
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 C 'ssion
/ , 6///0.6.
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 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.
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Version1.7 Commercial Building Permit May 15,2000
�� :::mt
en use only
f Northampton Status of Permit:
c,,,,:._._._...-i<---
�0�% in6 Department Curb Cut/Driveway -
G ., k 12 Main Street Sewer/Septic Availability
\ P� \���S Room 100 Water/Well Availability
,,\ DNS pton, MA 01060 Two Sets of Structural Plans
�� <phckte -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
This section to be completed by office
1.1 Property Address:
4
0 1-1) W / S It., /:<)ei Map Lot Unit
m0 % A R,g4,7-'--1 / mA Zone Overlay District
Elm St.District CB District
Cfi)
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Gi F Verrillo 254 Old ,vilson_Rd
Name(Print) Current Mailing Address: Florence 8. 01062
413-584-4570-
Signature Telephone
2.2 Authorized Agent:
C4 ,l)-0,/P i- I am, s-, L Lw, P J1%��. /iL i , C (1 ./ £,
Name(Print) Current Mailing„Address
Signature /441I Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item ' Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / 3 C% 0(2 0 (a) Building Permit Fee
/ ? _
2. Electrical (b) Estimated Total Cost of`),
e e Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection """"" '
6. Total = (1 +2+3+4+5) / c G/ O 0 e7 Check Number ,S 7 O
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
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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 0 Demolition 0 Repairs 0 Additions Accessory Building
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing❑ Change of Use❑ Other 0
Brief Description Enter a brief description here. /gel J ""'�'"R S Jo Px'3 i-n4K io-'-e-t--- "
. Of Proposed Work: /1'X30' L-rfv r.)e-rt s le Iki- 0t- l,-.iie ,, 0,s r 0.v.0,✓-
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A I 0
El
A-4 ❑ A-5 ❑ 1 B 0
B Business 0 2A 0
E Educational ❑ 2B I 0
F Factory 0 F-1 ❑ F-2 ❑ 2C 0
H High Hazard 0 3A ❑
I Institutional 0 I-1 0 1-2 ❑ I-3 ❑ 3B 0
M Mercantile 0 4 0
R Residential_ ❑ R-1 ❑ R-2 ElR-3 ❑ 5A 0
S Storage 0 S-1 0 S-2 ❑ 5B I 0
U Utility Specify:
M Mixed Use 0 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 360 h 1st 3
2nd 2nd ._.3 d 3rd
4
4th
th
Total Area(sf) Total Proposed New Construction (sf)
3 4 0
Total Height(ft)
Total Height ft /0 '
7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zoned Municipal ❑ On site disposal system
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Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
Ihis column to he 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
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW ►44 YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO ;0 DON'T KNOW ; YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO i
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 0 NO i:1
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:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s): ,
/d/4 f] G tJ /4. 4%..� ,5 r fr.r L.
Name-- Area of Responsibility
3/ , -5-4 M or s /1✓,e..�.2O s 7 OA)., ! .. .0,a f t . 3 - 7 G f�
Address Registration Number
, ' 4c,t2 6 7S 2e(0 4.3 A at
.---ram L ".. -�
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
_____
Signre _ Telephone
atu Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
. ................ ........................... .............. ...... .
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Gene6r
-
r•C.h/ �#41 C2frffr10t4'Cl%td ...Ate.. Not Applicable 0
Cop ny Name:
Responsible In Charge of Construction
PA Sr...f."._ .. '� G EAeo`of nV.V o2d.�6
•
..nature Telephone
41'
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 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i
II, Gil._ F Verrill° , as Owner of the subject property
1
ereby authorize \r r 2.o n ,/f i/ SS to
act on my behalf, in all m.i•.:r 1 o o thori s building permit application.
;r'1 - / 7/24/2006
1zu=W
/
k Date
I, Ctif,.. , p1o.- _._.... _.. .._.Acid .„,.._ 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 u t e_ ins les , _ rluA._,_ _
Print Na
� 6/,9/0 i
Signature of Owner/Agent Date
48 ECTION 12-CONSTRUCTION SERVICES
0.1 Licensed Construction Supervisors Not Applicable 0
Name of License Holder: S7f[/rA) Cc,vviAlt
License Number
PO-SOY 2S6 WocR I 5 N/7/ 038,4 07045
Address • Expiration Date
— 9-g6D �
/ 5-5 -- °7
•
Signatu , 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 building permit.
Signed Affidavit Attached Yes '►Ai No 0