31B-305 (2) Initial Construction Control document
'Io be Submitted with the building Pei-III itapplication by,a
r 1a c, Registered Design Professitonal
`� y ;' for work per the Sa:, edition of the
c
'` Massachusetts St.
lit►ildin" Carle. '80CNIR. Section 1117.6.'
Project Title. pui n ul� ion projec Date: 12!3�j"1"?
Property dilress: Tyr_ t 7;, sr.- 4 P fC T r�aca. N :x_tleatn i ear t l iJ2 a?
---� _ _
Prc7jert: t;loerk one or tooth as aprlie�rhlc: Tslet4 c�artstaucticaao l xistilt i tott5trtactir7ao
Pr }ect descriptiori Ir su-' ate attic with ter ?se- ack
. ._.. -
Po
1 C x le F. Sharples N4 A R e istralion Number 28940 F xpiration(late: u 30/Z'C1 4,a►n a
re i,tored d�vign taraofesstonal. and hereby certify that I have prep it►°(Iircctic superyised the preparation of all desi,u
plants.cor putati(ons and specil`mations cconcernitt4:
l
Entire Protect ( ArchileCtural ( l Structural M cllarlic ll
j Fire protection I I Electrical Other ,
ti}r Lh(:above named project and that such plans,computations and speci ficati(n s meet the applicable provisions of the
Vlassachusetts State Batilding Code. (780 t`1 R).and accepted ellgineeriug,practices for the proposed project, 1
understand and agree that I tear rny designee)shall perform the ntccssaryr professional services and 1 e present oil tltt
construction site on a re-ular and peri odic basis rr,;
1. Re vieoi, ror c(onfcon-trance to this code and the resign concept,shop draMngs,samples and(,alter submittals by the
contractor in accordance ivith the requirernc ins of the construction documents,
1 Perform the duties fi-rr rrt;istered design professionals in 780 C'NIR Chapter 17, as applicable,
3. He present ill intervals appropriate to the stooge aafconstrtat;tion to become generallY familiar with the progress and
(quality of the work and to determine if the %vork is being performed in a auanner coa►sistent with the approved
call struc.tion doctiments and this cod._
When required by the builcfinp official. t Skill'Albilait field4rogrc:ss n:ptorts(see item 3.r tr)grtber with pertinent
comments. in a form acceptable to the building oftici al.
Upon ttiompletion ofthe � ork_ I shall subruit to the building official a 'Final Construction Control Docurn
CHARLES
P.
sHM PLES
Enter in the space to the ri"ht a"l'vt`t' or t ; aQ�
elLctronie signature and seal: � X28940
Phone number: 0135 732-4333 Email: :-sharp.1.�es�.._. x I yc �re tas;
iarple�r>.cotr
1361dim C!ft cixol C,itc t a',I;
Buildim!O l is al+l.tnie', t'a rna I.No-
. (l ate
Trial Vcr4iv?l 10 09 2012
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House
Addition
Replacement Windows
Or Doors
Alteration(s)
Roofing
Accessory Bldg.
Demolition
New Signs[ Decks()siding()Other(g
Brief Descxi llsedenvelo a insulation - dense- ack cellulose
Work: 4 ing P P
Alteration of existing bedroom Yes g__No Adding new bedroom Yes _No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll-Sheet
ea.If New house and our addition to existing housing, complete the following:
a.Use of building:One Family Two Family Other X
b.Number of rooms in each fami�tp unit n/a Number of Bathrooms j a
a Is there a garage attached? NO
d.Proposed Square footage of new construction. none Dimensions
e.Number of stories? 4 4 3 & 5
f.Method of heating? steam nom central platElreplaces or Womistoves C Number of each
g.Energy Conservation Compliance. n/a Masscheck Energy Compliance form attached?
Brieklwand, Brick/wood, Brick/wood, Wood, Brick/concrete
I. Type st construction X No.Is construction within 100
I.Is construction within 100 ft.of wetlaruds? Yes yr.floodplain Yes
X No
j. Depth of basement or cellar floor below finished grade
k.Will building conform to the Building and Zoning regulations?—X3 I.Yes No.
I.Septic Tank City Sewer X Private well City water supply X
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I Facilities manag&m-g=as Owner of
the subject
property Chapin House, Tyler House, Unity House, Admissions & Burton Hall
herebyauthorize Jonathan Tauer, Cellu-spray ; ;
to act on my behalf,in all matters relative to work authorized by this building permit application. Z
a
Signature of Owner Date
I. -- - 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.
F,
k_
R F
7,
Page 2
PURCHASING DCPARTT,,i_T�,IT
1,26 WaT SI-REET
'NOIni IANIPTON.NIA 0106-1
Issue Daie: 1"All"11,
991101145
Cellu-Spry insulation
55 5 M P ate St Smith Coi`iage
126'Alest Strp 'i
Nortfiampton MA 01063
I A'1'71)535-2240
Lynn Pelland. ;Iei 30 D@�,;s
6
Jsj
-------------------------------------------------
Zit l.° , i-11 C_ 0%,EL �,i I i In C 11 e 9 e
_nI I To/Sh_iD To addrea s f or oa-,,-ment. Tile in"Irolce
-must reference the purchase or-de-r- n.;-1her and
vendor #. Your -7endor i� is ak)-ove the
veyador name on the purchase order.
Chapin House _Jnsulat�ion as p�Z rhe at:t:achad 23, i2_33 .0000 23, 713 .00
It ilk
1, 77-B De-t-D-F.tion 113,00
J�
-h i r,h r�z .3{. r7 rd:1 4 7-,
F1 74
J
-Signature: I,,.oa
"771!
LNT
PPOG AC" A,'OU
I'M
B8!855 -C,91 C, q-o .00
5, 170.00
TTze Commonwealth of Massachatsetts
�• � Department oflndustialAccidents
Office Oflnvestigations
' 600 Washiligton.Street
r
Boston,
��- MA011ll
Workers' Compensation Insurance Affidant Builders
-4 Iicant Information /Contractors/Electricians/plumbers
Name(Business/Organization/Individual); �� Please Print Leaibiv
L
Address: O`'i r f-5L,6 ho�f
C
City/State/Zip: R-oreli Ce p�0
Are ou an employer?Check the a PP p ro ri e box: Phone#: E 5 ' 3 700
1 . 1 am a employer with 4. Type of project(required):
I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors
6. ❑New construction
- ?•_❑ I am a sole proprietor or partner- listed on the attached sheet. '7•
ship and have no employees These sub-contractors have ❑Remodeling
working for me in any capacity, employees and have workers' $' ❑Demolition
[No workers'comp.insurance comp.insurance.1 9. Building addition
3.❑ required.] 5. [] We are a corporation and its 10.
1 am a homeowner doing all work officers have exercised their Electrical repairs or additions
myself.[No workers'comp. right of c—laprion per MGL 11.❑Plumbing repairs or additions
insurance required.]t c. 152, §1(4),and we have no 12.M Roof repairs h
employees.NO workers' 13. 0ther V1 JJ a4l�
comp,insurance required.]
Any applicant that checks box Rl 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 subcontractors and state whether w not those entities have
employees. If the sub contractors have employees,they must provide their workers'co policy COMP.P Y number.
i o an employer tbnt:s provtaiRa workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
//j ^ ! 60
Policy�or Sells ins.Lic. L_ 1 o�e Q
Expiration Date: l l L
Job Site Address:_ City/State/Zip:& m t--!'�'! 0�Q
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 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 a;ainst the violator, Be advised that a Copy Of this statement may be forwarded to the Office of
1 do hereby certify u r he pains and u [ties of perjury that the information provided above is tru' and correct.
_mature: ate:
qk 5 3?0 C�
j Official use only. Do not write in this area,to be completed by city or town official
-- --Gity or Town:
- -- __ . - Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector �.Plumbing Inspector
6.MIRY
Contact Person:
Phone#:
Version 1.7 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 0
SECTION 11 OWNER:AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize.'.. _ ._ to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date W
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 enalties of oetjuD(,._,
Print Name
Signature of Owner/Agent Date
,,SECTION 12-CONSTRUCTION.SERVICES
/ 10.1 Licensed Construction erviso : Not Applicable ❑ �- �
Name of License Holder 42" ____. .✓i_..._. L !�,w__.. .._.. w ___...__ .: _ _i.--f _'- _ _.-_
License Number
Addre ' Expiration Date
i ure Telephone ,
c
SECTION 13-WORKERS':COMPENSATION INSURANCE AFFIDAVIT(Wt:G L c:152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affid2 t will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes e No
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON:ZONING
Existing Proposed Required by Zoning ,
This column to-6e filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L•'--^---- R:'_ L. R:
Rear
Building Height - -
Bldg. Square Footage — ; %
Open Space Footage j_ _ % -- ,
(Lot area minus bldg&paved w .-
#of Parking Spaces = #
Fill: V
(volume&Location) —. — —— --A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO i& DONT KNOW Q YES 0
IF.YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q 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 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued
C. Do any signs exist on the property? YES 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 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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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 MORETHAN 35,000 C.F.OF EKLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
t
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 _ - R29istration Number
Signature Telephone Expiration Date
Name Area of Responsibility M
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
-- 3
Signature Telephone~ I Expiration Date
9.3 General Contractor
& ( q. T " Not Applicable ❑
Compa am
Res nslble In Charge of Construction
_Address.-.i
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS:THAN 35,000 Y
CUBIC FEET OF ENCLOSED SPACE-
Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description Enter a brief description here.
Of Proposed Work
B EN-_L �.._1.�_:`�L4T C��� �
SECTION 5-USE GROUP AND CONSTRUCTION TYPE`
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory I F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ -- - _ - 3A ❑ ,
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 1 4 ❑
R Residential ❑ 1 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 UNDERGQING 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'USEI ONLY
Floor Area per Floor(sf)
1
St
........ .._....
3 3 rd
rd
4th _____ __.___--• ____.� _ 4`h ' �
Total Area(so 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 El Zone'-, Outside Flood Zone❑ Municipal 0 On site disposal system❑
Versiont.7 Commercial Buildin Permit May 15,2000
Departmer(t u. e,only.
City of Northampton Status of PerTnit
Building Department Cuib cut(Dnueway 'em a— '
\t ` 212 Main Street sewef�septic �vaitabitity
Room 100 ability
3 �
Northampton, MA 01060 Tuna fiefs of Structural--Plans
ph't3'te,413-587-1240 Fax 413-587-1272 Plot/Site-Plans
..... ...,r"`.
� Other Specify
tPLICATION 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
Address: This section.to be completed by office
1.1 Propefir
Map � Lot Unit
Zone Overlay District
19.L .
Elm St."District CIS
2 PROPERTY OWNERSHIPlAU.THORIZED AGENT
2.1 Owner of Record: _
•��_---fit'' _.�.- _. _�__________.__.____� __._. _,_ .__-
Name(Print) Current Mailing Address:
C/O
rflPs �. �retenl-�' - ---
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 ermit applicant
1. Building _ C (a).Building Permit Fee
J
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 �p
This Section For Official Use Only
Building Permit Number Date:
issued
- Signature:.
Building mmissioner/Ins t f Bu iris
Date
UNITY HOUSE-6 BEDFORD TER BP-2014-0774
GIs#: COMMONWEALTH OF MASSACHUSETTS
MV.-Block: 3 1 B-305 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2014-0774
Project# JS-2014-001326
Est. Cost: $5970.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JONATHAN TALLER
Lot Size(sq. ft.): 10410.84 Owner: SMITH COLLEGE OFFICE OF THE TREASURER
Zoning: EU(100)/URC(100)/ Applicant: JONATHAN TALLER
AT: UNITY HOUSE - 6 BEDFORD TER
Applicant Address: Phone: Insurance:
55 MAPLE ST (413) 584-3700
FLORENCEMA01062 ISSUED ON:11612014 0:00:00
TO PERFORM THE FOLLOWING WORK.-BUILDING ENVELOPE CELLULOSE
INSULATION
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 1/6/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner