18D-004 (50) 100 DAMON RD- 100A& 108 BP-2017-0120
GIS n. COMMONWEALTH OF MASSACHUSETTS
Mao:Block: I8D-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: renovation BUILDING PERMIT
Permit q BP-2017-0120
Project p JS-2017-000203
Est.Cost:$3500.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ROBERT ARDIZZONI 051547
Lot Size(sq. ft.): 87120.00 Owner: MOCK WILLIAM D
Zoning: GB(1001/GI(0)/ Applicant: ROBERT ARDIZZONI
AT: 100 DAMON RD - 100A & 108
Applicant Address: Phone: Insurance:
7 LAKESHORE DR (413) 531-4841
H O LLAN DMA01521 ISSUED ON:8/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE STAIRWAY EGRESS UNITS 100A &
108
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: Housea 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:
FeeTvne: Date Paid: Amount:
Building 8/1/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File p BP-2017-0120
APPLICANT/CONTACT PERSON ROBERT ARDIZZONI
ADDRESS/PHONE 7 LAKESHORE DR HOLLAND01521 (413)531-4841
PROPERTY LOCATION 100 DAMON RD- IOOA& 108
MAP 18D PARCEL 004 001 ZONE GB(100)/GI(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT oki /b� Wien)Fee Paid I�
Building Permit Filled out
Fee Paid
Tvoeof Construction: REPLACE STAIRWAY EGRESS UNITS I OOA& 108
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051547
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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
Demolition Delay / �J
4 2' 1 - G2 //�
s re of Min:. I(ficial 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.
• 4 • �_Version1.7 Commercial Building Permit Ma 15,2000
RFS '-' Department use only
' City •f N. hampton Status of Permit:
2 Z� Idi g D•partment Curb Cut/Driveway Permit
12 ai Street Sewer/Septic Availability
^. Cm 100 WaterNVell Availability
+j{f i• A 01060 Two Sets of Structural Plans
- 87-1240 Fax 413-587-1272 Plot/Site 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 Property Address
9/ . / This section to be completed by office
-/OB QgryJOf:J i<-d Map alp Lot Lf Unit
#LiriztA4Pinp Zone Overlay District
-- - - - - - -- Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Lu.u:win _l) Aloe Peth £3996 -boaMir9h+prc,ci 17kE
Name(Print) Current Mailing Address:
, ,eirk- i3 . 23c - y75'
Sig nature _ r'� /� Telephone
2.2 Authorized Agent:
h {{ \ )� Z Lake. SHORE Oft
Name(Print) Oma/\'a ARA l Current Maying„Aedress
rioi\1f:5Ld rrc'A �`5J
Signature Telephone 4 LI 531 -4 Kt' 1
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building f 3 I < ) 1 (a) Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) — , /0
5. Fire Protection (ah7. 18 ,�{ Ov/�J�g
6. Total=(1 +2+3+4+5) Check Number rI �{/`a ,j'lO
This Section For Official Use Only /tee/
./ 1/76"1411-
Building
fj4776 MSO
Building Permit Number Date /��[ '/� /"'v"
Issued
Signature.
Building Commissioner/Inspector of Buildings Date
4 1-foto Mt& seoryl
Versionl.7 Commercial Building Permit May 15,2000 .
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 '
CUBIC FEET OF ENCLOSED SPACE jjjj
Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 v
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use❑ Other 1P
Brief Description Enter a brief description here. ,erp4rc�Xn%C— si Lii a y/ei-/tE'Ss c I /dtg-00
Of Proposed Work AAA,4-104.(70.t.9 STA-ie,„r<y/FEPFss e x ie s494n,eit, ,['d _. ... ... ..
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) 1 CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 1A 1 ❑
A-4 ❑ A-5 0 18 0
B Business 0 2A ❑
E Educational 0 28 1 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard 0 3A 0
I Institutional 0 I-1 p I-2 0 1-3 ❑ 3B 0
M Mercantile 0 4 0
R Residential 0 R4 0 R-2 0 R-3 0 i 5A 0
S Storage 0 s-1 0 S-2 ❑ 58 0 •
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 _ 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)
1s1
,m
2nd
3e
3rd _. _..
4th 4
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 0 Private Zone l_...._..._... Outside Flood Zone❑ Municipal On site disposal system
Versionl7 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 L. R __. L. _ . R'. . ... _..
Rear
Building Height
Bldg. Square Footage o ' "
Open Space Footage
(Lot area minus bldg&paved _ ...
parking)
#of Parking Spaces -. -- - -
Fill: _.._
(volume&Locmon)
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO 0 DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Q YES (3
IF YES: enter Book Page. and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO V DONT KNOW (3 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 f t' NO0
D
IF YES, describe size, type and location: / /n/,L�.7. 0 pais/,. SJ' Sit A—
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO l7"
IF YES, describe size, type and Location:
E. WII the construction activity disturb(clearing,grading,excav n,or tilling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
•
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:
Not Applicable 0
Name(Registrant) .._ . . _ . . _
_. _. Registration Number
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 Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Regstration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable 0
Company Name
Responsible In Charge of Construction
Address
Signature Telephone
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 Q No Q
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L_ &i t 194.7//t) Moth J,as Owner of the subject property
hereby authorize Se the V/€'2-O/✓/ to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner ` Date
I. Z(//etc/n/7 /) //loch __ ,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 und• the pains and penalties of penury.
L
Print Name
a,Li-47-m o i;u . t 7-Z3--J '
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
RQctd Ar
Name of License HCY
7oltler -- (c.CK ib'I1 _ t [' /
L V,C 1.f ip, bk.. �Cjllil�'J... �('
License
J`1
Address Date
[/A 9)3 S I'y �i Expiration�/ �S �� ;6
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 dental of the issuance of the building permit.
Signed Affidavit Attached Yes jiQ No Q
The Contnaonwealtlr of Massachusetts
Department of Industrial Accidents
Office of Investigations
��L fir t 600 Washington Street
Boston, MA 02111
www✓nass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organiza[ion/lndividual): { l�G )Alft ,(.�(it/ 1
Address: Le\tc j �atic ]p
City/State/Zip: t �\ ° I' 1'F Phone #: �1 )3 5J?\ LI pL
Are you an employer? Check the appropriate box:
Type of project(required):
I.LI I am a employer with 4. H l am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g, E Demolition
working for me in any capacity. employees and have workers'
ki
coin insurance.t 9. ❑ Building addition
[No workers' comp.insurance P
required.] 5. n We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [No workers' comp. fight of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152, §I(4),and we have no
employees. [No workers' lin Other
comp. insurance required]
*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 a new affidavit indicating such.
tContractors 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 inn 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.Lin.#: -_ Expiration Date:
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 fomr 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 D for surance coverage verification
f do hereby certifr nder l ains and penalties ofpeijay that the information provided alto a is Inc and correct.
Signature' - 2 ( � Date: 7 c25
Phone 9: 531 �Q1`r �)
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#:
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: 16- ICS ECM()N PC)
The debris will be transported by: U'Cck (n)
The debris will be received by: 0k5-1-C yN F, (t1Cj\'v
Building permit number: I 1
Name of Permit Applicant (A)� 1r_,r+, fir\ Cg.k.
Date Signature of Permit Applicant
Commissioner Hasbrouck 7/27/2016
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction
for the deck/stair repairs at 96-108 Damon rd 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,
'o•-rt srdiuoni
construction
7 Lakeshore dr
Holland ma 01521
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