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0›- 6 EXISTING �IARLEY SACKS Zbigniew Lewantowicz
Registered Architect
I ENTRY STAIRS RENOVATIONS ItA
CT c.X07007
It 11 CONDITIONS 31 TRUMBULL ROAD 1
102 4 East East
NORTHAMPTON, MA 01060 Southampton, MA 01073
lc
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• ' -' DFPARTMF.NT OF BUILDING INSPECTIONS: •
212 Main Street •; Municipal Building
INaPECTUR Northampton, , "'
Masi. 01060
CONSTRUCTION CONTROL DOCUMENT /
Project Title: ■f AIM �_J Sim efr Date : G
Project Location: ( i"'l m I/ Map : Parcel : Zone:
Scope of Project o J n
In accordance with SECTION 116.0-116.4.2 of the sixth edition of the Massachusetts State Building
Code: I, 2e7`�/VJ`4L1�"��w6�11�/,��""Mass.Registration Number 07 00 7
being a registered professional Engineer/Architect hereby certify that I have prepared or directly
supervised the preparation of all design plans,computations and specifications concerning:
[ ] Entire Project 11,1 Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection Electrical [ ] Other(specify)
for the above named project and that to the best of my knowledge, such plans, computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable
engineering practices and all applicable laws for the proposed project.
Furthermore,I understand and AGREE that I shall perform the necessary professional services and be
present on the construction site on a regular and periodic basis to determine that the work is proceeding in
accordance with the documents approved by the building permit and shall be responsible for the following
as specified in section 116.2.2: ,, #
1. Review of shop drawings, samples and other submittals of the contractor as required by the
construction contract documents as submitted for the building permit,and approval for the
conformance to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
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, iu general,l general,if the work is being perf V_LL c
LL in a
manner consistent with the construction documents.
I shall submit periodically,in a form acceptable to the building official,a progress report with the
pertinent comments.Upon completion of the work, I shall submit to the building official a final report as
to the satisfactory completion and readiness of the •ject for occult. cy
Signature of registered professional : /A,A■/ I, 1/
iERED q
Subscribed and sworn before me this day of /. LE.q' \ .
2�0
my commission expires on 1 N. 1E
1
Notary Public 9pAINGFIEID'
1*, MASS. ,/
OF SSA /
Building Department
413-587-1240 fax 413-587-1272
•
=.; 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/PIumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 7M ZoJA / 661//41A 411/284/0/Z
Address: ?o, &u' cji"/ _/7,2 L 1I sr-
City/State/Zip: e%e./.jtezirle/ G Oe/L. Phone#: ° 2°l .64
Are you an employer?Check the appropriate box: Type of project(required):
1.2 I am a employer with / 4. ❑ I am a general contractor and I 6. ❑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. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑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
❑ officers have exercised their 11. Plumbing repairs or additions
3. I am a homeowner doing all work p•
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no 13.[Q Other /� ui�
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
I 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. / s�
Insurance Company Name: A/' eg-/7 41/ve/ �1 n S. G '
Policy#or Self-ins.Lic. #: /i/G 2— i%S-- 3f,2/ff-- Op' Expiration Date: ,5�- ,.?d- ,2p/if
Job Site Address: S/ /44,04.44,// .A41/4/147 Ws?, City/State/Zip: Q/jffj /
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 theDlk for insurance coverage verification.___ ___
I do hereby certify under the pains an nnalties of perjury that the information provided above is true and correct.
SxQnaturE 1 741 /1t%�SvC D�tL. — 3- 13
Phone#: /�_ zy2—sc/6y
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#:
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 Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, • /l rY'i /VI ,as Owner of the subject property
act or y b if, in all matters relative to work authorized by this building permit application
Signa ure Owner Date
I t
,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
� _. � ..
Print Na c
er":44,- )7)/1. 9-3"/3
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Hoider: _.... y4h'LGS ..-+ .... 1./�.�«c .. ,. -�.....,•. .,._ .....w L- -..._� yr t .... .
License Number
r-_. —12)4__02_91.7 _..r.' 5��041 .s r. ..,_C,h jt, *Few _.0!df?- .._ 1 ._ . ... ... .
Address Expiration Date
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-0of -issuanceo#-issuance !__ding per __ _.
Signed Affidavit Attached Yes (2 No 0
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 ENCLOSED SPACE)
9.1 Registered Architect:L. I �,�1/1./,_._ _LcW4Uk: Z. Not Applicable El
Name(Registrant): .,_ ._ . __.,,._.._.. ....
Registration Number
`ro 4- 1171 /
Address / f.1.
xpiration D e
iiI/'.. el�
4/17 7 7 27
Sig/-.tu -��f Telephone z 4
9. R-•istered 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
/l?..._._ Q, A.e.v_.__..�Z.a°l ta.Ift.. . ....._._Gatz1, ' czg�, � ,___,, ... .._. Not Applicable ❑
Company Name:
Responsible In Charge of Construction
?o, 3 Q. `. ) .6 ,,t....G.htfit ee,• _ *. _awe-. ....-
Address
(1097///44.- 'e.a'01' ik 3 IV-Si hm.
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
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 C DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW (3 YES 0.
IF YES: enter Book ' Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (3 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
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 cornMOYI pl9n
that will disturb over 1 acre? YES 0 NO 0
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 ❑ xisting Wall Signs ❑ Demolition 0 Repairs Additions ❑ Accessory Buildin90
Exterior Alteration ff Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. f?ehvdd eyrs>r.+cf. Starlz eNtal4'11 • ,Ae+J
Of Proposed Work: Dee/4 X■LVhde�jsF, 6. .w„ �r� , r1?/44.10,4- QQK /-4•414.t'A.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1B I ❑
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 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 0 S-2 0 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
a
S Special Use ❑ Specifyv.
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): _ . ,_ ..____ _ m,_,.„:,,;
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1st
st
2nd
2"d
3rd 3rd
,. 4th
4th
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
e
Versionl.7 Commercial Building Permit May 15,2000
Department use only
i° `.. City of Northampton
Status a ,
� C�� � �1 �� I �
Build ng Department Curb CufiDnvetinray Permtt 5 � Room 1 00 WatefMiellAvallabitlfy'
orthampton, MA 01060
Two-Set 'of Structural Plans
Electric, Plumbing&Gas 14�sOl °413-587-1240 Fax 413-587-1272 PIoUSI#e Plans
Northampton,MA x1060 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
1.1 Property Address: This section to be completed by office
//P� .._ .
.71 Tk.(. .i ' I tJ Li..f F r,lr}-\ Map Lot Unit
i rI<. t'jft'Vt ''`"a1/,> rt)ii UjOt)v Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.. - - , . - . , , v
.--> _ _ . ,_ ' J_._. ' _!! ), j. t/))31.!/ 11� /;re1k 1_.)! .Oiv &
Name(Print) Current Mailing Address:
1(.11.1._i)2:4) ',IT,..."71:),,,,773,t'Ll),.. N, , .. ...._ , ___ ,_ _
iSignature (I /17,/ _�- Telephone
2.2 Authorized Agent:
/gym» )JooA �.__�...__._ m_. ..8L__! u .. ?.. .�! e4 _ , 5,,/�P
Name(Print) Current Mailing Address-„ 04,,. aye,-
/�/ ._.,,_. . .1/..13 . Z`17.w- 57.6..1.-._ , .. --
Signati(re __ 7�A— Gf Li 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
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) 1/7 /30 Check Number
75":)- /6
This Section For Official,Use Only
Building Permit Number Date
Issued
Signature.
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0272
APPLICANT/CONTACT PERSON THOMAS DOLAN
ADDRESS/PHONE P 0 BOX 297 CHESTERFIELD (413)585-0612 0
PROPERTY LOCATION 31 TRUMBULL RD
MAP 31B PARCEL 149 001 ZONE URC(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 775 d o,
Typeof Construction: REBUILD EXISTING STAIR ENTRANCE&TEMPORARY STAIRS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 039281
3 sets of Plans/Plot Plan
THE FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
- ; ition Dela
Signature of C 'Mint 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.
31 TRUMBULL RD BP-2014-0272
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B- 149 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-2014-0272
Project# JS-2014-000467
Est. Cost: $17130.00
Fee: $102.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS DOLAN 039281
Lot Size(sq. ft.): 41817.60 Owner: TJS PROPERTIES LLC
Zoning: URC(100)/ Applicant: THOMAS DOLAN
AT: 31 TRUMBULL RD
Applicant Address: Phone: Insurance:
P 0 BOX 297 (413) 585-0612 () Workers Compensation
CHESTERFIELDMA01012 ISSUED ON:9/9/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD EXISTING STAIR ENTRANCE &
TEMPORARY STAIRS
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 9/9/2013 0:00:00 $102.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner