31D-049 (3) 54 GREEN ST BP-2017-0685
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man:Block:31D-049 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
(::ateeory:RQ BUILDING PERMIT
Permit# BP-2017-0685
Project# JS-2017-001121
Est.Cost:$14000.00
Fee:$98.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Ilse Grouo BRIAN L YOUNG 102573
Lot Size(sa. ft.): 5314.32 Owner: SMITH COLLEGE OFFICE OF THE TREASURER
Zoning: EU(10q)INB(100)/ Applicant: BRIAN L YOUNG
AT: 54 GREEN ST
Applicant Address: Phone: Insurance:
P O BOX 1014 (413)498-0121 WC
NORTHF IELDMA01360 ISSUED ON:11/17/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: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 11/17(20160:00:00 $98.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Vcrsionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:
' 6 Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
r37,,,s Room 100 Water/Well Availability
" a 'orthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6r'p— ,' 7 -0 Oj
1.1 Property Address: This section to be completed by office
51 6r e. Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
5m1}h Li011ecoe,
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
3rw1L A)
ca-X6- \iLtii15RCL% v'S-Co,, �lC'�-C L�.rG=�c Fl�;'�ry:.,, or,. oicicJ,
Name(Print) 7 Current Mailing Address:
' 17 - 354- i3ij
Signature . / Telephone
e YY ��//rrpp//��
SECTION 3-E$TIM ED CONaTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
p U /^ completed by permit applicant
h
1. Building oYi✓�n, l i coo 0O (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) ILt Q'D.CL Check Number 2398 4/vs
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
4010011 X 77,... -
/7 -///�SBuil. .- o is Doer nspecto Date
Version1.7 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 0 Demolition❑ Repairs Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing® Change of Use Other 0
Brief Description Enter a brief escription here. S C<- ul- kuS P ue/x1
Of Proposed Work: VO
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 ElA-3 ❑ 1A I 0
A-4 ❑ A-5 ❑ 1B 0
B Business ® 2A 0
E Educational 0 28 I ❑
F Factory 0 F-1 ❑ F-2 0 2C ❑
H High Hazard ❑ 3A ❑
I Institutional 0 1-1 ❑ 1-2 El 1-3 D 36 fl
M Mercantile 0 4 0
R Residential 0 R-1 El R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 0 S-2 0 5B I 0
U Utility
0 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)
151
2"
2"
3re 3rd
41h 4Th
Total Area(s0 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 0 Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column,o be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage rlc
(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 O DON'T KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES i1) NO [o
IF YES, describe size, type and location: (`11 TIc2. Z,I (x a
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. WII 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
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(Registran0:
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 Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
h t4U' Et,id e6
Not Applicable ❑
Company Name.
G 2 Lc R,jft
Responsible In Charge of Construction
35 1-14i71 .4-, 6it'2c 191)j Ci6H
Address
(See coActe(lec4' F,'ctti3:.J '-h3 5-3 -S>LCD
Signature Telephone
Version .7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O 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 to
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I. �1gi) L
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 belief.
Signed under the pains and penalties of perjury.
bkrI(tl L, )10,1
Print Name
Signaturerowner/�'. nt / Date
SECTION 12-CONSTRUCTIO SERVICES
10.1 Licensed Construction Supervisor: Not Applicablep� 0
Name of License Holder. bit a 11 I L . • L"�i 1�5 - 10573
License Number
?.c! ak 6,0C (,. I/eite yC1r2S1 )7
Address Expiration Date
yl 5- 5yH- lAC7
Signature 3 Telephone
SECTION 13-WORKS 'C PENSATION 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.
Signed Affidavit Attached Yes F No 0
The Commonwealth of Massachusetts
_—,--- Department of Industrial Accidents
= Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): JJ115- �L'u� fiC(i -
Address: -'x (i005(,c
City/State/Zip: InC"C3 (1 IMA C' ICl1:�' Phone#: $.3 u 7
Are you an employer? Check the appropriate box: Type of project(required):
I.® I am a employer with 13 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. 10 New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.:
9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 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 Roof repairs
insurance required.] * c.152, 81(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit his affidavit indicating they are doing all work and then hire outside contractors must submit a new 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'comppolicy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
-rr v
Insurance Company Name:_ `SGV i-Hs Cra vie
Policy#or Self-ins. Lic. #: C'I DP(x'C o 7097(y I Expiration Date: ]/i )/7
Job Site Address: c}Li 4- 59 EY�f City/State/Zip: AJ6Yt t Hqv i Mg ()int
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature' --� %,' Date: / I )1711(p
Phone#: l 3 - .5.
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Young Roofing Co., Inc.
( iDate: November 7.2016
i«a�w To: Keiter Builders 35 Maim St.Florence,MA.01062
rbrer wm.riH _ _
0400 _..,..__._.._.._ __._.._�_...- ___ _._._..._.__...._.._ - t
MYMnii"dents 'lobLocation: 44& 54 Green St Northampton. MA.
%Men.ruuiou
+is 'Ns ISpecaKabonr._.-______. Install the following roof system to roof ares.
. • n3Sii9i[t 1,2.3.64and 7A
<YI
fawn*
34}}}L$
I. Install I12 inch nailer to all roof edges.
4915 2. . .Install 1/2 inch- 100 PSI polyisocyanurate insulation.
moaeavgr,wm 3. install Carlisle's .060 reinforced EPDM mechanically attached roofing system.
tulialeasiLiorsatri
14. Fabricate and install .040 bronze brown aluminum edge metal.
utt=! h." 15. Flash all walls and roof edges.
to qa-OUR
6. Remove all ow roofing debris from the job site.
17. New roof applied by this Company is Guaranteed for a period of Five (5)
years under normal conditions excluding.fire.roof traffic.fallen tree limbs.etc.
#5 Tower roof.
I. Repair missing and broken slate
112. Fabricate and install new 20 oz.copper caP
A 65'lift will be rented for this project.
! i
78- Patch and coat with asphalt*erect aluminum.
88- Seal head flashing
' c:
young Roofing Co., Inc.
r .. ,Date: November 7.2016 f
1
«;:EM P.O ;To: Keiter Bulide's;Inc. 35 Main St.Florence. MA 01062
MnOnwt P .
, .._
01093
oltop AdOi" D""" Location 44 & 54 Green St Northampton MA. i
PO Sou 4054
%moa MA 01042
4f145.0441.1.7 'Specifications:
htA-144e167 '
too phorw
411-S1.Yti.
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40.605-0716
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DATE OFACCBTANCE�„il• , _ _—
Massachusetts Department of Public Safety
® Board of Building Regulations and Standards
License: CS-102573
Construction Supervisor 'y
BRIAN YOUNG /'i
PO BOX 104
NORTHFIELD MA//01360 - '
Expiration_
Commissioner 02128/2017
young Roofing Co., Inc. Office-144 Texas Rd.Northampton,MA.01060
Mailing Address-P.O.Box 6C056 Florence,MA.01062
Phone-413-584.1367!413-586-9167
Fax-413.585-0226
Date; November 17, 2016
City Of Northampton
212 Main St.
Northampton, MA. 01060
RE; 54 Green St. Northampton, MA.
I request that you grant a modification to waive the requirement for control
construction for the project above because the work is of minor nature, will not affect
health, accessibility, life , and fire safety, or structural requirements. Thank you for your
consideration.
Respectfully,
/ ^ men,
Brian L Young,
President