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23B-044 (13) 41 LOCUST ST- 1ST FLOOR BP-2017-0762 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-044 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2017-0762 Project# JS-2017-001274 Est.Cost: $23400.00 Fee: $161.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MICHAEL BISGROVE 085661 Lot Size(sq. ft.): 23435.28 Owner: DAVID GARDNER Zoning:NB(1001/ Applicant: MICHAEL BISGROVE AT: 41 LOCUST ST - 1ST FLOOR Applicant Address: Phone: Insurance: 8 HERRICK RD (413) 241-1757 BLANDFORDMA01008 ISSUED ON:12/12/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATION OF EXISTING SPACE, NEW DRYWALL & DOORS, NEW DROP CEILING, ELECTRICAL, NEW BATHROOM DOORWAY AND 15 REPLACEMENT WINDOWS 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 It 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: FeeTvpe: Date Paid: Amount: Building 12/12/2016 0:00:00 $161.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0762 APPLICANT/CONTACT PERSON MICHAEL BISGROVE ADDRESS/PHONE 8 HERRICK RD BLANDFORD (413)241-1757 PROPERTY LOCATION 41 LOCUST ST- 1ST FLOOR MAP 23B PARCEL 044 OW ZONE NB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT + Fee Paid /�1 ,,� Il Building Permit Filled out VVV Fee Paid Typeof Construction: RENOVATION FISTING SPACE,NEW DRYWALL&DOORS,NEW DROP CEILING,ELECTRICAL,NEW BATHROOM DOORWAY AND 15 REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 085661 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN O 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 lition D ay Signature of Building 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 granted only to those applicants who meet the strict standards of MGL 40&Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit May 15,2000 Department use only DEC - 8 City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability_, Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-5871240 Fax 413-587-1272 Plot/Site Plans l Other Speeify 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 4i Liao This section to be completed by office 4i Lo'1ci4d ¶ j- - Ut.0`54.6,3 5 Map Lot Unit 3IUdr44' arntia 77Y1 t+ t. Zone Overlay District ---1 - - -- - - Elm St.District CE District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .. f 0/076 pair /ftaATtt lAt. •! / // Ues11Qrn luc Name(Print) Current Mailing Address/ > f 7 3 766`? 3/5— Signature Atire4 - Telephone 2.2 Authorized Agent: M1 rJ-c.,eJ 31st ccne_ _. 8 Herrick, ed. ` ala.cwnrd (!Mi of •g Name{Pant} Current Marling Address Signature :L `�Ce.C..naAAA: Telephone _ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building + 4200 co (a)Building Permit Fee / A 2. Electrical (b)Estimated'Total Cost at Oy IJ -C} Construction from e 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) I8r f.d /q J. Fire Protection (J(,) 6 Total=(1 +2+3+4+5) 60a Check Number •r - This Section For Official Use Only Building Permit Number Date Issued Signature. Building Commissioner/inspector'of Buildings Date ti CKyblsyovc, 3mco l . Lure Le V ersioi t.7 Commercial Building Panne May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,090 CUBIC FEET OF ENCLOSED SPACE Intoner Alterations 0 Existing Wall Signs ❑ Demolition❑ Repairs L+J Additions ❑ Accessory Building Exterior Alteration 0 Existing Ground Sign❑ New Signs 0 Roofing❑ Change of Use❑ Other❑ Brief Description S{,nUT1QtUn O -`3 S 't tSknCj S (J(Lf;,vkc oz;rs >7ps.0 Of Proposed Work: a,§-73p t trn tie civ- LcL -'�. 4 ACt-af xd2ta!?ttiuX.,f, t // SECTION S-USE GROUP AND CONSTRUCTION TYPE #410 Acta /.W rxl(y+rc USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A..1 0 A-2 ❑ A-3 0 1A ❑ A-4 ❑ A-5 0 18 0 B Business 0 1 2A ❑ E Educational ❑ 28 ❑ F Factory ❑ F1 ❑ F-2 0 _ 2C 0 H High Hazard 0 3A { ❑ I Institutional ❑ I-1 p 1-2 0 I-a ❑ 3B 0 '�.. M Mercantile ❑ 4 ❑ R Resldenliat ❑ R-1 0 R-2 ❑ R-3 0 5A ❑ S Storage 0 S-1 0 5-2 ❑ 5B ❑ U (ARO ❑ Specify: : M Mixed Use ❑ Speciry .. .... . . . 5 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 OMR 34)- Proposed Hazard Index 780 CMR 34) SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXIST7PIG PROPOSED NEW CONSTRUCTION Floor Area per Floor(s0 arda 4m , 4^ Total Area(si) Total Proposed New Construction(s'p Total Height(ft) _.. Total Height ft 7,Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: L3 Sewage Disposal System: Public 0 Private ❑ Zone' _Outside Flood Zone I Municipal ❑ On site disposal system!: Version] 7 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 % - -- - Open Space Footage (Lot area minus bldg&paved parking) -- --. -.-_ - #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ♦;9 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES 4) NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO co IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris 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. Version 1.7 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 Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name _... Area of Responsibility 1i 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 ISC`f(J 1t COns CL1iiC-1-iotn _. _.. Not Applicable 0 Company Nae 0'9 litAel r6 ,s141DJ Responsible In Charge��off(C�ons ction y-/) /,/ ry HFfrlck ed bl&nclC� iliA d/(1Dd ' Ad ss LNCUCC 'Of') 9-132y1.1751 Signature Telephone Vermont Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) pp^^�� Independent Structural Engtneenng Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTR44ACTOR APPLIES FOR BUILDING PERMIT I...... A`!t G `,+-�fd-T1¢ ,as Owner f the subject property hereby authorize. . V.tC1/1Ln A._ ) ALV• to ac '.n my bete ) I• -tt relative authorized by this bolding penal!apphcattun t Sp-na /n�ture of Owner Date I, PA I C.�I(A i I,�I S Qv ,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 end belief. Signed under the pains and penalties of perjury I" IL.-11pd Becj rove _.. Pr Name Signature of Ow rlAOent Data SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Constructi((o)�n/}}Supervisor: Not Applicable 0 Name of License Holder• Oil/! i } t �_ ... .. ... _ License Number -c riot Cd BiCcoafiWj AA O)VO CS- e iFitc(cl Pdpress Expiration Date ..� $�. Li/1,141 . 1161 - 30 ( 07 Signature / Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL.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 th(e building permit _ Signed Affidavit Attached Yes e. _ The Commonwealth of Massachusetts Department ofIndusn-iat Ac idents `, , �_ re. Office of Investigations 16--1" - 600 Washington Street Boston, M.4 02111 www.ma,ss.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): ffi/l�y�4 131310 /-�) h l f 51)rt v tn- Address: 1-1 .7 t _. e/ jn tpy City/State/Zip: ._. _ A 'a. ... I 04'hone#: i , L-.,1, ) 7f. 7 Are you an employer?Check the appropriate box: Type of project(required); I.❑ 1 am a emPIoYer with 4. ❑ 1 am a general contactor ands o. ❑New construction employees(full and/or part-timer have hired the sub-contractors 2.yo I am a sole proprietor or partner- listed on the attached sheet. 7. 12 Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp insm'auce required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself.[No workers' comp. right of exemption per MOL 12,11 Roof regatta insurance required.]t H. 153,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#t must also en out the section below showing their workers'compensation policy information. t Homeowners who submit tits affidavit indicating they are doing all work and then hire outside cuneacmrs mnstsuknit a new affidavit indicating such. *Convectors that check this box nwstaetaclled an additional sheet showing the name orate sobcontra,ttors and state whether or not these 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 the policy and job site information, Insurance Company Name: Policy#or Self-ms.Lie,#: 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 MOI,c. 152 can lead to the imposition of criminal penalties ofa 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 1 investigations of the DLA for insurance coverage verification r do INrely ;tiff �'�he,,c 'us and penalties of perjury that the information provided above is true and correct Phone ;tiff underIlii- Date: /3 . /6 Ltorch S o #: '7 4,1 / J 7 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License k ,.. 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 k: __ The Commonwealth of Massachusetts Department of Industrial Accidents ll-=-— = 1= "l Office of Investigations Y te ' 11 t=_i - I Congress Street, Suite 100 ='•►_►_� Boston,MA 02114-2017 •�`''J www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Leeibly Name (Business/Organization/Individual): 'ndividual): ]Lint,.� D/1 rtvt, I- Address: k Cfr1co Pd City/State/ZiplR}&y'r xp A' . DIOOS Phone#: I3, olgI , I -- 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 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 2.1p I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition workingfor me in anycapacity. employees and have workers' P ty 9. ❑ Building addition [No workers' comp.insurance comp. insurance.- 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❑Roof repairs insurance required.]' c. 152,§1(4),and we have no - ' employees. [No workers' 13.1]Other YerpIacipti to hnagOkb comp. insurance required.] ..// •Any applicant that checks box 01 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 suck 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. /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. Lic.#: 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 herebil ertify under t t,ins and penalties of perjury that the information provided above is true and correct Signature:: [ It . 'lit./' h/& Date: } Phone#: 413 , L[ I . 1lir 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): I.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: 41 L0 CSS S* The debris will be transported by: ( �\SGC0V2 Con��rlAC�hun V The debris will be received by: Val e) R,Q c lel c ) i 1)c J Building permit number: Name of Permit Applicant IN\ V ki,,e l 1:‘5(A r( v-e gl � �J Date Signature of Permit Applicant cc tt *ioa d° S cimieig .1-.1499—/I/ ca %: Q ' N N , 441 74 .L-d9 .9-2 /' .Z-.9 (Vase N e.Npew o3 C , 1 co2 V4-ome i 2�1V€& roa61 I w F,arc.,11 INS Ir_ z-,9 i5. Kfre,Sits ill 1, o0Jsv- cr - qr-Cerl; / fyi 7161 u VI aR;Zo1V City of Northampton Building Department • Plan Review 212 Main Street / Northampton, MA 01060 tr. 1,-,1„1,-,1„Sc55e/t4/e-41- eIvLe/I�y a-,£ 6 N „OhE N a o m N a .14 “z-,k A)3 Z A N x w . " p CVVit o4 u