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s . * "— DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building
Northampton, Mass. 01060 `'y,
WORKER'S COMPENSATION INSURANCE A.YFLUAVTT
I, Pioneer Contractors
(l iccuscrdpermi tree)
with a principal place of businesshesidence at:
•
P_O.Box 1145 Northampton, MA 01061 (Phone') 586 5491
(5trce.t/ci ty / statrhi p )
do hereby certify, under the pains and penalties of perjury, that:
(t4 I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Wcc 500595701200
Asset Employers Insurance Co — — 6/1n/10_
(Insurance Company) (Policy Number) (Expiration Date.)
( ) I am a sole proprietor, general contractor or homeowner (circie one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insu aucc Cornpany/Poticy Number) (E) iration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Conn - actor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(artaeh additima1 short if necessary to include infa - m.Roo pertaining to all ooatru.ctore)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: plcese be aware that wixile homeowncca who employ pasossr to do min rea i- construction or repair work ou a dwelling of
not more then tbroo units in uitich the boanoovrocrresides or no the grounds appurtaum thereto arc not generally considered to be
employers under the workers . compensation Act (GL152,sa l (5)), applicioo by a ho 000em r for a lice or permit may cvi a the
legal name of an employer undertho Worker's Compemaiion Act-
1 understand that a copy of this ciatameat may be forwarded to tine Departrneod of leaustrial Aoodmts' Office of lrwn000 for lb*
coverage verification and that failure to secure oovcraga under section 2.5A of MOL 152 can lead to the imposition of criminal penalties
oomistasg of a fine of up to S 1,500.00 =Net impri omacrit of up to one year and civil pcvaltia in the form of a Stop Work Ordc and a
tine oC5100.00 is day agaiao roc, •
J
Fa - dcguun toe t Permit Number only
11., Al Ti /4.4 , & , c5 / - %,'
,)-/ Map Lot
Sip.. ture of Licenscc/Permi - - _e
•
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
Manhan Narrow, LLC.
I, as Owner of the subject property
Pioneer Contractors - -David Claxton
hereby authorize to
act on my behalf, in all matters rel tive to work authorized by this building permit application.
44.-- 1 /1-27/1'
Signature of Owner Date
Pioneer Contractors - -David Claxton
, as•AevrEffAuthorized
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 perjury.
71 & *
Print Name
Ael6Itallw /2--27-09
Signature of Or *aAgent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : David A. Claxton 17890
License Number
P.O. Box 1145 Northampton, MA. 01061
ICI
01/19/2010
Address Expiration Date
1(413) 586 -5491
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 THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Thomas Douglas Architects Not Applicable
Name (Registrant):
Thomas Douglas Architects Registration Number
Address
(413) 585 -0641 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
Pioneer Contractors Not Applicable ❑
Company Name:
`David Claxton
Responsible In Charge of Construction
P.O. Box 1145 Northampton, MA. 01061
Address
'(413) 586 -5491
Signature Telephone
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
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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES Q
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 0 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 0
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 0
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 Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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 C7 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other GI
Brief Description Enter a brief description here. Selective Demolition--See Attached Plan.
Of Proposed Work:
SECTION 5- USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 El A-3 0 1A I 0
A-4 0 A-5 0 1B El
B Business 2A 0
E Educational 0 2B
F Factory 0 F-1 El F-2 0 2C 0
H High Hazard 0 3A
I Institutional 0 1-1 0 1-2 0 1-3 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 El 5A
S Storage 0 S-1 0 S-2 0 5B 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: Business Proposed Use Group: Business
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)
St
1St
n d
2nd i
3 rd
3rd
4th
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 s Private 0 Zone Outside Flood Zone si Municipal 12 On site disposal system 0
Versionl.7 Commercial Building Permit May 15, 2000
','iP.01, # C 01 : 0Ptt i llt*P114W031
City of Northampton
Building Department lvewemIt
212 Main Street seejttjt
Room 100
NOrthampton, MA 01060 id se o Pro
phone 413-587-1240 Fax 413-587-1272
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:
196 Pleasant St. Map Lot Unit
■ Zone Overlay District
- Elm St. District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Manhan Narrow, LLC. i136 West St. c/o Tom Doulgas
Name (Print) Current Mailing Address:
(413) 585-0641
Signature
Telephone
2.2 Authorized Agent:
Pioneer Contractors P.O. Box 1145 Northampton, MA 01061 i t
Name (Print) Current Mailing Address:
!(413) 586-5491
Signature "4(1,. Telephone
SECTION 3- ESTIMATED CONSTRUCTI N COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building $12,000.00 (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 /3D0 0 di? 17P
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File # BP- 2010 -0628
APPLICANT /CONTACT PERSON PIONEER CONTRACTORS
ADDRESS /PHONE PO Box 1145 NORTHAMPTON (413) 586 -5491
PROPERTY LOCATION 196 PLEASANT ST
MAP 32C PARCEL 166 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out n � ��
Fee Paid / d0
Typeof Construction: SELECTIVE INTERIOR DEMOLITION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 017890
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
0i/Oy/i0
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.
`. A BP- 2010 -0628
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0628
Project # JS- 2010 - 000914
Est. Cost: $12000.00
Fee: $72.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIONEER CONTRACTORS 017890
Lot Size(sq. ft.): 5401.44 Owner: MANHAN NARROW LLC
Zoning: CB(100)/ Applicant: PIONEER CONTRACTORS
AT: 196 PLEASANT ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586 -5491 Workers
Compensation
NORTHAMPTONMA01061 ISSUED ON:1/4/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:SELECTIVE INTERIOR DEMOLITION
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 1/4/2010 0:00:00 $72.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo