32C-067 (16) Initial Construction Control Document
11 /, To be submitted with the building permit application by a
I�l Registered Design Professional
I, j' for work per the 8th edition of the
SJS,, Massachusetts State Building Code, 780 CMR, Section 107
Ime
Project Title: ARE NC60 �f4 Date: VICl/
f
Property Address: 12' -��Z C---TV
Project: Check one or both as applicable: ❑ New construction ,Existing Construction
Pro ect description: A S f 1 . NL� A.-1�l'D L(,CLO
I OST S L\i rVi-ir AZT=K i7-2(:),642-0S. ��/y 1Z TRt_,LQ s (�Y�v " %X L>� Aztt�c�S
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RA Li.)f N.U� , .t2c= gC:eXi f2c1:) . e
r(� >c P C K oN F
0 l`La i; G , "tritA MA Registration Number: , am a
g' �Z`7� Expiration date:��31��
registered design professional, and I have prepared or directly supervised the preparation of all desig plans,
computations and specifications concerning:
Ni Architectural [ ] St uctural [ ] Mechanical
[ ] Fire Protection [ ] Electrical [ ] Other
for the above named project and that to the best of my knowledge, information, and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept, shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to 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 approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit e - euilding official a`Final Constructi. %% u�9 ,: ent'.
�. E. C4A:1s,
Enter in the space to the right a"wet" • L� � c�
electronic signature and seal: ,'; t �, No. 3270
�� Springfkaid;x
MASS.
Phone number: 3 —13.2 -- t toSC9 Email: t—
Building Official Use Only e.e hair. (� ' 0• � /'U 1
Building Official Name: Permit No.: Date:
Version 06_11_2013
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The Commonwealth of Massachusetts
Department of Industrial Accidents
A y i-=-�-r " 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):
-L- S C c_s C
Address: '.xl.��.C' c� --�
` 0 L0 g `m c t 7 S
City/State/Zip:�c`S ���°��< < � Phone#: ��
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with Lt 4. [j I am a general contractor and I
mP Y er 6. 0 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.'�I�emodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers'comp.insurance comp.insurance$.
required.] 5. 0 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 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have n 0 13. en th ` o r
employees.[No workers' �'rz
comp.insurance required.] h a i\S - �r�� <v.er k
*Any 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. I �
Insurance Company Name: J'
� ,[ 1 _
Policy#or Self--ins.Lic.#:Lt--) C ° Expiration Date: U
Job Site Address: a_ C t`Z ` y-eK `k `�'`� City/State/ZipkJ v L e` `1 d t 060
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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
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#:
Version1.7 Commercial Building Permit May 15,2000
4
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required • Yes Q No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED.WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Lev _,as Owner of the subject property
authorize.`._® ' ., VA.-'p�
.ct on y behalf,i rs r-lative to , authoriz-d by this building permit application.
Signature of Owne' Ak Date
w
I, _ • VuL C } ,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 perjury. m.__ - ..-_- . -
Print Name
Signal-of Owner gent Date
SEC •N 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
. .._... ...e.- E
Name of License Holder:' . `Tt .c-C a__�-\-�. � .4� , v . - O 5-5-Li tt 0
License Number
, Lit
••dress i Expiration Date
.,r>G'. WA r ' '1.1�..'..� ) 7 -? ?
Siz -ture gar Telephone
SECTION 13-WORKERS'C• PENSATION INSURANCE AFFIDAVIT(Nf.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 buildi ermit.
Signed Affidavit Attached Yes No
t :c.,.....jag-pi
•
Version1.7 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 EIJLOSED SPACE)
9.1 Registered Architect:
�r SK �.f C��+.� �in j Not-Applicable ❑
Name(Registrant): ------
a■ C I �' S 1 . y U Registration Number —
Address _ __ _
73a_ id Expiration Date
0 i
Signature Telephone
9.2 Registered Professional Engineer(s):
j I
i , ,
Name _ Area of Responsibility
_._.
I
Address Registration Number
i
Signature Telephone Expiration Date
I i
Name Area of Responsibility
E
Address Registration Number
, t I
:
Signature Telephone Expiration Date
-
Name Area of Responsibility
_ ______.._m.__ . I
` i
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
.
Signature Telephone Expiration Date
9.3 General Contractor
cc:'c,` .. __ . ,` S ry C ` G!�, Not Applicable ❑
Company Name:
Responsible In Charge of Construction
-�l . ..�. .. .c.._................._................. rcc S L . ()tot.. 0 (C5 E.
A,dress_ 1 , 111
"l L A if
• 1111?-6)7- Y
Sig-.re 9111111."" Telephone
•
Version1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING :: ,
Existing Proposed Required by Zoning .
This column Mt;e filled in by
Building Department
Lot Size i ; f 3. .,....,._....
Frontage .._ ....._._ :_
Setbacks Front 1 ' I ' I
Side L:i i R: 1 L:L __.... R:L` :
Rear _ _ 77 1
Building Height
Bldg. Square Footage 1-------7 % i _. I
..
4 ' € t
Open Space Footage s € ; f % i _____....
(Lot area minus bldg&paved i I i i I i ! ,
parking)
#of Parking Spaces
Fill: a � _ ...,
i 1
(volume&Location) . "'"""" '_,""'"
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW fir YES 0
-IFYES, date issued: ' 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES ^^ m My^^
IF YES: enter Book ' Page and/or Document#':
B. Does the site contain a brook, body of water or wetlands? NO` DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
_
Needs to be obtained Obtained 0 , Date Issued: 1 }
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location: 7 0, b,ve,),�4./c k r c,`o
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 ,
t!t►
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
J
SECTION 4-CONSTRUCTION-SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
a
Interior Alterations ❑ Existing Wall Signs ❑ Demolition 0 Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Othe
e-- i„_Q c�rcC Vr ct u-t -I LA-cry(-L r■(� _ _..
Brief Description -Enter a brief description�re. � P
Of Proposed Work: i .R ■t t LA-1 Lt----c, ,;�.A S U•,t,t L- s A-e e S ° 0...t r > T S
C C cS-s� - / .v-�w w i 4Cti'OI &�w„A: ) !-P i`�i�a` (,ja y
SECTION 5-USE GROUP AND CONSTRUCTION TYPE r
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑-
E Educational ❑ 2B r ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ - 3A ❑
I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 0
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
_
U Utility ❑ Specify:g
M Mixed Use ❑ Specify:i
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): _mm _„_._� Proposed Hazard Index 780 CMR 34): _ m__
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
t
1st .___ __m__., 1 sc s ;
_ __-_
2no .____.W___.__.__ _.______.____ 2nd ' ,
:..._...�_..�..�__�..._. ...._._ _�._�_i
4th 4� _.______ s
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
Version1.7 Commercial Buildin:Permit Ma 15,2000
REGEI�1 � ® e: usct'
�i City of Northampton
L
Building Department � _ -q
JUL 2 4 2013 2 2 Main Street "_ -
.
,
Room 100 n ti � Ty �
TLTiPErIorth mpton, MA 01060 '� " ;i� 3 t�13-r 7-1240 Fax 413-587-1272 pi:* � 4 � k NORTHAMFTO o $ �
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:
t Ut't Art 0.u. . 4 rk , Lot Unit
�. �CyVl2 � � 1,.) c.;,-- Map
to c��" ,
1
rte,,,:\ -e(to`. ). ,
7 y j Zone Overlay District
a_
' __ _}.
' On Sr District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _ _ __ _ __.
I_1• Off" ,. �"`^�iQ- c—.2 �) I ' 'r4eVk 5C� 41.____Qc_c._ _._
Name -rint) Current Mailing Address:
,1- , I , "Pe _0 -
Signature Telephone
2.2 Authorized Agent: r 4 0.c-4 ce
-/b Q (1 V�VL�Pc_ �G S 1-C _ y•Name(Print) Current Mailing Address: ____�___._..u.
Signature ,a 1 , Telephone iner
SECTION 3 (MATED CONSTRUCTION t m TS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
(a)Building Permit Fee '
1. Building (, o f1 j O 9
2. Electrical — (b)Estimated Total Cost of
a U`'e I Construction from(6) __.. .. __W._.___. _ _.
3. Plumbing 1 Building Permit Fee
4. Mechanical(HVAC) _m
5. Fire Protection _ ,,,., ___ ..._ _._._-_.....__.___. ...--
6. Total=(1 +2+3+4+5) 1111101Nrci b-0 v Check Number sq 6; qo
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
•
File#BP-2014-0083 t
APPLICANT/CONTACT PERSON JOSEPH KENNEDY
ADDRESS/PHONE 38 HARKNESS AVE EAST LONGMEADOW (413)525-1735 Q
PROPERTY LOCATION 2 CONZ ST-MAPLE AVE UNIT 26,32&92 -MAPLEWOOD SHOPS
MAP 32C PARCEL 067 001 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 .-- /
Fee Paid 5 1q�P 4q0
Typeof Construction: REPAIR PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 055440
3 sets of Plans/Plot Plan
THE FOLL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
PZ—/1.3
D- of ion Dela
Sig • re 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.
2 CONZ ST-UNITS 2-6 WHITE BLDG-MAPLEWOOD SHOPS BP-2014-0082
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-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:replacement windows/siding BUILDING PERMIT
Permit# BP-2014-0082
Project# JS-2014-000166
Est. Cost: $10000.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOSEPH KENNEDY 055440
Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning:CB(100)/ Applicant: JOSEPH KENNEDY
AT: 2 CONZ ST - UNITS 2-6 WHITE BLDG - MAPLEWOOD SHOPS
Applicant Address: Phone: Insurance:
38 HARKNESS AVE (413) 525-1735 0 Workers
Compensation
EAST LONGMEADOWMA01028 ISSUED ON:7/26/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & FRONT
1ST FLR SIDING
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 7/26/2013 0:00:00 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner