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31D-067 (5) INVENTORY FORM B CONTINUATION SHEET [NORTHAMPTON] [27 BELMONT AVENUE] MASSACHUSETTS HISTORICAL COMMISSION Area(s) Form No. 220 MORRISSEY BOULEVARD, BOSTON, MASSACHUSETTS 02125 NTH.753 Recommended for listing in the National Register of Historic Places. checked you must att .fctha completed .",ationaiRe, ister'C.riteriaSlal m:tit,ft)rfl7. Use as much space as necessary to complete the following entries, allowing text to flow onto additional continuation sheets. ARCHITECTURAL DESCRIPTION: Describe architectural features. Evaluate the characteristics of this building in terms of other buildings within the community. This is a unique house in Northampton built in the Spanish Eclectic style that was popular in California and Florida in the 1920s but relatively rare in the Northeast. It is a two - story, stucco -sided house with a low hipped roof laid with tapered Mission tile. The roof has a tile ridge laid across the base tiles set back slightly from the edge of the roof and ornamented at each corner with a high - profile ornamental tile. The ridge adds a heavy finishing border to the roof. A molded cornice surrounds the building beneath the tile roof and beneath the cornice is a row of over - scaled dentils. The main block of the house is three bays wide with a triple window composition and entry next to a blind bay on the first story of the east facade, and three arched windows on the second story flanked by pairs of 6/1 sash. The off - center entry is sheltered by a hipped, tiled hood that rests on stuccoed consoles. This main block has on its north elevation a one -story wing and at its southeast corner, a one -bay integral garage. Integral garages were appearing on houses during this period and this is a good example of their first scale and position. Fenestration on the other elevations of the house is asymmetrical and of varying sizes giving the house a visual interest. HISTORICAL NARRATIVE Discuss the history of the building. Explain its associations with local (or state) history. Include uses of the building, and the role(s) the owners /occupants played within the community. From the Form B of 1976, "This twentieth century dwelling whose style was influenced by Spanish architecture was built about 1930. A deed of February 1931 transferred "Lot #6" to Edward J. Gare; the selling price was $7,000. The house may be earlier, however, as one deed described the property of Inez Wilder, who owned the lot before Gare." In 1925 Harrison and Inez Wilder lived at 27 Belmont Street and both were Smith College professors. Inez was in the zoology department. BIBLIOGRAPHY and /or REFERENCES Beers, F. W. County Atlas of Hampshire Massachusetts, New York, 1873. Hales, John G. Plan of the Town or Northampton in the County of Hampshire, 1831. Miller, D. L. Atlas of the City of Northampton and Town of Easthampton, Hampshire County, Massachusetts, Philadelphia, 1895. Walker, George H. and Company. Atlas of Northampton City, Massachusetts, Boston, 1884. Walling, Henry F. Map of Hampshire County, Massachusetts, New York, 1860. Hampshire Registry of Deeds. Book 1464, Page 133; Book 1402, Page 256; Book 871, Page 246; Book 703, Page 256. Continuation sheet 1 FORM B — BUILDING Assessor's Number USGS Quad Areas) Form Ntunber 31D -40 Easth NTH.753 MASSACHUSETTS HISTORICAL COMIIMISS:[ON MASSACHUSETTS ARCHIZrES BUILDING 220 MORRISSEY V BOULE VARD BOSTON, MASSACHUSETT X2125 Town: Northampton Place: (neighborhood or village) Photograph Address: 27 Belmont Avenue ��� Historic Name: Harris and Inez W House �� TTY ��. � _ Uses: Present: college office and one lder living unit ' ' ''''' .,,,0 4,0 7: ' ,` , • Original: single family house Date o f Construction: ca. 1925 Source: Registry of Deeds, Book 871, page 246 Style/Form: Spanish Eclectic ArchitectlBuilder: � . - Exterior 1'trial: . 3 w* f Fl7USlC Liolan e : concrete Wall/Trim: stucco Topograp or Assessor's Map Roof: tile g _ f , Outbuildings/Secondary Structures: 3 u r .` li.. Y , - ; , u aeRS.. . rs i ( r , , i r-, � � Major Alterations (with dates): ` ' "F81.!" '1 t ' Condition: good „ ,' � � Moved: no 1 x 1 y °es l 1 Date Acreage: 0.065 acres u °' b Setting: This building is set in a neighborhood of large : � college buildings, residences converted to college use, and ; . ``�° �. private residential buildings. Recorded by: Bonnie Parsons Organization: PVPC Date (month I year: April, 2010 Follow Massachusetts H oraca' C'orrraission &rveti Afanzial instructions fer completing this fern_. DEMOLITION REVIEW APPLICATION Activity Tracking Sheet Property: 27 Belmont Avenue — Smith College Map 31D Parcel 067 Year Built 1930 Address: 21 Belmont Avenue Received in Building Department: May 23, 2011 Referred from Building Department: May 27, 2011 Action Taken/ Northampton Historical Commission Action Taken By: Entire Commission ✓ Sub - Committee of the Commission Commission Designee/ Staff Date Action Taken: June 7, 2011 Initial Determination Public Meeting held Public Hearing Held Determination Made: Property has been determined not to be Significant according to Ordinance definition. No further action will be taken. Demolition Permit may be issued. ✓ Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been /will be scheduled. Demolition Permit may not be issued at this time. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition permit may be issued. Referred by: Sarah LaValley, Preservation Planner Date: June 7, 2011 DEMOLITION REVIEW APPLICATION Activity Tracking Sheet Property: 27 Belmont Avenue — Smith College Map 31D Parcel 067 Year Built 1930 Address: 27 Belmont Avenue Received in Building Department: May 23, 2011 Referred from Building Department: May 27, 2011 Action Taken/ Northampton Historical Commission Action Taken By: ✓ Entire Commission Sub- Committee of the Commission Commission Designee/ Staff Date Action Taken: June 7, 2011 Initial Determination Public Meeting held July 25, 2011 Public Hearing Held Determination Made: Property has been determined not to be Significant according to Ordinance definition. No further action will be taken. Demolition Permit may be issued. Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been /will be scheduled. Demolition Permit may not be issued at this time. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. ✓ Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition permit may be issued. Referred by:5(0,k Lati Date: August 4, 2011 DEMOLITION REVIEW APPLICATION Activity Tracking Sheet Property: 21 Belmont Avenue = Smith College Map 31D Parcel 041 Year Built 1900 Address: 21 Belmont Avenue Received in Building Department: May 23, 2011 Referred from Building Department: May 27, 2011 Action Taken/ Northampton Historical Commission Action Taken By: ✓ Entire Commission Sub - Committee of the Commission Commission Designee/ Staff Date Action Taken: June 7, 2011 Initial Determination Public Meeting held July 25, 2011 Public Hearing Held Determination Made: Property has been determined not to be Significant according to Ordinance definition. No further action will be taken. Demolition Permit may be issued. Property has been determined to be Significant according to the Ordinance definition and a Public Hearing has been /will be scheduled. Demolition Permit may not be issued at this time.. Public Hearing has been held, Property was determined Significant but not Preferably Preserved. No further action will be taken/ Demolition Permit may be issued. Photo documentation may be required. ✓ Public Hearing has been held. Property has been deemed to be Preferably Preserved. The demolition review period has been initiated. No demolition permit may be issued until the Historic Commission approves an alternative plan or the twelve month period concludes. Alternate plan has been approved/ delay terminated. Demolition may or may not be approved as part of plan. Twelve month time period has expired, demolition permit may be issued. Referred by: Q i&4 Date: August 4, 2011 O � y SHAMp?, o ` PLANNING AND DEVELOPMENT _• - CITY OF NORTHAMPTON ^ � „,, j planning • conservation • zoning • northampton GIS • historic • community preservation • central business architecture I ' R1 b a k fi:�� Sarah I. LaVall Conservation, Preservation, & Land Use Planner • slavalley©NorthamptonMA.gov • 413- 587 -1263 EzEi August 3, 2011 Louis Hasbrouck Northampton Building Commissioner Puchalski Municipal Building 212 Main Street Northampton, MA 01060 RE: Historical Commission demolition review, 21 and 27 Belmont Avenue Louis: In accordance with Chapter 161 of the Northampton Ordinance, "Demolition," the Historical Commission held a hearing July 25 to determine whether 21 and 27 Belmont Avenue should be "Preferably Preserved." The Commission voted that both 21 and 27 Belmont are "Preferably Preserved, and would "be in the public interest to be preserved rather than demolished." A 12- month demolition delay was enacted, and a demolition permit may not be issued for either structure until May 23, 2012; one year from the initial application date. Copies of the Activity Tracking Sheets are enclosed. The garage to the rear of 21 Belmont was not part of the Commission's determination, and is not subject to a demolition delay. The Historical Commission will collaborate with the applicant during the delay period as needed to identify alternatives to demolition. Thanks very much Sarah LaValley 41" Conservation, Preservation & Land Use Planner Enclosures: Demolition Review Application Activity Tracking Sheet, 21 Belmont Demolition Review Application Activity Tracking Sheet, 27 Belmont Cc: Rebecca C. Lindsey, Secretary of the Smith College Board of Trustees Charlie Conant Peter Gagnon CITY OF NORTHAMPTON, MASSACHUSETTS ttarp . 4- i° TQ� DEPARTMENT OF PUBLIC WORKS f 4« j ,$ 125 Locust Street M r•:P a Northampton, MA 01060 -2066 - 413- 587 -1570 Fax 413 - 587 -1576 Edward S. Huntley, P.E Director August 21, 2012 Louis Hasbrouck, Building Inspector Municipal Office Annex 212 Main Street Northampton, Ma 01060 Dear Mr. Hasbrouck: Building #21 Belmont and #27 Belmont have been disconnected from the City water supply and the water meters removed as of August 14 2012. Please contact me if you have any questions. Sin 4111/ i2o) r — 6,, David Sparks Superintendent of Water Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer nationalgrid 40 Sylvan Rd Waltham MA 02451 August 20, 2012 Charlie Conant 21 Belmont Ave Northampton, MA RE: Service Removal for Building Demolition. This letter is to confirm that, per your request, National Grid has confirmed electrical service and meters have been removed from 21 Belmont Ave, Northampton, MA. If you have any questions or need further assistance, please feel free to contact me at (508) 357 -4520. Sincere , ara Moms Customer Order Fulfillment nationalgrid Massachusetts Department of Environmental Protection • Bureau of Waste Prevention • Air Quality 1100155686 B ■ P AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)? C] Yes ri No If yes, who conducted the survey? b. Surveyor Name c. Division of Occupational Safety Certification Number 7. Construction or Demolition: 8/23/2012 111 /30/2012 a. Start Date (mm /dd /yyyy) b. End Date (mm /dd /yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: seeding 1 paving ✓= wetting shrouding b. If other, please specify: covering other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? 'N /A a. Name of DEP Official N/A b. Title '8/10/2012 c. Date (mm/dd/yyyy) of Authorization N/A d. DEP Waiver Number D. Certification I certify that I have examined the ANDREW MIRKIN 0 above and that to the best of my a. Print Name 0 knowledge it is true and complete. [Andrew Mirkin The signature below subjects the b. Authorized signature signer to the general statutes PRESIDENT o regarding a false and misleading 'c. Po "sifionllitle °" _ statement(s). ASSOCIATED BUILDING WRECKERS, INC d. Representing f8/10/2012 co e. Date (mm /dd /yyyy) 0 C ag06.doc • 10/02 BWP AQ 06 • Page 3 of 3 .... Massachusetts Department of Environmental Protection __._.___ ...._...__.___......._._.. Bureau of Waste Prevention • Air Quality 1100155686 i BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement: If B. General Project Description (cont.) asbestos is found during a 4. General Contractor: Construction or Demolition [ASSOCIATED BUILDING WRECKERS INC. operation, all _ _ _.. _.__- _ _ ___ m.w. ____.__.._......__.I a. Name responsible parties �_ __ _ w_ . _ __ w._ __... __{ must comply with 352 ALBANY STREET .1 310 CMR 7.00, _.., b. Address 7.09, 7.15, and -- °-- _.._ . q -- € Chapter 21E of the SPRINGFIELD 1 MA 01105 General Laws of c, City /Town � d. State e ZipCode � the Commonwealth. 4137323179 ( This would include, i 4_ but would not be f. Telephone Number _(area code and extension) ,q, ; E -mail Address ( optional_, limited to, filing an �ISTEVEN HILL asbestos removal h. On -site Manager Name notification with the Department and /or a notice of release /threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department, if applicable. [ ASSOCIATED BUILDING WRECKERS, INC. I a. Name F 352 ALBANY STREET b. Address � [MA 01105 c. fit /Town S LSPRINGFIELD .. . _____ Zip Code � _..._. __ _ e.. __... _ _ _� _� ..__..,__, d. State e. p oe 4137323179 f. Telephone Number (area code and extension) g. E -mail Address (optional) 'STEVEN HILL i h. On -site Manager Name 2. On -Site Supervisor: ;WILLIAM BABCOCK On -Site Supervisor Name 3. Is the entire facility to be demolished? .'%i Yes 1 No 'N ° 4. Describe the area(s) to be demolished: o =ENTIRE FACILITY INC. GARAGE N ° 5. If this is a construction project, describe the building(s) or addition(s) to be constructed: "N /A to o 0 Q In aq06.doc • 10/02 BWP AQ 06 • Page 2 of 3 1 ' Massachusetts Department of Environmental Protection _ ■, Bureau of Waste Prevention • Air Quality 100155686 BWP ` A 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out PP y forms on the computer, use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor - do not use the return (DEP), Bureau of Waste Prevention - Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2) ten (10) days prior to any r - - - - - work being performed. The following information is required pursuant to 310 CMR 7.09. J (3 B. General Project Description Y.7 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner- occupied Instructions residence of four units or less? ✓d Yes Ej No 1. All sections of b. Provide blanket decal number if applicable: B S a � � . „ , this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of _ ...._.w__..._ ._, Environmental APARTMENT BUILDING _ Protection a. Name _.. _.. notification 21 BELMONT AVENUE i requirements of b. Address 310 CMR 7.09 Northampton MA 01060 c. City/Town d. State e. Zip Cod 4135852424 f.. Telephone Number Jarea code and extension) _ q E -mail Address (optional)„ s 11711 2 j h. Size of Facility in Square Feet i. Number of Floors j. Was the facility built prior to 1980? Ej Yes [7,11 No k. Describe the current or prior use of the facility: 'APARTMENT BUILDING I. Is the facility a residential facility? €✓l Yes No 6 ° m. If yes, how many units? Number of Units ° 3. Facility Owner: SMITH COLLEGE o a. Name ..._.__...._.. _.. _.._,_.,_._ ...... ..._. ,.. _. o 126 WEST STREET b. Address NORTHAMPTON 1 AMA _ m X01063 c City /Town d. State,_,_, __ e Code ° 413585242 F CHARLES CONAN tenf_ , ,, „ , ,_ ,_,_ _q E -mail Address (optional) � w . , „ .._ CI elephone Number (area code an ex sion ,, _,... .._ _ _.,__ _.... v _.... _.._ _ ...... . ..... ...._ . _ . _ ,. Q h. Onsite Manager Narne ® ag06.doc • 10/02 BWP AQ 06 • Page 1 of 3 IN Massachusetts Department of Environmental Protection '100155686 Bureau of Waste Prevention — Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 G. Certification The undersigned hereby states, under the penalties of perjury, that he /she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his /her knowledge and belief. 'ANDREW MIRKIN Andrew Mirkin 1. Name Authorized Signature _— PRESIDENT 8/1512012 { 2. Position /Title 3. Date(mm /ddb/ y�Y� �, 'ASSOCIATED BUILDING WRECKERS, INC. 4137323179 Representin 5. Telephone Representing_ e _r._.._._r�.....u._ ...__..,...— _._<_._..._.. .... .P 352 ALBANY STREET �~ 6. Address SPRINGFIELD � t. X01105 7. City /Town 8. Zip Code anf06pdrn.doc • rev. 2/5/04 Massachusetts Department of Environmental Protection 1100155686 Bureau of Waste Prevention — Air Quality Decal Number��___ ;, Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 Important: A. Facility Location When filling out y forms on the f __..___. _..__ ___ __ __ _ ___ computer, use APARTMENT BUILDING only the tab key 1. Name of Facility to move your 21 _ BELMONT AVENUE cursor - do not 2, Street Address ���� " "�� use the return _ key. ( NORTHAMPTON IMA 3. City 4. State 5. Zip C f ode 4135852424 I ".._. I 6. Telephone Number INSTRUCTIONS B. Project Cancelled 1. This form is only available for 1. Check here if this project is /was cancelled. online filing of project date revisions. 2. Enter project decal number. C. Project Dates 3. Validate that _' "°`_°'. "`.'.'W " "` " the project 8/23/2012 I 11/30/2012 location is correct 1. Original Start Date (mm /dd /yyyy) 2. Original E „ Date (mm /dd yyxy_) _„ _ for the entered decal. .._.... ..... __. " _ _._. ". .___.__ -_. __. "_" W _.._ "...._._ 3. Latest Revised Start Date (mm /dd /yyyy) 4. Latest Revised End Date (mm /dd /yyyy) 4. Enter your new project dates. 5. Certify your notification. D. Revised Project Dates Submit date changes. 1. Revised Start Date (mm /dd /yyyy) 2. Revised End Date Date (mm /dd /yyyy) E. Other Project Revisions REVISE TO INCLUDE: ASBESTOS SURVEY PERFORMED BY ADAM LESKO OF GREEN ENVIRONMENTAL CONSULTING, LLC MA INSPECTOR LICENSE # A1073071. ASBESTOS ABATEMENT TO BEGIN 8 -16 -2012. `( F. Revision History � t anf06pdrn.doc - rev. 2/5/04 DIG SAFE SYSTEM, INC. - Create New Quick Ticket Page 1 of 1 Request Number: 20123211601 Date 08/10/2012 Time 13:53 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address / Intersection: 21 BELMONT AVE Nearest Cross Street 1: AHWAGA AVE Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITON OF APARTMENT BUILDING & GARAGE Area Of Work: PRIVATE PROPERTY Area Is Premarked: Y Start Date: 08/16/2012 Start Time: 13:00 Caller: TALIA Title: Return Call: BEF 430PM Phone #: 413 - 732 -3179 Fax #: 413 -734 -6224 Alt. Phone #: Email Address: TALIA©BUILDINGWRECKERS.COM Contractor: ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation Name AJ COMCAS COMCAST - SOUTH BURLINGTON J8 FBRTEC FIBERTECH NETWORKS - MA MC NGRDEL NATIONAL GRID ELECTRIC -MASS ELEC SP VERIZN VERIZON WG CMAGAS COLUMBIA GAS OF MASSACHUSETTS ON ONTARG ON TARGET LOCATING I RJ IDM INNOVATIVE DATA MANAGEMENT • There may be non - member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. l Create New [ Create From Existing j r Print Ticket [ Return To Menu 1 [ Return To Home j http : / /digsafeform.digsafe.com /cgi- bin /dlcgi.exc 08/10/12 - i Golumgia Gas® of Massachusetts - — — - -- `— . A NiSource Company 2025 Roosevelt Ave. P.O. Box 2025 Springfield, MA 01102 . Date: /C� / o� 66 To Whopri, lay Concern: •The address listed below has had the gas service(s) a disconnected and is now ready for demolition. ADDRSS: •/ �- - TOWN —47 STATE : Massachusetts •- l Sin -rely, Maintenance Administrator integration Center Columbia Gas Of Massachusetts 413- 784 -2115 • 4137883143 12:03:27 p.m. 07 -31 -2012 1 11 365 State Street Springfield, MA Fax# 413 - 7883143 Date: July 31, 2012 Re: Demolition Attn: This letter is to inform you and any interested parties that Verizon telephone services have been disconnected for the purpose of demolition of a building or structure located at 21 Belmont Ave, Northampton MA as of July 31, 2012. Sincerely, eed/teaCe ,r PeNte4 Clarence Jones Dispatch Manager Pioneer Valley and Berkshires ► 5MITI -I COLLEGE Facilities Management Smith College Northampton, MA 01063 T (413) 585 -2400 F (413) 585 -2444 City of Northampton August 20, 2012 Building Department Gentlemen, This correspondence is being sent to you to verify that all power has been disconnected to 21 and 27 Belmont Ave., Northampton, MA, by National Grid as of Friday, August 17 2012. If you have any questions, please contact me at (413) 585- 2411. Respectfully, Rene Corderre Licensed Electrician Smith College Northampton, MA 01060 SMITH COLLEGE Facilities Management 126 West Street Northampton, Massachusetts 01063 August 10, 2012 Mr. Steven Hill Associated Building Wreckers, Inc. 352 Albany Street Springfield, MA 01105 Dear Mr. Hill, This letter is to inform you that your firm is the low qualified bidder on the project known as the Demolition and Removal of 27 and 21 Belmont Ave. It is the College's intent to have you begin work on the project immediately while a contractor agreement is processed. If for any reason we should fail to make an agreement on a contract, Smith College will notify you in writing to stop work and pay you for costs incurred for any work done up to that point. I look forward to a successful project and our next meeting. Sincerely, or.A.L.D 0_,T-1/7 Charlie Conant Project Manager Facilities Management, Smith College , \, The Commonwealth of Massachusetts Department of Industrial Accidents >i �,' Office of Investigations r 600 Washington Street Boston, MA 02111 wmv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant information Please Print Legibly Name (Business /Organization /individual): Associated Building Wreckers, inc. Address: 352 Albany Street City /State /Zip: Springfield, Massachusetts 01105 Phone tE: 413 732 -3179 Are you an employer'? Check the appropriate box: Type of project (required): L. l am a employer with 26 4 ❑ 1 am a general contractor and 1 Yp P I" ( rl )� have hired the sub- contractors employees (full and /or part- time). * 6. 11 New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub - contractors have ship and have no employees 8. ® Demolition working for me in any capacity. employees and have workers' 11 Building addition [No workers' comp. insurance comp. insurance. 5. n We are a corporation and its 1 ❑ Electrical repairs or additions 3 . El am a homeowner doing a l l work officers have exercised their 1 1 . 0 Plumbing repairs or additions self. [No workers' comp. right of exemption per MGL m Y [ 1 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *, \ny applicant that checks box #I must also lilt out the section below showing their workers' compensation policy information. t I IOmcowners 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 i,ip employees. Below is the policy and job site information. Insurance Company Name: Great Divide Insurance Company Policy it or Self-ins. Lic. #t: WCA 154516510 � ar'54516510 Expiration Date: �(�� 02/01/201/, t� lob Site Address: t��c < <'.Ca . City/Stale /Gip: ,k: ct c i+tA 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 tine up to 51,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day aga the violator. 13e advised that a copy of this statement may be forwarded to the Office of Investigation of the DIA ; r insurance coverage verification. / do hereby lily b pains and penalties of perjury that the inlnrmation. provided above is true and correct. Signature: A ndrew M President Date: ;'( ,Ci� r1�, l7 Phone 11: 413 732 -3179 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 1lcalth 2. Building Department 3. City /Town Clark 4. I?Iectrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Version1.7 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 ,/. ` as Owner of the subject property hereby author A& -4 A: ibLAL�1�+J�1 t.�1R -- - per to act o m behalf, in all mat ers relative to work authorized by this building permit application. Si nature of Owner Date 1 Si j 13 tA k . , as'QIAuthorized 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 t • pains and penal (-s of perjury. � � K s r �iG, Tl‘,L Print Name �_ V "2-t — l _ gory Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Andrew Mirkin 62382 License Number 299 Tan ) mood Drive ongmcadow, Massachusetts 01 106 10/31/2013 Address Expiration Date / ■..A._ '' (413) 732-3179 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 0 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 TI-IAN 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Associated Building Wreckers, Inc. Not Applicable ❑ Company Name: Andrew Mirkin Responsible In Charge of C i struction 352 lbany Street S • - ingfield, Massachusetts 01105 Addr s- (413) 732 -3179 Signature Telephone Versionl.7 Commercial I3uilding Permit May 15, 2000 8. NORTIIAMPTON 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 I3Idg. Square Footage Open Space Footage (Lot arca 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 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW C) YES IF YES: enter Book ` Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW C) YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES (7 NO CD 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 O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 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 0 Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Demolition of the structures removing all dcbris to Western Recycling, 120 Old Boston Road in Of Proposed Work: Wilbraham, Massachusetts. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 [D A-2 ❑ A -3 0 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 ❑ 1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B 0 M Mercantile ❑ 4 ❑ R Residential el 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): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1s 1 st 2 nd 2 3 rd 3 d 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 151 Private ❑ Zone Outside Flood Zone p Municipal 12 On site disposal system Version1.7 Commercial Building Permit May 15, 2000 Department use only VEC ..: - City of Northa mpton Status of Permit: Building Department Curb Cut /Driveway Permit 1 AUG Z $ 212 Main Street Sewer /Septic Availability Room 100 Water /Well Availability L s 21C716NS N rthampton, MA 01060 Two Sets of Structural Plans DE �r 1000 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 This section to be completed by office 1.1 Property Address: 27 I3elmont Avenue Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Smith College 126 West Street Northampton, MA 01063 Name (Print) Current Mailing Address: / (413) 585- 2424 Signature Telephone 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $37,800.00 (a) Building Permit Fee 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 Rebo This Section For Official Use Only Building Permit Number Date Issued Signature: 1 Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0189 APPLICANT /CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413) 732 -3179 PROPERTY LOCATION 27 BELMONT AVE MAP 31D PARCEL 067 001 ZONE URC THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � /� ` �� U Fee Paid 7 Typeof Construction:_ DEMOLISH BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062382 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION 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 /4" 2/u 2-■ 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. 27 BELMONT AVE BP- 2013 -0189 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31D - 067 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit # BP- 2013 -0189 Project # JS-2011-001581 Est. Cost: $37800.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 062382 Lot Size(sq. ft.): 3746.16 Owner: Trustees of Smith College Zoning: URC Applicant: ASSOCIATED BUILDING WRECKERS INC AT: 27 BELMONT AVE Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732 -3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON:8/23/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH BUILDING 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 8/23/2012 0:00:00 $200.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner