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31D-152 (5)
13 OLD SOUTH ST BP-2016-1460 GIS#: COMMONWEALTH OF MASSACHUSETTS Mato:Block:31D- 152 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Stair BUILDING PERMIT Permit 4 BP-2016-1460 Project# JS-2016-002505 Est. Cost:$2000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class_ Contractor: License: use Grouo: GERARD STORDEUR 108497 Lot Size(sq.ft.): 7710.12 Owner: I W INC C/O HPMG zoning: CB(100)/ Applicant: GERARD STORDEUR AT: 13 OLD SOUTH ST Applicant Address: Phone: Insurance: 61 NONOTUCK ST (323) 363-0659 F L O R E N C E MA 01062 ISSUED ON:6/9/2076 0:00:00 TO PERFORM THE FOLLOWING WORK:REBUILDING OF SMALL STAIRCASE FROM PRIVATE PARKING LOT DOWN TO PRIVATE WALKWAY 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: OI: 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 6/9/2016 0:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2016-1460 APPLICANT/CONTACT PERSON GERARD STORDEUR ADDRESS/PHONE 61 NONOTUCK ST FLORENCE (323)363-0659 PROPERTY LOCATION 13 OLD SOUTH ST MAP 31D PARCEL 152 001 ZONE CB(10(1)/ THIS SECTION FOR OFFICIAL,USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Ce4n-A4 / (� RASA Filled out Fee Paid Typeof Cpnstrtnon uc : REBUILDING OF SMALL STAIRCASE FROM PRIVATE PARKING LOT DOWN TO PRIVATE WALKWAY New Construction Nog Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 108497 3 sets of Plans I Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)MATION 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 • ' 'o •elay 1-7-/KSit, of B - ding •fficia 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. ,Ch c �ffiC`c��LL� 7b Icy l foryn 7" Version1.7 Commercial Buildin_Permit May IS,2000 sU DeParfineht useronlyt r -1 City of Northampton Status P '� ' � �: s ��: ++ -. ` ---- ` Building Department Ciid ,;veway Permd..,:+;nx'x'?: z - r 4w: tder' t""n'"` x;i 212 Main Street Sewer/Sept! (ti"ada5l6ty - �1 —$ � •. Room 100 tt«rel�allabY ��'-�� n+e Northampton, MA 01060 Two°°Sffi - 1s� _'" ,�° - _ Dem ne 13-587-1240 Fax 413-587-1272 PIo7S)te Plans _- - 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 Pro a Address This section to be completed by office 13 07 �G., ` '(///Lr /F`i)7 e G {L Map Lot Unit Zone Overlay District fra( J _ - Elm St District CB District ' SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: yU ite1:1(10.ffil„WV3,04,-*S_CLIWIr4/C.. 75 Name(Print) Current Mailing Address Vic 57S_ 0Pr65 Signature /AL—.A— Telephone �j� /j� 2.2Auth• ed Agent 6L M'467C?r CC /� er S �cn r c __ eerr e e . Ms o1 0.O Name(Print) PEINO Current Mailing Address idi 4, 37-3 7g3 0659 Signature Telephone SECTION3-ESTIMATES ' •NSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1642 ( -) (a)Building Permit Fee 2. Electrical ____4_ --- --- - (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ----- -- - - - -- 5. Fire Protection 5 - - - - --- 6. Total=(1 +2+3+4+5) if 2._, a,0 Check Number f yet/ /f!z) This Section For Official Use Only Building Permit Number Date . Issued Signature' Building Commissioner/Inspector of Buildings Date • Version!.7 Commercial Building Fermat May 15,2000 I .. SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 I , CUBIC FEET OF ENCLOSED SPACE ib Interior Alterations 0 Existing Wall Signs 0 Demolition0 Repairs 0 Additions 0 Accessory Building 0 E-54)11°T Alteration 0 ,.sti 9 Gs° Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other 0 Brief Description 's - 7, - .13 in oil cfC11/4cr Ca_3 C FrO(fr• erfuc.-4--e zi Of Proposed Work:I 10roark ii___, 2re)' .7 1° =IOWA fr 6-46-4--e kticti4tockr ._ , . . . . SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 0 IA 0 0 A-4 0 A-5 0 16 0 B Business 0 2A 0 _ E Educational 0 28 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 ' 3A 0 I Institutional 0 14 0 IS 0 i-3 0 as 0 M Mercantile 0 4 0 R Residential 0 R4 0 R-2 0 R-3 0 5A 0 S Storage 0 s-i 0 S-2 0 58 0 u Utility 0 Specify- M Wised Use 0 . Specify- S Special Use 0 Specibo, — -— -- --- _ COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOINGRENOVATIONS,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 S BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) t - - - . - -- - -IP 1----- 1st _\YHd ,,...W YLK0.•l I.M\N. VW 2act ---- rt ------,----- — — —------- tfl 4th - _. . ___ _______.... Total Area(sf) ' Total Proposed New Construction(sf) Total Height(ft) _ 7.Water Supply(NI.G.L.c.40,§54) 7,1 Flortd.,Zon‘tnformation: 7.3 Sewage Disposal System: Public 0 Private 0 Zone Outside Flood Zone0 Municipal 0 On site disposal system 0 Version S.3 Commercial Holding Permit May i,>,2000 8. NORTHAMPTON ZONING -. Existing Proposed Required byZoning g Buil ng Dea nfilled in by Building Crpamnent Lot Size -..___. ________ ._ Frontage -___ _____ __ ____ Setbacks Front --..._...: __ _. -- Feat _ __ Building Height "'" --: .".___. Bldg. Square Footage ._..-.. % .,_, —'...._. Open Space Footage __...—, % . . ----- (Lot arnminus bldg&paved . `_,,,; #of Parking Spaces -- 1 Fill: f (-mime .'_ A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O 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 DONT KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained O , Date Issued: C. Do any signs exist on the property? YES V NO O IF YES, describe size, type and location: J fX 4 I i 7) 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,ex ation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ? NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version!.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: Not Applicable 0 Name(Reactant). -- Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address �.. Regstratem Number Signature Telephone Expiration Date Name Area of Responsibility Address Resist abon Numbe --_.. _— Signature Telephone Expiration Date ._ __ Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responseddy- Atltlress Registration Number l_.__ _______ _...____ Signature Telephone Fq»ration Date 9.3 General Contractor _ `1os1 . / -te 0 Comp Name y rerev Re onsible l Chargee of C_ / onstmct on__ i/ 1. .°7C �J—. 1. !U/Cif CC0. OJO EZ-._ Address + .+'C. . 723 3170g. 5 Signature Telephone Version 1.7 Commercial Building Permit May U,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 FORBUILDING PERMIT { -SCyj,NL'-i/aSt 4i .as Owner of the subject property hereby authonze _ L ` tom Ley .1 UAk elisr _ _.. ... . to aP on my behalf,,in ai>,ram-ret-.'+ authorized by this building permit application._ / /_ Signature of Oxne are 1. ef4L! �___ _ _. .. .as OwneriAuthonzed 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 a the pains aand_penattties c/penury. - _ _ f d i?lc+i ___ Print Name / Signature of Owner gen Date SECTION 12-C• STRUCTION.SERVICES 10.1 Licensed Construct[o t...�.upervisor Not Applicable 0 Name of License Holder: eCa_CT_. f d eu,, ..- VV ( / !. License Number 6f , CLCAL _— e. . ( Ce 0/u 1-1— /2 7) — 7 o7J Add resExpiration Date r=te .7? 3-56 5-v65. Signature - Telephone SECTION 13-WORKERS`COMPENSATION INSURANCE AFFIDAVITM.0A_c.162,§25C(6)} Workers Compensation Insurance aftidaust be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the hull ' 9 permit. Signed Affidavit Attacl rd Yes No 0 a The Commonwealth of Massachusetts 7 t Department of Industrial Accidents a -,m" Office of Investigations 600 Nashington Street tc,n Boston,MA 02.111 `,=�_.="` www.mass.gov/dia Workers' Compensation Insurance Affidavit: BuildersiContractorsll;lectricians/Plumbers Applicant Information O r'' ) Please Print Legibly Name(Busitseesss/OOrganizadoor/dindividuall)): ({,J C rovj 5-bid d eck� Address: U f ,'1o4 oY4tT - f7a ee- Cityfstatefzip:� ,Fent ee Ma. G! 0 6 -Phone m 3x.3-..763 e—o (, S `9 Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and f I. l am a employe[with r6. ❑New construction loyees(full and/or part-time).' have hired the gab-connectors - 1.am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor me in anycapacity. employees and have workers' P �' = 9. 0 Building addition [No workers'conga.insurance comp. insurance. required] 5. [ We are a corporation and its 10.0 Electrical repairs or additions ?.❑ 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"kif airs insurance required.] t e, 152, §1(4),and we have no y�P ) employees.[No workers' I3. ndrAA dock- d.I 47 64- MS comp,insurance required.) i e t.r. itis C.. Ass O ''Any applicant that checks box 41 nest also fill out the section below showing their workers'compzsgeey L.— '_j j I .J,n c 4e, r' ' Homeowners who submit this affidavit indireeiag they are doing all work and then hire ouaide con rs st sub . .new a�x t md(c`o'tine su J :Contactors that check this box must attached an additional sheet showing the mare of the sub-umvazmrs and stare whether or nor those entities have employe . If the sub-contractors have employees,they mon 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. - Insurance Company Name:, Policy#or Self-ins.Lk.#:_ Expiration Date: lob 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 certify u the pains d pena ' s of perjury that the information provided gbore is true and correct. ...CS Date: (a/ ., e— ( O (Phone tt: J L 3- > G7 - o O 5? —....—..._ I Official use only. Do nor ratite in this area,to be completed by city,or town official - I City Or Town: Permit/License# Issuing.Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact PersonPhone#: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: 13 0-0 eruct 4 ST. The debris will be transported by: kit< The debris will be received by: / 5 Building permit number: Name of Permit Applicant 644 /ZIA Date Signature of Permit Applicant GERASTO-01 VCARRIER ►coizv CERTIFICATE OF LIABILITY INSURANCE DATE /2016 Y) _�--' Brsml5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is en ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s). PRONJCE0. NAmE CF Valerie Carrier Whalen insurance Agency PHONE - - - - Fq Tt King Street lac No,EMI:(473)586-0000 104 luc wok(413)685-0401 EMAIL Northampton,MA 01060 ADDRESS valerfeeWhalonlnsurance.0om INSURERS)AFFORDING COVERAGE NAIL* INSURER A:Utica First Insurance Company INSIREO. NR1RER a, _.._ .. Gerard Stordeur DEA Gerard Stordeur Finishing INSURER c: 61 Nonotuck Road INSURER Florence,MA 01062 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDCSUBR - --- POLICY EFK POl1CYEXP LIN TYPE OF INSURANCE INSO WVD POLICY NUMBER (MMVOMYYY) (MMIDO(VYVYI LIMITS A X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE S 1,000001 CL IMS,MADE X OCCUR ART-5056886-01 01/30/2015 07/30/2016 DAMAGETORENTEte "' • ,_ PREMIse (Fa ouwa�) S 50.001 MED EXP YTS ma iron $ 5,0r.t. • ._ __ PERSONAL a ADV INJURY 5 1,000,001 OEN'L AGGREGATE LIMO APPLIES PER. G£NERFLAriGRFv0.'.'E b 2,000,0I1. X ROLICY PRP LOC PRODUCTS.COMP/OP AGC 5 2,000,001 OTHER. AUTOMOBILE I beee In OOMBFNEC SINGLE L,MIT t (Ellecadeno ANY AUTO WOOLLY INJURY(Per pewn)... ALL OWNED SCHEDULED BODILY INJURY{Petad) AUTOS ED PROPERTY DAMAGE $ HREOAUTO$ _. AUTOS (Per accident) • UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAO CLAWS-MADE AGGREGATE I$ CEO RETENTIONS $ WORNERS COMPENSppp AND EMPLOYERS'WJTY BIIYIN PER FRH ANY PROPRIETORIPARTNEPoEXECUTIVE — EL.EACHACOIDENT S OFFCENNEMDER EXCLUDED', N (Mandatory In NII EL.DISEASE EA EMPLOYEES If9es d Tcnbeuotlol _ . OESCRIPTrON or OPERATIONS below E.L.DISEASE.POLICY LIMO S oescaanos OF OPERATONS ILOCAION$I VEHICLES(ACORD 101,Additional Remarks Soliedule,may be aN[MM If mom apace IS required) Certificate Issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TOE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CIt Main rStha ACCORDANCE WITH THE POLICY PROVISIONS. 21Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD E(Uri A Vet L.3 flcit'rt la^r 15---/-79.)- --- . - 4aeredas %u w 6<-71/4"1 2 �6 �� - "' /� �ebu / /G' City of Northampton r i.� c ri - -2 /I 'fa l / 7- k- z Seto. �I e S H 3P211 ,dart vo.j C I✓af ICH.n 5 L0 -1-- Building Department 7 {� tP` I 212MainStreet ff Pa dS - I i rf fey e ) sApec)l4 p 03 iLL-- �'•'.:, Northampton, MA 01060 / at/IC.ho� -CJ. -fo Sieiccaujh cn,4„1V �......» top oTp ttc„r'-`J .. � 2 IQi--F{i r1 (Ce Wf^ !Ii 20Hr-A -)-0 NSunfprs /-/4 � �onAral 5 � S 6 - zxi L )f;nitfl j4 ��airs = y d Ni3 A 7P � circ 1( r �U( �. r r< S Ill ,. --r N W f `cV ' i Y i x) I , j F(luc.. c e*.rk;nc Lu-}- rtu£+- i j 4' SI dCL-)c...1 IC i 4k i %�I e! e —......y N i o- f // 2 W,� fi' 7- e v'} 0a(1 f 0.4 i i E ///// / j, t 13 old 504h She Et- X Are � ' ., 2 {77 <b' 0 -de 3- N •t l'Aatsi, fon 1 7 1 6e a.rd SI—a/'detar • /' 32. 3 — 3ca 63 — d59 i t j err . s'f'Ord/' Ctcr- e 0ot44i . 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