Loading...
39A-078 (6) I I VEL= DESIGN kLARM S YSTEMS INC. STREET BUILDING 518 PLEASANT S ,<ac��o )0 BOSTON ROAD /WILBRAHAM MA 01095 t, a( S--1)10 Ni 3'0 F �e Storeroom , r"' ,te, 3 Ct.; S��tie l Sa 0 D F E x T -3'-b �-Ib Q Ha/1105 S S Eli OHaft 101 F O Half 102 E j WOMEN S H Boiler 0 MEN O O O O oI 4 0 �.T Half 103 0 a F Sete NEI S J�1e / � Cl rF] O . to K RF . FIRST FLOOR Commissioner Hasbrouck Subject: Request for Waiver I request that you grant a modification to waive the requirement for control construction for the minor renovations at 518 Pleasant Street in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of the proposed work.All work will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" Respectfully, 7 V The Commonwealth of Massachusetts Department of frtdustrial Accidents A — r Office of hives 1p ations i-rt 600 Ul'ashingt n Street _= Boston, MA 2111 -< www.nnass.g 7vldia Workers' Compensation Insurance Affida-0t: I3 ilders/Contractors/Electricians/Plumbers Applicant Information Please Print LeQJbly Name (Business/Organization/Individual): Address: 7 S _ City/State/Zip: i Phc ne#: / 5 ��3 _t / C) Are you n employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. I am a general ulb-co for and I 6. ❑New construction employees (full and/or part-time).* have lured the sue-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. E modeling These sub- ship and have no employees and have have g. Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. 7 We are a corporation and its 10.0 Electrical repairs or additions �. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance egt,tred.] *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 anew 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 thepolicy and job site information. Insurance Company Name: (_ — �(j � 1_) 'y Gam- ' G` Ex/iration Date: �^ Policy#or Self-ins.Lic.#: P Job Site Address: City/State/Zip: 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 c 1 under the pains an/d�penalties ofperjury that the in/ormation provided above is true and correct. Sienature: �- `—° Date: Air Phone#: - �l C, L Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit icense# 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#: i 'I r 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 as Owner of the subject property hereby authorize ' ;... �'wl�c i :'�. to act on my behalf, in all matters relative to work authorized by this building permit application Signature of Owner Date as OwnerL uthorize CIA 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.._ _ a.� ........ i r ' ��'JI..✓_ �� V .I ..'yf.1�........ ........... ..__.... ... ..__ .... Per ame Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ ...... Name of License Holder: License Number ess EE p tion Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit mus be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin g,rermit. Signed Affidavit Attached Yes No 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICE -FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAININ MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: ....., _.....:.. .....�,... ._..... , .....,._, :.,...._ .,__, Not Applicable ❑ Name(Registrant): _. ,.,..: .._... .. ... __...__... ...._..__.. Registration Number ... .. Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility __._. _... _.... _. Address Registration Number Signature Tel phone 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 _.,_._�. ,.�.,..... , ..._,._._.,:..r. ._._.__. .....,...._, Not Applicable ❑ Company Name: Responsible In Charge of Construction Signature / Telephone I � i Version 1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L. w_..._... R. L R::. Rear ......... _..m...,, 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 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 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 Q 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 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Buildiing Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE t Interior Alterations Existing Wall Signs ❑ Demolition❑ Repai s dditions '('1 Accessory Building❑ Exterior Alteration Existing Ground Sign❑ New Signs❑ Roofi g❑ Change of Use❑ Other ❑ _.:.., :. Brief Description Enter a brief description here. Of Proposed Work: � � j' �V-, X i G' rte . 1 �° ._ r�l-r►c�—� SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly E] A-1 ❑ A-2 1:1 A-3 ❑ 1A 13 A-4 ❑ A-5 ❑ 1B ❑ B Business 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 1 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify:.. .. .... .......... __. ............... .......... _..._............................ ..._..._ S Special Use F-1 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). „ 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) 1St 1St 2nd 2 nd 3rd :. 3rd Oct, 4th Total Area(sf) Total Proposed New Constructiion(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[—] I I Versionl.7 Commercial Building Permit May 15,2000 Department use only, R CEO City of Northampton status of Permit: Building Department Curb Cut/Driveway Permit - ,A� 206 212 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans oFiguunir>GIKSPe�on 13-587-1240 Fax 413-587-1272 Plot/Site Plans Wwm Other Specify APPLICATION TO CONSTRUCT, REPAIR,RENO',ATE, CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TW:7 FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office J1 i✓ �L� .S: A'f Tf cr Map Lot Unit Zone Overlay District .......... Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: n�i'r y1, Signature u ? Telephone 413 • $'R 2.2 Authorized Agent: Name(Print) Current Mailing Addressc�l /� Signature Telephone a 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 .........._.. 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 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0910 APPLICANT/CONTACT PERSON ANDREW O'BRIEN ADDRESS/PHONE 75 Clayton Rd. HOLYOKE01040-1543 (413)563-1902() PROPERTY LOCATION 518 PLEASANT ST MAP 39A PARCEL 078 001 ZONE GB(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 Typeof Construction: DIVIDE INTO 2 OFFICE SPACES&ADD DOORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 047357 3 sets of Plans/Plot Plan THE FOL WING 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 D t' y Sigr ici I 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. 518 PLEASANT ST BP-2016-0910 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39A-078 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate,,ory: renovation BUILDING PERMIT Permit# BP-2016-0910 Project# JS-2016-001546 Est. Cost: $3500.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ANDREW O'BRIEN 047357 Lot Size(sq. ft.): 48612.96 Owner: MCCOLGAN HARRY H&TULLY zonin4: GB(100)/ Applicant: ANDREW O'BRIEN AT. 518 PLEASANT ST Applicant Address: Phone: Insurance: 75 Clayton Rd. (413) 563-1902 O Workers Compensation HOLYOKEMA01040-1543 ISSUED ON.111912016 0:00:00 TO PERFORM THE FOLLOWING WORK.DIVIDE INTO 2 OFFICE SPACES &ADD DOORS 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 1/19/2016 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner