39A-080 (4) 440 PLEASANT ST-HAMDEN ZIMMERMAN BP-2017-0597
GIs#: COMMONWEALTH OF MASSACHUSETTS
//vials:Block:3M-080 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ELECTRICAL BUILDING PERMIT
Permit P. BP-2017-0597
ProjectJS-2017-000938
Est.Cost:$40000.00
Fee:$280.00 PERMISSION IS HEREBY GRANTED TO:
const.Class: Contractor: License:
Use Group:- JAMES MAILLOUX ELECTRIC 081694
Lot Size(sq.ft.): 1306.80 Owner: SANBORN ROBERT P
Zoning:GB(IO0)/ Applicant: JAMES MAILLOUX ELECTRIC
AT: 440 PLEASANT ST - HAMDEN ZIMMERMAN
Applicant Address: Phone: Insurance:
55 MAIN ST-2ND FLR (413) 585-1592 Workers
Compensation
FLORENCEMA01062 ISSUED ON:10128/2016 0:00:00
TO PERFORM THE FOLLOWING WORICBUILD PARTITION WALLS FOR LIGHTING
SHOWROOM & RAISED FLOOR FOR CUBICLES
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 10/28/2016 0:00:00 S280.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0597
APPLICANT/CONTACT PERSON JAMES MAILLOUX ELECTRIC
ADDRESS/PHONE 55 MAIN ST-2ND FLR F1,ORENCE (413)585-1592
PROPERTY LOCATION 440 PLEASANT ST-HAMDEN ZIMMERMAN
MAP 39A PARCEL 080 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPI ICa ON HECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid Sr.
TvpeofConstruction: B IILD P RTI ION •LL. -IR LIGHTING SHOWROOM&RAISED ti;LOOR FOR
CUB CLE,S- _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 081694
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 Han AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding_ Special Permit Variances
_ 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 Dela
Signature of Bu lding Official 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 grunted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
1
( Versieol.7 Commercial Building Permit May IS,2000
Department use only —'
Li City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit _,_„�
__ 212 Main Street Sewer/Septic Availability
cam. v ” Room 100 Water/Well Availability__
Northampton, MA 01060 Two Sets of Structural Plans
phone 413587-1240 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
I
1.1 Prop arty,Atldrens) - /.j//jy This section to be completed by office
/1( O 7cpa n t,' � Map Lot Unit
/ d/i177 {,f Pt.' j 0f06c1 Zone Overlay District
(,LL -- -- - -- - Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
...2_1 Owner of Record: /ina, v L,r.;.- .jiyl.4,-n
Name pint} Current Mailing Address
Signature .y- wG Telephone
se
2.2 Authorized gent:
Fu-Netd r� qq� /cms �1 s ' v»6d
„
Name(Print) Current Mailing Address
y.3-czy.- S-/e u
Signature _ Telephone _,
SECTION 3-ESTIMATES CO STRUCTION COSTS
Item Estimated Cost(Defiers)to be Official Use Only
completed by Demist applicant
1. Building (a)Building Permit Fee
2. Electical (b)Estimated Total Cost of
_ Construction from(6) _
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection /�q
6- Total=(1 .?,.3+4+5) U/ C�4 CS jjCheck Number i,3l 97 o
._-.
This Section Fo�cial Use Only
Building Permit Number bate
Issued
I
Signature:
Building C:ommieslaner/Inspector of Buildings Date
y/
VersionI 7 Commercial.Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions ❑ Accessory Building 0
Exterior Alteration 0 Existing Ground Sign O New Signs 0 Roofing❑ Change of Use Other 0
Brief Description Enter a brief description here. Ig..,z/ P.a./15 r't r A-A/!s 742- (..4) /'p 52evrilod"1
Of Proposed Work: f d74/�� /
-t ./ E ... ?Alt— 1r 0CdbEt- y
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 1A I ❑
A-4 0 A-5 0 f' 113 0
/
B Business 0 _..—..�./ 2A _-...I 0
E Educational 0 i,„--- 2B ` 0
F Factory 0 F-1 0 F-2 0- 2C 0
igh Hazard 0 3
H Hi '/
A ❑
1 (H
stitutional 0 I-1 ❑ L 0 13 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 �R-3 ❑ SA 0
S Storage 0 S-1 ❑ 5.2 0 5B j 0
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use 0 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
IBUILDING ARCA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
15 ....
161 _.
2.,d
d 3'u _ _._....
Total Area(sf) Total Proposed New Construction(sr)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.v.40,5 54) 7.1 Flood Zone information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Version1.7 Colmnercial Budding Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing I Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear ( . . .
Buikhing Height
Bldg. Square Footage °a
Open Space Footage ,. / ...
(Lot area minus Wag&. ed
parking) •
#of Park^• Spaces
(volume&Locarion) - - - - - -
A. Has a Special Permit/Variance/Finding er been issuedrf'oyr/on the site?
NO 0V
DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the R try of Deeds?
NO Q DON'T KNOW YES 0
IF YES: enter Book Page and/or Document d
8. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 127 YES (3
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained V Obtained
, Date Issued:
C. Do any signs exist on the property? YES 0/ NO Q
IF YES, describe size, type and tocation'
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,exca ion,or filling)over 1 acre or is it part of a common plan
that wID disturb over acre? YES (3 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Viersion].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
Name(Registrant):
Registration Number
Address
Expiration Date
..�_..
Signature Telephone
9.2 Registered Professional Engineeris):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature TetePhone Expealion Date
Name Area of ftespenstiiiy
Address
Regtsbatton Number
Signature Telephone Expiration Dale - - -
Name Area of Responsibility
Address .. . -.. . Registration Number . . .-.....
Signature Telephone Expiration Date
9.3 General ContractorJ
/77.5%1 f`" er/(/.,/,‘ Not Applicable 0
Company Name'.
Responsible In Charge of Construction
/ -7/C >r.., L',.l" t/. ,/,j ...
Address
41011111 IR.Fkr,cr.t,
Signature Telephone
Version f.7 Commercial Building Permit May IS,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
V
Independent Structural Engineering Structural Peer Review Required _ Yea No 0
SECTION 11 .OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Is ,as Owner of the subject property
hereby authorize. . _.. .. _m
act on my behalf, in all matters relative to work authorized by this building permit application.
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 beget
Signed under the pains and penalties of pequry,
f rint Name
Signature of Owner/Agent Date __
SECTION 12-CONSTRUCTION SERVICES L __
10.1 Licensed Construction Super
visor: ,/� r/ Not Applicable 0
Name of License Holder:_.._ �i4 1�S („r + '�/L"x-^'r<�r�' .. 4 a f/t 9e
/--7 License Number
�..
515- ,44,47”1" sr` /-/✓i9 , /144 op. 6.Z._- lo/ ill
Address Expiration Date
lif y/.3- -/ss;�
Signatures ' it 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 denial of the issuance of the building permit Vit\. ._ _,,,
Signed Affidavit Attached Yes 0 No _ _
The (;bnantonwealti, of Massachusetts
-fir Department of Industrial Accidents
t - Office of Investigations
=�-r •_ 1100 ii ashzington Sb yet
Boston, MA 02111
www.marsgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information M Please Print Legibly
Name(Business!Organization/Ltdividual): '.1A'' ( I'rsit tj./*!
Address! J i (44,0 Ai St l�'
City/State/Zip: vey6- p10GZPhone#: `7�13 "SSS-/Sy t--
n
Are you all employer?Check the 1ppropriate b Type of project (required):
1.0 I am a employer with 4. I 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. emodeling
ship and haste no employees These sub-contractors have 8. n Demolition
working for me in any capacity. employees and have workers' y Building addition
[No workers'comp.insurance comp. insurance.: [,�.�/
required.] 5. C We are a corporation and its 10,1[��Elecnical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their ILO Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL IZ.[ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees.[No workers' 13,[ Other„_,_
comp. insurance required.]
'Any applicant that checks box kl must also CHI out the section below showing tluir workers'compensation policy Information.
Homeownerswho submit this affidavitiidicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tcontratorthat check this box must attached an additional sheet showing the name of the sub-cnnnactors and state whether or not those entitles have
employees. litre sub-contractors have e ployees,they must provide their workers'comp.policy number,
I'an an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy dor Self-his.Lia d: Expiration Date: V�
Iob 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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the foam of a STOP WORK ORDER,and a foe
of up to 5250.00 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,
1 da hereby certify • r hep tint/penalties of perjury that the information provided above is true
and correct.
•
///
Signature: Date:
Phone F: '//�.Z !S`r _,..
Official rise only, Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License ft
IssuingAuthority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 4;
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: L/`{01 ?e, sh.
The debris will be transported by: _ 4Ac,E 1t-'^,Aur+P,t-v‘tyu i
The debris will be received by:
Building permit number: I
Name of Permit Applicant \ .. 4ai / 2u-t(
Date Signature of Permit Applicant
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