31D-166 (21) 274 MAIN ST-ACADEMY OF MUSIC BP-2017-0742
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31D- 166 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# BP-2017-0742
Project# JS-2017-001236
Est.Cost: $500.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
use Group: Homeowner as Contractor
Lot Siae(so.ft.): 87120.00 Owner: NORTHAMPTON CITY OF ACADEMY OF MUSIC PULASKI PARK
Zoning:CB(1001/ Applicant: NORTHAMPTON CITY OF ACADEMY OF MUSIC
PULASKI PARK
AT: 274 MAIN ST -ACADEMY OF MUSIC
Applicant Address: Phone: Insurance:
274 MAIN ST
NORTHAMPTONMA01060 ISSUED ON:12/2/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL TEMP PRESSURE TREATED LANDING
- STEPS OVER DETERIORATED STEPS TILL SPRING 2017 WHEN REPAIRS WILL BE MADE
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 12/2/2016 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
•
Verdi onl-7 Commercial Buildin3 Permit Mav 15.2000
Department use only
City of Northampton Status of Permit
Building Department CurbCut/Driveway-Perna
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Avarlability --
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587'1240 Fax 413-587-1272 PIoeSde Plans ,
Other Speedy
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 Prooer[y Address: This section to be completed by office
2_I A- tiVky-t 5. . Map Lot Unit
„00— AIM CHIT &\ Zone Overlay District
N - - Elm StDrstnct CB.District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
or
0n {u(cat9u _ _____. 146 iNo �uacsH Or
Name(P t) Current Mailing Address.
ArDatli SC)
Signature 4 i1__ Telephone
22 Autho�Agen •
�
Name(Print) Current h ling Address
Signature Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Off offal Use Only
—
completed by permit applicant
1. Building 5613 Fermat(a)Building Fermat Fee
.___ I.
2 Electrical — (b)Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) __•— --
6.Fre Protection
6- Totai=
(1 +2 +3+4+5) 5li-PV- .. Check Number
This Section For Official Use Only
Building Permit Number Dale
Issued
b
Slgnamr
Butdire C nspea of Buildings 1 l
Date
Version) 7:Commercial Building Permit May IS.2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition Repairs El Additions 0 Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing❑ Chance of Use❑ Other
Brief Description Enter a brief description here. 1 5'(AU— QatA¢, {TPS cos I er p
a , n 1A r ouc.:�p S'IS LISC� SPP--U441 , i4r1
Of Proposed Work: Uva S \W
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 0 A-2 ❑ A-3 ❑ 1A I ❑
A-4 D A-5 9 1B 0
B Business 0 2A ❑
E Educational D 28 0
F Factory ❑ F-1 ❑ F-2 0 2C i ❑
H High Hazard 0 3A ❑
I Institutional ❑ I-1 0 1-2 0b 0 38 ❑
M Mercantile ❑ 4 0
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA 0
$ Storage ❑ S-1 0 S-2 ❑ 58 0
U Utility ❑ Specify-
--
pecify — " ___
M Mixed Use ❑ Specify __ . _ _
.. __._ __—_ _ __.
S Special Use ❑ Specify: ;
COMPLETETHIS SECTION.IF EXISTING BUILDING UNDERGOINGRENOVAIIONS ADDITIONS AND/OR CHANGE IN USE
Existing Use Grcup: _.. __. ____ Proposed Use Group: -
_ I
Existing Hazard Index780 CMR 34)C.________.___ Proposed Hazard Index 780 CMR 34) _
SECTION 6 BUILDING HEIGHT AND AREA
OFFIGE'USEONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1s)
3r7 __ ____ —" - - _.
4m
Total Area(sf) Total Proposed New Construction(sf)._.
Total ieight(ft) __.
__.. _ _.... . Total Height E
7.Water Supply(M.G.L C.40, §54) 7.1 Flood Zoneinformation: 7.3 Sewane Drsposel System:
Public 9 Private❑ - Zone __ O,rtside Flood Zone I Municipal 9 On site disposal system❑
Versienl.7 Commercial Building.Permit May 15. 2000 - -
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCT!QN CONTROL PURSUANT TO T80 OMR 11E(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9,1 Registered Architect-
-
._____._.___._ _._ _... Not Applicable 0
Name(Registrant) - .-.
t _____ v.. --
Registaton Number
Address �..
— Expiration Date
v
Signature Telephone
9.2 Registered Professional Engineers}.
Name_ Area of Resod b ty
Address Registration Number
'
Siyature Toleptone Expiration date
Nine ,_. .. Area of Responsibility
Address _....—. T.. Redsgation Number
SCynature1''elephone Expmotion Date
Name Area of Reuponsisthty
Address Regrstation Number
Segiatuse Telephone Fxprabon Date
Name Area of Respor. b ly
F.tlUress Regisiragon Number
Signeyre Telephone Exp .on Date v`
9.3 General Contractor
NW-AL- Wm)le '/tu"t •
_______ Not APPliC2hle ❑
Company Name:
Responsible In Charge of Constmclion
A.. e
des
C . tyak2
^ Telephone -
Vermont-7 Comma:Jai Buildme Permit May 15,2000_
8. NORLki4b?PION ZONINGli
Existing Proposed Required by Zoning
]3is cohvnn to he filled m by
Building Depatnnent
Lot Size I - —""' —
_
Frontage ---
--___. __.. _ --
Setbacks Front ,.__
Side L. R:— L:_— R:__ __
1 Rear - -- -----
Building Height _„__ ----
Bldg. Square Footage _. ___ ._
Open�S mace Footage % __ _
unit arca us bldg paved
parkin el
le of Puking Spaces —
Fill:
A. Nas a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page : and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: :- -. ---
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E WE the construction activity disturb (clearing, grading,excavation,
vation,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
The Common-wealth of Massachusetts
Department oflndustia1.4ccidenrs _. - _-
. Office of-Investigations
600 if¢shin on Street
Boston, MA 02111
-_-' www.mass.gov/dia.
`workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers
Applicant Information Please Print Lenibly
Name (Business/Oranizatio/Individual:
Address: -
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: T}pe of project(required): •
4.lI am a general contactor and I
I.L employees am a employer(full
with6. n New cons-Mien=
and/or parr-time)." have hired the sukcontactors
2-E I am a sole proprietor or partner- listed on the attached sheet. 7: E Remodeling
ship and have no employees These sub-contractors have S. [fl Demolition
working for me in any czFaciry employees and have workers'
9. n Building addition
o workers' comp. insurance comp.instuance..t
required.]o
d. ❑ We are a corporation and its 10.x1 Electical repairs or additions
i.❑ I ammh
a homeowner doing all work officers have exercised their 11.7 Pllunbins repairs or additions
right of exenndon per MGL
myself [No workers' comp. p 12.❑Roof repair,
insurance required_]T c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box'1 roust also Sa out the section below showing their workers'compensation policy infonrauon.
Homeowners who submit this affidavit ndiathiz they are doing all work and then hire outside contractors must submit a new amdavit indicating such.
;Coot-actors that check this box must attached an additional sheet showing the nare of the sub-contmotors and state whether or not those entities have
crry]loves If the sub-cont-actors have a nplayen,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information-
Insurance Company Name:
Policy#or Self-ins.Lic.@: 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 form of a STOP WORK ORDER and a Pae
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 DLA for insurance coverage verification.
f do hereby certh under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phoney:
Official use only. Do trot write in this area, to be completed by city or town official
City or Town: Permit/License#
Is Board Authority(circle one):
of Health 2.-Building Department 3..Ca}2orc Clerk 4.Electrical Inspector 5.Plumblrg Inspector
6.Other
Contact Person: Phone g: ��
Verion:.7 Commercial Building Permit May 35,2000
SECTION 10-STRUCTURAL PEER REVIEW(T80.CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
(0/4 LT3- UtL"7U--Q -- ._a_'_SF`I.IL ✓__SXYT�1`- ! as Owner of the subject property
ac •=rt.If in all waiters relative to work authorized by this buildinc permit application.
k
Sign.ture• Own r Date
/' aO C14.1:091A4C7/- _.___.. ,Os uthorizetl
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____
_ �l _
r �
U,'b LRD ---- --- -
S igna[ o r/Ag nt Date
SECTI 12 CONS R TION SERVICES
10.1 Licensed Constru n Supervisor: Not Applicable ❑
_
License Number
Address Exerraton Date
Signature Telephone --__
SECTION 13--WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MGL c. 152,§ 250(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 0 No 0