32C-001 (57) 150 MAIN ST SUITE 6 BP-2017-0864
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-001 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-2017-0864
Project# JS-2017-001457
Est.Cost: $62500.00
Fee: 5441.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MARK SMITH 104325
Lot Size(sq. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG
Zoning:CB(100)/ Applicant: MARK SMITH
AT: 150 MAIN ST SUITE 6
Applicant Address: Phone: Insurance:
5 ANNA ST (413) 531-7342
WAREMA01082 ISSUED ON:1/25/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE & IMPROVE FACADES ON SUITES
50 & 80. FABRICATE & INSTALL NEW RAMP ASSEMBLY TO REPLACE EXISTING STAIRCASE
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: OI: 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 1/25/2017 0:00:00 $441.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0864
APPLICANT/CONTACT PERSON MARK SMITH
ADDRESS/PHONE 5 ANNA ST WARE (413)531-7342
PROPERTY LOCATION 150 MAIN ST SUITE 6
MAP 32C PARCEL 001 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
LOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid j, I t
Building Permit Filled out _Ut
Fee Paid
Typeof Construction: RENOVATE& IMPROVE ' "PES ON SUITES 50&80. FABRICATE&INSTALL
NEW RAMP ASSEMBLY TO REPLACE EXISTING STAIRCASE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 104325
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
• on iielay
20 0
%�
gnature of Buil.in: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 40A.Contact Office of
Planning&Development for more information.
Versionl.7 Commercial Building Permit May 15,2000
Department use-only,
-- City of Northampton Status otPermit:' `i
Building Department Curb CutfDnyewayPmmit +
Al2 Main Street Sewer/SepticAva3ibl6ty i
u i i 7 an Room 100 WaterANei Avails iy
Jw
North mpton, MA C1060 Two Sets of9tnrclNla4plags
__. -phone-41$-5 -1240 Fax 413-587-1272 PIo75de Plans t
_ _
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: This section to be completed by office
Thornes Marketplace Map Lot Unit
150 Main Street Suite 6
Northampton,MA 01060 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
i 2.1 Owner of Record:
Richard M Madowitz Hampshire Property Management _ Il
•
Name(Pnnt) r. - Current Mailing Address
t p582-9970
I 413
Signature ,�/Y_�l`- �
V Telephone
2.2 Authorized Anent: j
Mark Smith 5 Anna Street 2
Name(Print) Current Mooing Address
S
(413) 531-7342 _ -_
Signature `� � -Rebhan° ,
SECTION 3-ESTIMATED CONSTRUCTION COSTS
(
Item I Estimated Cost(Dollars)to be I Official Use Only
completed by permit applicant
11. Budding - (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6) -.---.—.-..._._. ..._._.
l3. Plumbing Building Permit Fee
14. Mechanical(HVAC)
5. Fire Protection - -- _--- ---
6. Total=(1 +2+3+4+5) .(02. VF1 OII"--' i Chen Number W l/ / 1d3/
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
I
Building Commissioner/Inspector of Buildings i 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 0 Existing Wall Signs 0 Demolition Repairs Additions 0 Accessory Building
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use❑ Other
Brief Description Renovate& improve facades on suites 50 and 80. Fabricate and install new ramp assembly to
i Of Proposed Work: replace existing staircase.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ 1A-1 ❑ A-2 0 A-3 0 to I 0
I A-4 0 A-5 ❑ 1B ❑
B Business 0 I 2A 0
E Educational ❑ 2B I 0
IF Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A 0
Institutional ❑( I Li 0 i-2 0 1-3 0 3B 0
M Mercantile al I 4 0
R Residential 0 i R-1 ❑ R-2 0 R-3 0 SA ❑
5 Storage Els-i r0 S-2 ❑ j; 5B 0
i U Utility
0 ISpecify:
y.
I
S Special Use ❑ Specify:
COMPLETE THIS SECTION !F 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 ANC AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1`
17
2"
277
315
4m 4,. _ !
Total Area(sf) Total Proposed New Construotion jse
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:
I
Public 0 Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system]]
Version1.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING 1
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side I L:-_ R: L: R:
Rear
Building Height
Bldg. Square Footage - - -
I
Open Space Footage _ /o
(Lot area minus bldg&paved _
e rxmei
of Parking Snares
Fill:
(volume&Location) - —
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES O
IF YES, has a permit been or need to oe obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: Varies
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, excavation,or filling)over 1 acre or is it part of a common plan
that wil!disturb over t acre? YES Q NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version':.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:
0
Thomas Douglass Architects Not.Applicable
Name(Registrant): ---- - —
Thomas Douglass Architects Registration Number
Address
(413) 585-0641 Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsblty �I
Address Registration Number
Signature Teephone Expiration Date
Name Area of Responsibility
I '
Address Registration Number
Signature Telephone Expiration Dale
Name 111 Area of Responsibility
Address Registration Number
Signature Telephone j Expiration Date
9.3 General Contractor
Woodsmiths Not Applicable 0
Company Name
Mark Smith
Responsible In Charge of Construction
5 Anna Street
Address _.
(413) 531-7342
Signature Telephone
Version l.7 Commercial Building Permit May IS,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) i
Independent Structural Engineering Structural Peer Review Required Yes 0 No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Richard M.Madowttz _ —, as Owner of the subject property
hereby authorize Mark Smith _ _ __ _ _ __lto
act on my pehpll a ers r lab to work authorized by this building permit application _
�� 12 28/2016
Signature of Owner Date
Mark Smith j
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
ane belief.
Signed under the pains anC penalties of penury. 1 ,
ark
rin[Name Smlt
t
P E..-- 57"1/153._---- l-12-17 __ ____ -I
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder Mark Smith ( 5 101'32!7
License Number 11
5 Anna Street Ware MA 01082 12113 11
Ad r sExpiration Date
2._. /1",cr (413) 531-7342
[padre Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
I
Workers Compensation Insurance affidavit must be completed and subrmtted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the ybuilding permit. _ �
Signed Affidavit Attached Yes L/ No 0
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, ! 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: i v MM.) `.k7
irm( e ste
The debris will be transported by: beck� '1J\n L- cvi-teak—
The debris will be received by:
Building permit number: n1
Name of Permit Applicant MAILcctk
1 ' 2- 17 (43oz. ( 1 � L _
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
—,—— Department of Industrial Accidents
=1d!=�t Office of Investigations
=�e__0 I Congress Street, Suite 100
=t
1= Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information tn,t \ "� Please Print Legibly
Name(Business/Organization/IndivSM 1iidual): I v`A 1 /F( j�gQ 'vgCkutvt I 1 ft
Address: J /viTNnr '1 .
City/State/Zip: kpr - wt4 Phone #: `it -S 1-73TZ_
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. I am a sole proprietor or partner-
listed on the attached sheet. 7. [�Remodeling
ship and have np employees These sub-contractors have g. 0Demolition
workingfor me in anyemployees and have workers'
c 9. ❑ Building addition
[No workers' comp, insurance comp. insurance.-
required.] 5. E We are a corporation and its IQ❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.D Roof repairs
insurance required.] ' c. 152, §1(4), and we have no
employees. [No workers' 13.E Other
comp. insurance required.]
*Any applicant that checks box:1 must also till out the section below showing their workers compensation policy information
Homeowners who submit this 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'comp.policy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site •
information. / ,,�� I� �t
Insurance Company Name: („�tv4 .�-r451,trmJCe (.4.
Policy 0 or Self-ins. Lie. #: 07(..e[ L•03 3 Expiration Date: 7-2-[7
Job Site Address: 176 Mkr$l � -. City/State/Zip: 1\)0t44vR0I0I0iJ,lrtrt—
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure covegage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as will 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 NA for insurance coverage verification.
I do hereby certiff under the pains and
penalties of perjury that the information provided above is-true and correct.
Signature: l 99 """—' Date: 1 'Ito -1 /
Phone#: Ltt7 '�7�1�-�?j�I�'
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#:
Initial Construction Control Document
1 fL To be submitted with the building permit application by a
NRegistered Design Professional
r. for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Thornes Marketplace Proposed L1 Ramp and Storefronts Date: 01/12/2017
Property Address: 150 Main Street, Northampton, MA 01060
Project: Check one or both as applicable: = New construction X Existing Construction
Project description: Renovation of existing storefronts and construction of accessible ramp in corridor for access to
phased bathroom construction.
I Thomas Douglas MA Registration Number: 8944 Expiration date: 8/31/2017 ,am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[X] Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [ ] Electrical [ ] Other
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that t(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit t fficial a `Final Construction Control Document'.
,
Enter in the space to the right a"wet"or L-ce^.perV9 es0i.' :,',t.;�i q
electronic signature and seal: f p p
rrau�,^aI�� l.S t
a:. ;f
Phone number: 413-585-0641 ";i?,- ; '- Email: douglas@tdouglasarchitects.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06_11_2013