18D-063 (15) 168 INDUSTRIAL DR BP-2000-0719
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-063 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: renovation BUILDING PERMIT
Permit# BP-2000-071 9
Project JS-2000-1334
Est. Cost: $8000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: .
Const. Class: Contractor: License:
Use Group: William Mazuch 010936
Lot Size(se. a.): 435600.00 Owner: KISSELL, INC.
Zoning: GI Applicant: William Mazuch
AT: 168 INDUSTRIAL DR
Applicant Address: Phone: Insurance:
1411 Westhampton Rd (413) 586-8749
FLORENCEMA01062-9751 ISSUED ON:2/23/00 0:00:00
TO PERFORM THE FOLLOWING WORK:FRAME 2 BATHROOMS & 3 PARTITION
WALLS FOR N'TON PLUMBING STORAGE AREA
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
0
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough:2/151.0 U r_Rough: belikA S ,O House# Foundation:
Final: , , ,r•(;,..Tv.? Final:
Lip
Rough Frame: n� 3l
Gas Fire Department Fireplace/Chimney:
*Rough: Oil: Insulation:
i
Final: Smoke: Final: Oirii7OporrIliSt, i•i
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
..----- ...--</1 .e-
Certificate of Occupancy Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 2/23/00 0:00:00 2978 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2000-0719
APPLICANT/CONTACT PERSON William Mazuch
ADDRESS/PHONE 1411 Westhampton Rd (413)586-8749
PROPERTY LOCATION 168 INDUSTRIAL DR
MAP 18D PARCEL 063 ZONE GI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid p,P9,7Z
Typeof Construction: FRAME 2 BATHROOMS&3 PARTITION WALLS FOR N'TON PLUMBING STORAGE
AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 010936
3 sets of Plans/Plot Plan
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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 om Conservation C ission
7
2....0:40d
Signature o 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.
. .. Is � � �� II
\ PECS \ File No.�!/
NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1./l i 1 f J,4 4 PIA 2 0✓ {
Address:M (',YEE'T))-4`N ',/ A f 1`l fl?iv Telephone: 6 I " 1-9
Property: sa `2. Owner of Pro e i
c deg
Address:J '6 gi.UL" O7 N '/d/il Telephone: 6-Y11 L 1-101 re
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): C0AfT/?,4 c /,2
4. Job Location: i t g L ,yn O'57 1.41 0 e Ale R7"MA /iP reitJ', /77 ,
Parcel Id: Zoning Map# /f p Parcel# 3 District(s): �Y�__
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property cr eIRAO
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Ft/TI)RF 170I4g 0i A1 'RYitAMPreN PL,ii(jiIW.
c're RA L3 E Te9&c' A-RE,4
7. Attached Plans: Sketch Plan X Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermitNariance/Finding ever been issued for/on the site?
NO )C DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO ;c DON'T KNOW YES _ _w
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
10. Do any signs exist on the property? YES A. NO
IF YES, describe size, type and location: N.C'' 2-Au)
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES, describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks Jront
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking Spaces
it of Loading Docks
Fill:
{vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: j/ji�/;Zc�1k' APPLICANT'S SIGNATURE ,0,44/45....1pri�
NOTE: Issuenoe of a zoning permit does not relieve an applioant's bij#4le,to comply with all
zoning requirements and obtain all required permits from the Board of Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
0-91
FEB 14 2�0
DEPT OF BUILDNG INSPECTIONS
NORTI-IP,McION MA01660
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8'�I:r14:151 FEB I A 2000 11
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:—� EPARTMENT OF BUILDING INSPECTIONS '� __'_._
puT or-P' - INSPECTIONS
',.;;.GO 12 Main Street ' Municipal Building
M� �
Northampton, Mass. 01060 `",
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I-, 42/ 11/4/1 M2 tiv/I
(licensuipermittee)
with a principal place of businesslresidence at:
l4 Pm) ) /U /i n) - (phonei#) �$��-�'Al'/9'
(st1tzt/city/stales zip)
do hereby certify, under tbe,pain.s,.and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
.R v 4Rs 'I—GW-aq9 31--oof 67/i/o-e
(Insurance Company) (Polio N r) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet ifnecessaryto include inform atioa pertaining to all coaractor3)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
•
NOTE:please be aware that while homeowners who employ persons to do r*:*mtrn• construction or repair work on a dwelling of
not more than throe units in which the homeowner resides or on the grounds appurtenant thereto are Dot generally considered to be
employe under the worker's oompcasation Act(GL152,s5 1(5)),application by a hotneowne-for a license or permit may cvidcaoe the
legal status of an employer under the Worker's Compemaiion Act
I understand that a copy of this stateme t may be forwarded to the Department of Industrial Aaade b'Office of Insurswoo for the
1 coverage verification and that failure to segue coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine 0(5100.00 a day against me.
For dcputmcnsl use only
����A� �// Permit Number - �
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Zoning
Miscellaneous Additions, Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
coikr`3.1.)
Garage
g
1. Location / t rA,J,C 7 RIA-) DR Lot No.
2. Owner's name /<!S.S E )1 &'A P Addressed/sir )OA/f UT n�d RTii+,4A4 AloN A
Builder's name 1 21///kf1 n A ZU&11 Address 1 /1 L}EST1tAMP%o ill RA Fie),
Mass.Construction Supervisor's License No. Expiration Date 6 —q— P-'
4. Addition D is C'f.34
5. Alteration FRAN1E FOR ,,,` (j,4T/7'R04ns ,( pi/D L.. P 77T 'N �,4J/14- f4 P/ oJe4
6. New Porch fie)
7. Is existing building to be demolished? /Vt)
8. Repair after the fire fli,e
9. Garage ,VO No. of cars Size
10. Method of heating 6/4S
11. Distance to lot lines
12. Type of roof gG'6Bci2 pigM13J'AME
13. Siding house f E TA I ti 5R IC 1<
14. Estimated cost-p Ol ,,,,
The undersigned certifies that the above statements are true to the best of his.
knowledge and belief.
....5-1,im zei-#Z,
ignature of responsible appicant
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►-till MAY �e8 JI�
taknF�.t✓tot.ts 1681ndustrial
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` Scale: )4�11 p'
General Notes: Date: Z,MOD
• This plan is diagrammatic in nature and it's intent is to show bask requirements&scope of work to be performed.
-All conditions and dimensions are to be field verified by contractors on site before pricing and/or implementation. Revised:
Do not scale bran-Written dimensions suoersede scaled dimensions.
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