31B-277 F L
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• RYAN S. HELLWIG, PE • STRUCTURAL ENGINEER •
Secondary Construction Control Document
October 24, 2011
��ti1N OF
Louis Hasbrouck
Building Commissioner s. HELLWIG
Department of Building Inspections ° smucrURAL y
212 Main Street NM 373W
Municipal Building .o�01 �fGrSTt�k
Northampton MA 01060 �
Re: Emergency Floor Repairs
55 State Street
Northampton, MA
Contractor: Wright Builders, Inc. (Northampton MA)
In accordance with the 8" Edition of the Massachusetts State Building Code § 107.6.2,1 hereby
certify that I have personally prepared the STRUCTURAL design drawing S -1 (dated October 24,
2011) for this project. To the best of my knowledge, this drawing conforms to the applicable
provisions of the Code and to accepted engineering practice.
I shall personally perform the necessary professional services during construction of that portion of
the work as shown in the above - mentioned drawing, including the following tasks:
1 • Be present at the site at appropriate intervals during construction to observe and
become generally familiar with the progress and quality of the work, and to
determine if the work is being performed in a manner consistent with the above -
mentioned drawing.
I shall also submit to you a final report upon the completion of this portion of the project.
Respectfully,
Ryan Hellwig
us is Professional Engineer #37300 -STRUCTURAL
• 28 ALDRICH STREET • NORTHAMPTON, MA 01060 •
• VOICE 413 - 584 -HLWG (4594) • FAX 413 - 584- HLWFax (4593) •
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, P " - S, I as Owner of the subject property
hereby authorize v' P ` " 'i r iv, yv _' to
act on my If, in all matters relative to work authorized by this building permit application.
r
Signature w e Date
as Owne uthorized
gent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
elief.
Signed under the pains and penalties of perjury.
14 p k
Print Name
Signature of er/Agent Date �
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor Not Applicable ❑
I�
Name of License Holder ,6039' � " � VV� �' h` �� `" -
License Number
AD k N, MA I /as A _y_
Address Expiration Date
to �
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 building permit.
Signed Affidavit Attached Yes No 0
Versioni.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 7 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 I ,�
w#- � (iD
.-
- �y efs Not Applicable ❑
Company Name:
L l / WeH
Responsible In Charge of Construction ' O
�g B s T , ova t- Arn1PtvN', M� 7, 1C/ �Cj
Address tU
Signature Telephone
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Version 1.7 Commercial Building Permit May 15, 2000 0►f' gs'
8. NORTHAMPTON ZONING 11
Existing Proposed Required by Zoning
This column to be fill n by
13uilding Depa - nt
Lot Size
Frontage
Setbacks Front
Side L: R: L R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arkin g)
# of Parkin aces
Fil .
olume & Location
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW 0 YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO X DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 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
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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 ❑ RepairsX Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here.t 9W &T/ A-ArL , W4*
Of Proposed Work:
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1g ❑❑
❑ A -4 ❑ A -5 El
B Business 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 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: W Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor (sf) IV
1S St
2nd 2 nd
3 rd 3rd
4 th
4 tn
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
7. Water S pply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewa a Disposal System:
Public Private E] Zone Outside Flood Zone Municipal On site disposal system[]
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Version 1.7 Commercial Building Permit May 15, 2000
Department use only
�fa City of Northampton Status of Permit:
G ` uilding Department Curb Cut/Driveway Permit
�G \\ 12 Main Street Sewer /Septic Availability
16' Room 100 Water /Well Availability
rth mpton, MA 01060 Two Sets of Structural Plans
7 -1240 Fax 413- 587 -1272 Plot/Site Plans
N�
Other Specify
APP ICA O CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
P V� O
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address This section to be completed by office
J55 S TATE - - Map Lot P7? Unit
b P-T* N-M M M� AW Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record
U o eel-9 PA) CANb 5 t SfiAst- S1 Ns P*Av"?Tv /VW
Name (Print) ( W V P � Current Mailing Address:
I f N Signature Telephone
2.2 Authorizbd Aaent.
wg"(f, BNB h'N 4vp4 7% 8ATUC sT, Nof- i*aN,MA-
Name (Print) Current Mailing Address:
Signature !/• Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building Q'� �a . (a) Building Permit Fee
2. Electrical U (b) Estimated Total Cost of
Construction from 6
1 Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2+3+4+5) Check Number
This Section For Official Use Onl
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0433
APPLICANT /CONTACT PERSON WRIGHT BUILDERS
ADDRESS/PHONE 48 Bates St NORTHAMPTON (413) 586 -8287 (116)
PROPERTY LOCATION 55 STATE ST
MAP 3113 PARCEL 277 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction:_ EMERGENCY STRUCTURAL REAPIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin¢ Plans Included:
Owner/ Statement or License 060378
3 sets of Plans / Plot Plan
THE FO 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
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.
55 STATE ST BP- 2012 -0433
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Bloc 31B - 277 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0433
Proiect # JS- 2012- 000690
Est. Cost: $8900.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WRIGHT BUILDERS 060378
Lot Size(sq. ft.): Owner: COOPER'S DAIRYLAND OF NORTHAMP
Zoning: Applicant. WRIGHT BUILDERS
AT. 55 STATE ST
Applicant Address: Phone: Insurance:
48 Bates St (413) 586 -8287 (116) Workers Compensation
NORTHAMPTONMA01060 ISSUED ON. 1117120110:00:00
TO PERFORM THE FOLLOWING WORK.- EMERGENCY STRUCTURAL REAPIRS
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 11/7/20110:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner