32A-138 (115) BP-2009-0435
Gds#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0435
Project# JS-2009-000588
Est. Cost:$2000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const,Class: Contractor: License:
use Group: PIONEER CONTRACTORS 017890
Lot Size(sq.ft.): Owner: FEMBSTED INC
Zoning: Applicant: PIONEER CONTRACTORS
AT: 23 MAIN ST - FITZWILLY'S BASEMENT
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586-5491 Workers
Compensation
N O RTHAM PTO N MA01061 ISSUED ON:10/21/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR WALL,NEW PANELI NG,PLY FLOOR &
BASEMENT TOILETS
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 10/21/2008 0:00:00 $55.0012912
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
•
File#BP-2009-0435
APPLICANT/CONTACT PERSON PIONEER CONTRACTORS
ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491
PROPERTY LOCATION 23 MAIN ST-FITZWILLY'S BASEMENT
MAP 32A PARCEL 138 000 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �jav
r!_
Fee Paid
Typeof Construction: REPAIR WALL,/09/
EW PANELING.PLY FLOOR&BASEMENT TOILETS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO 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
Demoli '.n Delay
421/1/2a-25
Signe POT Building Ifflci. 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
DepaMient use only
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 Structurat 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
1.1 Property Address' This section to be completed by office
23 Main St. (Basement @ Fitzwilly's/Toasted Owl) Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
FEMBSTED Inc. d/b/a Fitzwilly's 23 Main St.,Northampton, MA. 01060 O
Name(Print) Current Mailing Address'.
// (413) 584-8666
Signature //V// /
Telephone
2.2 Authorized Mont:
Pioneer Contractors P.O. Box 1145 Northampton, MA. 01061
Name(Print) Current Marling Address_
(413) 586-5491
Signature iGiJ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $2,000.00 (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) *ZIIDD- - Check Number /079/?- 65—
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
•
Version!.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 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use❑ Other 0
Brief Description Enter a brief description here. Repair wall, install new wall paneling, install new plywood floor
Of Proposed Work: underlayment &vinyl flooring - g Uy anis dr '(a it
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 ❑ A-3 Er 1A I ❑
A-4 0 A-5 0 1B 0
B Business ❑ 2A 0
E Educational 0 2B 10
F Factory ❑ F-1 0 F-2 0 2C I 0
H High Hazard 0 3A 0
I Institutional 0 I-1 0 1-2 0 1-3 0 3B 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S-1 0 S-2 0 5B I ❑
U Utility ❑ 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: Assembly Proposed Use Group: Same
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)
lst
2"° 2"° /I
3 3ra
4 _. 4m _.
th
Total Area(sf) Total Proposed New Construction (sf)
Nit
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 E Private 0 Zone Outside Flood Zone❑i Municipal ❑i On site disposal system❑
Version1.7 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 -- -
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page and/or Document it
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Qi 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 O NO O
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 will disturb over 1 acre? YES O NO Q
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(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
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
Pioneer Contractors
Not Applicable 0
Company Name:
David Claxton
Responsible In Charge of Construction
P.O. Box 1145 Northa���mp/t-Q[Fl 0 161
Address /'/j//� /// / / �
�� ' I/I � (413) 586-5491
Signature ✓✓✓ Telephone
Version l.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) 0
Independent Structural Engineering Structural Peer Review Required Yes No Q
SECTION 11 •OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Fembsted,Inc.
,as Owner of the subject property
Pioneer Contractors--David Claxton
hereby authorize to
act on my behalf,in all matters relative 0 work authorized by this building permit application.
• 10/20/2008
Signatureof OCvner ✓�'�— nate
Pioneer Contractors--David Claxton as6wneNAuthurized
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 pai nd pe Iti of•ese ry.
yy n <.it/
Print Name
10/20/2008
Signature of Owner/Agent Date
SECTION 12•CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of Loose Homer David Claxton 017890
License Number
P.O.Box 1145 Northampton,,,, MA. 01061 C 01119/2010
Address ��) //� / Expiration Dale
/%[ /�(j/I r/ 7 (413) 585-5491
t �-
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8))
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 V No 0
lomp
J
%e (1-1-ifg n{ Narfljenuptnnetrol
DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building = .,
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE. AFFIDAVIT
I, Pioneer Contractors
(ieensedpermirlee)
with a principal place of business/residence at:
P.O HOZ_ • • • - • • I t . (pbcne ) 586 5495
(sarn/dry/swcdip)
do hereby certify, under the pains and penalties of perjury, that.
0.,71 am an employer providing the following workers compensation coverage for my
employees working on 'his job:
Wcc 5005957012008 6/3��
Assnciatnd 1 P Fmpinynrc n5nrancCo ---- - q
(lnsurenw Company) (Policy Number) (E.piratiou Date)
O I am a sole proprietor, general contractor or homeowner (circle onel and have hired
the contractors listed below who have the following worker's compensation policies.
(Name of Conaacwr) (lnsuran« Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (EPUUnO0 Dale)
(Name of Contactor) (Insurance Company/Policy Numly ) (Spire Doo Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiranou Dale)
tr am aStitimal shad if --"try to moh.d deformation pa-imog m.11 mmutan)
O I am a sole proprietor and have no one working for me.
O I am a home owner performing all the work myself.
NOTE:plae be aware that wink homeowma who endplay paaom m da Cot;m.t.no' aanmavtio9 m maw a work on a dwelling of
not mat Wn throe unit in which the bamoonoc rmda a oo We gvaut ayyM1mau Wcw art Oat gmaalty ambad to be
ea,ployva nada the workers minim Aa(GL152pt(5)),yylimtiw by a hamo>wm for a Loam err permit may cnOre-We
Obal Ono of.n cl0yw under the WoekeeiCoospeasatioct Act
I uodaaund the a copy of this wt®m may be fvwaNad to the Deyermaaaa of behobi.Aeddmv Of6oe of Imanom for the
wage aaSmtiaa and that Lilt=m amus macvnga umda acaioa 25A of MOL 151 on Ie4 to the impmmoe ataimmil cabbies
com:ttingofa floc of up to S1y00.00 arbor ere)peo marry u000 year and vW pa Uc'w tbeformof a Slop WmtOrde Ltd t .
fico or 3100.00 a thy;Sawa me_
For&p.^^-e. we only
� P null Number
�0ry — kly�l Map# Lot#
Slgua of Llvneir'a� toe/Perm