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31B-272 (10) Construction Control Affidavit THE COMMONWEALTH OF MASSACHUSETTS Department of Public Safety Date: April 2, 2015 To: Inspectional Services Commissioner-City of Northampton, MA Project: Hampshire County Courthouse Main Street Entrance Stairs & Repairs, Historic Preservation 99 Main Street Northampton, MA 01060 In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 116.2: I, Ronald J. Alex, Registered Architect, MASS Registration Number 5494 being a registered professional architect, hereby CERTFY that I have prepared or directly supervised the preparation of all architectural design plans, computations, and specifications 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, 8th Edition, all acceptable architectural practices and all applicable laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned design of the work proceed in accordance with the documents approved for this building permit. Upon completion of the work, I shall submit a final report as to the satisfactory completion of the above mentioned project. REGISTERED ARCHITECT Boston Bay Architects, Inc. Ronald J. Alex, AIA 7- Name L--l-5i" ature Mass Reg. No. Date Projects/Northampton-CA—Main Street Construction Control Affidavit Commonwealth of k4assachusetts M1i L \` x County of On this day of r 2015 before me,the undersigned notary public,personally appeared,Ronald J.Alex, proved to the through satisfactory evidence of identification,to be the person whose name is signed on this document in my presence and who swore or affirmed to,nie that the contents of the document are truthful and accurate to the best of(his)(her)knowledge and belief. '.L NOTARYOUBLIC ANDREA HERZOG r , Nowy Public My Commission Expires: \� .L� ��J , MassachusSUAL E40�ommission Expirss Sep 24.2021 1 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 e SECTION 11 -OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Todd Ford as Owner of the subject property !Marois Construction Co, Inc. hereby authorize :to act on my behalf, in all rs a ork authorized by this building permit application. 1;04/10/2015 5ignature.of 074 , Date Todd Ford 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 penalties of perjury._ 1Todd Ford 1. Print Name i 104/10/2015 Signature:of er/Agent Date SECTION 2'.CONST(UCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable Name of License Holder:€Jerome R Elzold _ _ � CS-0�8164� License Number a 16 Maple Crest Circle Unit G Holyoke, MA 01040 0$/15/2015 M _ .. Address Expiration Date (413)533 320 Signatur Telephone SECTION 13-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) _T 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 tiullding permit. Signed Affidavit Attached Yes (D No Q 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: a Not Applicable ❑ 214 Licolon St.Unit 305 Boston 02134 — , - — - — . . , M 5494 Name(Registrant). E i Registration Number 214 L' on ��05 Boston MA 02134 _.. _.,. Ad ,ess a 617 782 0255 Expiration Date Signature Telephone 9.2 Regis eyed Professional Engineer(s): !RJ Farah Engineering, Inc. } t'Structural Engeneering Name � Area of Responsibility i80 Montvale Ave. Suite 201 Stoneham MA 02180 j Add res Registration Number (617) 645-09 01 .. _. Signature Telephone Expiration Date Name Area of Responsibility r , Address Registration Number 3 Signature Telephone Expiration Date Name Area of Responsibility r. Address Registration Number Signature Telephone Expiration Date ( i Name Area of Responsibility Address Registration Number � � F Signature Telephone EVIration Date 9`3 General Contractor Ma;i ots'Construction Co. Inc. Not Applicable C[ .�m�. GomPany Name» Jerome^R,. Ezo14 Responsible In Charge of Construction 262 Old Lyman Rd. South Hadley, MA 01075 I __ .�.�._ ,..__ .. Address 1(413) 533-:1320 I Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be fi lled in by Building Department Lot Size d Frontage Setbacks Front i Side I:� R: I U ' R:" . . Rear Building Height Bldg. Square Footage I Open Space Footage %' (Lot area minus bldg&paved J parking) #of Parking Spaces Fill: volume&Location)__ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES IF YES: enter Book Page'. and/or Document # B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW 0 YES 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 Q NO O IF YES, describe size, type and location: :Building Identification Sign D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 O NO e IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Now 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 ❑ Existing Wall Signs ❑ Demolition❑✓ Repairs El Additions ❑ Accessory Building❑ Exterior Alteration ❑✓ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description lHampshire County Courthouse Historic Preservation Main Street Entrance Stair&Portico Roof Of Proposed Work: `Repairs 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 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 213 ❑ F Factory ❑ F-1 Cl F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I1 ❑ 1-2 ❑ 1-3 ❑ 313 M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑ 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: r Proposed Use Group: Existing Hazard Index 780 CMR 34): P.roposed,Hazard Index 780 CMR 34): i SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) ( .. 2n° i,.. 3 rd 4th ' 41h' '. 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 E] Private ❑ Zone, ) Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 D 7AW % Department use only ity of Northampton Stetus of P�rrit' a uildin Department 9 P GurEz 3` ,D udWay 5 20i f:1..j 212 Main Street � �� � � � �' , SeWerr tIC,AYalla i � � Room 100 � � a. � � �< � � , aer a AV Ibfllt � � i`I@CtrIC,PlUmbing&G^5 Ins n ui � r � 'v aitt, Nortnam ton, PeCtior�sl rthampton, MA 01060 Tw� �5 cEual Plans�� � p MA 01 zar -587-1240 Fax 413-587-1272 Ploi/Site Plans APPLICATION TO CONSTRUCT REPAIR, RENOVATE CHANGE THE USE OR OCCUPANCY. F.„ 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 ;'Hampshire County Courthouse Map 3 )'13 Lot d ? Unit i99 Main St. {Northampton,MA 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Aoent: Todd Ford =99 Main St. Northampton, MA 01060 d a Current Mailing A .: ... Name(Print) dress: t(413) 584-1300 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit applicant 1. Building _ , I z- 13 01 y"� (a)Building Permit Fee 2. Electrical �° T. ` " µt (b)Estimated Total Cost of $0.00 Z13 j OI'�* `l9. Construction from B 3. Plumbing $0 0.00 Permit Fee 4. Mechanical(HVAC) 5. Fire Protection .e._v $0.00 �� t Z ,• � _ 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit NJmer Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0976 APPLICANT/CONTACT PERSON MAROIS CONSTRUCTION CO INC ADDRESS/PHONE 262 OLD LYMAN RD SOUTH HADLEY01075-2653 (413)533-1320 PROPERTY LOCATION 99 MAIN ST-COURTHOUSE MAP 31 B PARCEL 272 001 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 T ypeof Construction: REPAIR MAIN ST ENTRANCE STAIR&PORTICO ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building-Plans Included: Owner/Statement or License 098164 1` 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: __e�kpproved 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 lition Delay j Signature of uildi g fficial 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. 99 MAIN ST-COURTHOUSE BP-2015-0976 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B-272 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: renovation BUILDING PERMIT Permit# BP-2015-0976 Project# JS-2015-001883 Est. Cost: $213013.00 Fee: $1277.77 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MAROIS CONSTRUCTION CO INC 098164 Lot Size(sq.ft.): 15812.28 Owner: THE COMMONWEALTH OF MASSACHUSETTS Zoning: CB(100)/ Applicant. MAROIS CONSTRUCTION CO INC AT: 99 MAIN ST - COURTHOUSE Applicant Address: Phone: Insurance: 262 OLD LYMAN RD (413) 533-1320 Workers Compensation SOUTH HADLEYMA01075-2653 ISSUED ON:412112015 0:00:00 TO PERFORM THE FOLLOWING WORK.REPAIR MAIN ST ENTRANCE STAIR & PORTICO ROOF 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 4/21/2015 0:00:00 $1277.77 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner