18D-004 ".' Versionl.7 Commercial Buildingjermit May 15, 2000
Department use only
ity of Northampton Status of Permit:
ilding Department Curb CL,Itif)rivevYaY„f9.91/it
6
\ 12 Ma Street S f /S eptic Availability
VIP 1�
• Room 100 Water/Well Availability -
°!„1. ,. - Northampton, MA 01060 Two Sets 4f Structural Plans
one 413- 587 -1240 Fax 413- 587 -1272 Plot/Site tans
V
Other Specify r z
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
Damon Road Self Storage Map Lot Unit
106 Damon Road Zone Overlay District
;Northampton, MA 01060
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
William and Evelyn Mock 106 Damon Road Northampton MA 01060
Name (Print) Current Mailing Address:
(413) 586-4477
Signature Te lephone
2.2 Authorized Agent: 40
Michael Byrnes PO Box 377 Southampton _ M o
' MA 01073
Name (Print) Current Mailing Address:
``413) 527 1360
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
$80,000.00
2. Electrical (b) Estimated Total Cost of
Construction from (6) :.
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 +3+4 + 5) Check Number 35 7 7 ( if 9ge -
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings ate - -
,
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 GI Roofing CI Change of Use ❑ Other ❑
Brief Description Reroof of existing self storage facility
Of Proposed Work:
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 El A-3 ❑ 1A I ❑
A -4 ❑ A -5 ❑ 1 B ❑
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 ❑ 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): L__M_m ,.,., __ ......
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 St _ _ St r
1
2 nd
2nd T 3rd
th _ ._
....
4 th 4
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 El
Versionl.7 Commercial Building Permit May 15, 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 i
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location) S
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT 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 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: ,
C. Do any signs exist on the property? YES 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 0 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 0 NO
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):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
p p to
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
O'Leary Group, Inc Not Applicable ❑
Company Name:
Ronald Hannah
Responsible In Charge of Construction
18 Pequot Road Southampton
Add e
. (413) 527- 1360
Signature Telephone
' 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
Evelyn Mock
as Owner of the subject property
hereby authorize Michael Byrnes
to
act o y behalf, in all matters relative to work authorized by this building permit application.
e.-ectx� 03/16/2011
Si ature of Owner Date
Michael Byrnes
•- -- - - - -- - , 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 penury .
Michael Byrnes
Print Name o3 e .....
.��GJzda/
Sig ature of Owner /Agent Date
SECTION 12 CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder . , Ronald Hannah ......._.. 96240
Mason License Number
,2 John Mon Rd Southwick MA 01077 0 •. 0 .....
_... __..... ..._.. ........... _._. ...... ..... 04/03//2012
Address Expiration Date
(413) 387-8658
C - 2 2..A.._ 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 0 No
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 0
Address: \ b n.
City /State /Zip: v� ►,.. t \ (:)\0l'3Phone #: \?' ' 2ar - *3 ko
Are you an employer? Check the appropriate box: Type of project (required):
1.4 I am a employer with 1 4. ❑ I am a general contractor and I 6. El New construction
employees (full and/or part- time).* have hired the sub - contractors
listed on the attached sheet. 7. ❑ Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees These sub - contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.1E Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*My 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.
$Contractors that check 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company N a m e : - 1 - 5 1 1 , ■ Ea L . E Q S ( )A c 7 At-A) 1
Policy # or Self -ins. Lic. #: C f5 CI VA \ L 2 4" Expiration Date: \\ Z\ \ 2.,
Job Site Address: \C tor+ At) City /State /Zip: 4p p.. nA O t
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 criminal 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 fine
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 hereb . '� under the pains - enalties of perjury that the information provided above is true and correct
Si. ature: Date: J \O
Phone #:
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 Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
N assachusetts - Department of Public Safet■
4) Board of Buildint Regulations and Standards
Construction Supervisor License
License: CS 96240
RONALD HANNAH
2 JOHN MASON ROAD
SOUTHWICK, MA 01077
Expiration: 4/3 /2012
t ' unun issioner Tr#: 31246
SUPPORT BLOCK
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EXISTING STRUCTURALS
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(SPACER CLIP TO EAVE STRUCTURAL
EXISTING EAVE STRUT) PREPUNCHE
EAVE SPAC CLIP EAVE ANGLE
DATE: 9/05/08 I REV. NO. 03 TYPICAL INSTALLATION LAYOUT ROOF STRUCT.
DETAIL Y570 LOW PROFILE M.O.M MR -24 EXISTING
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EAVE SPACER CLIP EXISTING
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DATE: 9/05/08 REV. NO. 02 TYPICAL ASSEMBLY AT EAVE ROOF STRUCT.
DETAIL Y571 LOW PROFILE M.O.M. MR -24 EXISTING
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6" GABLE TRIM SUPPORT CLIP
GABLE FLASHING (FIELD FORM
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TAPE SEALANT &
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ROOF PANEL
rule —1/4" MIN.
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EXISTING ROOF PANEL
SCRUBOLT CORE. EXISTING TRIM
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EXISTING STRUCTURAL
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DATE: 9/05/08 l REV. NO. 03 GABLE TRIM INSTAL. REUSING ROOF STRUCT.
DETAIL Y585 EXISTING TRIM ON LOW PROFILE M.O.M. MR -24 EXISTING
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