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31B-230 (10)
64 GOTHIC ST UNIT 202 BP-2017-1078 GIS4: COMMONWEALTH OF MASSACHUSETTS Mao:Block:31B-230 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit BP-2017-1078 Project q JS-2017-001847 Est. Cost: $3500.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: ConstClass: Contractor: License: La: TEAGNO CONSTRUCTION INC 082248 Lot Size(sq.ft.): Owner: FIERST FREDERICK U& EVA C Zoning: CB(100)/ Applicant: TEAGNO CONSTRUCTION INC AT: 64 GOTHIC ST UNIT 202 Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413) 549-0803 Workers Compensation AMHERSTMA01002 ISSUED ON:3/29/2017 0:00:00 TO PERFORM THE FOLLOWING WORK ADD DENSE PACK CELLULOSE INSULATION TO APARTMENT COMMON WALL 3OLF 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: Cas: 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 3/29/2017 0:00:00 $100.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File tt BP-2017-1078 APPLICANT/CONTACT PERSON TEAGNO CONSTRUCTION INC ADDRESS/PHONE 228 TRIANGLE ST AMHERST (413)549-0803 PROPERTY LOCATION 64 GOTHIC ST UNIT 202 MAP 31B PARCEL 230 000 ZONE CB(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST D REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �l.J Fee Paid Typeof Construction: ADD DENSE PACK CELLUILOSE IN JFEATION TO APARTMENT COMMON WALL 3OLF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082248 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION 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 r z;OA,Delay • Sige of:uil. ng •ffi ml 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. TEAGNO / CONSTRUCTION \, INCORPORATED / ey % March 28, 2017 / N To City of Northampton Building Department Subject: Request for Waiver request that your department grant a modification to waive the requirement for control construction for the insulation project at 64 Gothic Street, Apt. 202 in Northampton, MA because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in :hat the cost of control construction is considerable when compared to the cost of the proposed work.All work mi'I ae completed within the prescriptive requirements of 780 CMR.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" ?espectfully, ciez SIGNATURE / NAME Louis Gallinaro :OMPANY Teagno Construction, Inc. ADDRESS 228 Triangle Street CTY, STATE, ZIP Amherst, MA 01002 228 Triangle Street Amherst, MA 01002 413 • 549 • 0803 www.teagnoconstruction.com FAX 413 • 549 • 2628 r-- Version 17 Commercial l Huildin2 Permit May 15.20(44AR 29 I— — j Department use only City of Northampton Status of Pe mit 1. Building Department CurbcutVDr¢ewayPermit - 212 Main Street Sower/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Rottsite 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 � ry SECTION 1 -SITE INFORMATION /7-P✓k 1.1 Property Address: / t'''^� This section to be completed by office LC e/ 6 c I- A c „) ( - Map Lot Unit c,/E. R' du" Zone Overlay District Elm St District CB District • SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 1 2.1 Owner of Record: (2- k%t-<gmv-itiv-, 7tX 4;(alU,', C/662 Nan (Pdnq - '> - Current Mailing Address, t • E:un t-re Telephone 413 2,3? Gg] `/ 2.2 Authorized Agent /'- s.cl /i. JP - /1 4T'f J-7, '- Nerve(Print) r Current MaiiIng Address �6/t0'2, Sipnatury '/ �-"Ic- r --..—~--- Telephone _ SECTION 3-ESTIMATED CONSTRUCTION COSTS rein Estimated Cost(Dollars)to be Official Use Only completed by permit applicant _- 1 1. Building .t et_OC 'V 0 (a)Building Permit Fee I 2. Electrical Co)Estimated Total Cost of Construction from(6) C. Plumbing Building Permit Fee 4. Mechanical(HVAC) E. Fire ProtectionI / 15, E. Tota: u(1 +2+3+4 +5) Check Number / g9yd I This Section For Official Use Only r— B,,ding Fermis Number Date f Issued i 1 3 Signature; I —. _........ Building Commissioner/Inspector of Buildings Date eMr.co l2lr. ,..- p *"fr.c Version l.7 Commercial Budding Permit May 15.2000 I SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 I. CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repair Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing Change of Use❑ Other 0 i Brief Description Enter a brief'e^scription be e. Of Proposed Work: Ala�1 brief ift-c K del icleJ2 ;Aso7rr-fm.'1 't'9 A�y, Crt‘r'e'.--t r'e- 464. ¢/f®/extu 421; li 3® LF SECTION 5-USE GROUP AND CONSTRUCTION TYPE /JO C IS 4141.1J-) USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 0 1A I 0 1 A-4 0 A-5 0 1B 0 I B Business 0 2A Eli `E _Educational 0 2B I ❑ F Factory 0 F-1 0 F-2 D 2C 0 ' kH tigh Hazard 0 3A ❑ i l:stitutional 0 I-1 0 1-2 0 1-3 0 36 0 i !FM Mercantile 0 4 0 1 R Residential 0 R-1 0 R-2 0 R-3 0 : 5A 0 5 Storage 0 SA 0 S-2 0 s 5B f 0 I1 U 'Utility ❑ Specify: M Mixed Use Specify: S Special Use o Specify: /t/f (./trrcfly > -i COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS.ADDITIONS AND/OR CHANGE IN USE j Ex sting Use Group: Proposed Use Group: I Ex sting 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) IA 2" 2�e sT 4` 4'" Trial Area(sf) Total Proposed New Construction(sf) Tetal Height(ft) Total Height ft ,7 ,`7-Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: 1 P. sire 0 Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑ 11 Versionl?Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING NO Ctiaa'yes Existing Proposed Required by Zoning I Thu:column to be Filled bi by Building Derailment Lot Size FronIatc Setbacks Front Side L: k. L R: Rear Building Height Bldg. Square Footage .o Open Space Footage ILot area n mus bldg k paved parkint:I a of Parking Spaces Fill: i reoatme&Lacellunl A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO /(-) DONT KNOW O 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 O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O N0 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 yl IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version' 7 Commercial Building Permit May I5,7000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANTrTO 789 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) r 4.7 Registered Architect Ay fr— Not Applicable 0 Name(Registrant). Reafsation Number Peeress Expiration Date 'ianatcre Telephone 9.a Registered Professional En•ineer s): I f Name Area of Responsibiiay �I. F,amess Registration Number inane __.... Telephone Expiration Date Name Area of Responsibility Acdfess Regi:irallop Number Signature Telephone Expwtion Date Nome Area of ResponneeitY Actlress Registration Number St mat_e Telephone E6pirabon Date Nsme Area of Responsibility Andress Registration Number Signatu'e Telephone Exgwtion Date 9.3 General Contractor ,fir " .VP (.e)Guj-frc %CA; 1 -LMC ' ... Not Applicable p Company Nonle r l c2(ei 6;e1 • Rasponsibte In Charge of Construction 9,01.8 'rr ire. �e rf"+ ' /('K/r.i I/ H/.�cm) �--` na. es I/I c\ ..� ,.yn.ture Telephone F Version I.7 Commercial Building Permit May 15.2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) }}pp(( '.lependent Structural Engineering Structural Peer Review Required Yes © No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, fiPtrVCk.— q 1I'e,4-- / , �J,as Owner of the subject property heresy authorize AOVC_I /5 6' [�!/t1A 20 /Ec k � t (.c ' yuGJ`CCa-r yNL - f; act on my b- alf, in all .-.ers relativ A, work authorized by this building permit application. Air Sria_r 3 ® / ?)ate _.. • ACuii- C lllNlifw� %Payr'o l°n2, e�c�mz Ztirr. .asdw�d - Acant hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. S;_ned under the pains and penalties of perjury. l Lois C6 ///Qe4g- tre bre ofowaanAgant Dara SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed ConstructionSupervisor: / / Not Applicable ❑l 'I C/ (J Name of License Holder: 1.11--n01.11--n0 U ( S C/4 (/[N++-tO _ C -0 ,2,'/ (Q License Number /3) Rdimuwvelq p . %22-k N4 er/Co1 . k:64-l7 Acdies Expiration ale 7 gl e.U--: /� � Cr t-ct.22-c5' y/3— 576 —I/oA Si nature Telephone SECTION 13-WORKERS'COMPENSATION 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 uilding permit. Signed Affidavit Attached Yes No © _ 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: UiLrt it - G 6 f (or' /t X- - 44"Ot G e4«V-16 The debris will be transported by: /cel&y,vC &A-tic rIiatJ ,Y N( • The debris will be received by: /4/7" d ec y /,y -) 3,7 p1(4 jfifileed R ) ht,„± .47,,Ao<>. Rs," Building permit number: Name of Permit Applicant 1 est S (1:;4141,0",a9 %12.9/(}0 d� (�ocAior V3-2/ 2.1'77 /4,,. Date Signature of Permit Applicant s\ The Commonwealth of Massachusetts Department of Industrial Accidents �ff<' I,j. Ofceolinvestigations ' 1 Congress Street, Suite.100 V. :1ie, Al Boston, MA 02114-2017 3 5 www.masss.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information ` j Please Print Eegibly Name BusinessOruanzationandividuap: , °'j+yA/Ca i41er air'VL."Y/C!c ±:-,(;C Address a l/2' City/State/Zip: ,Lf'r1-� J11A otecJ Phone IS: 4, ; - a? , ,to-5 it re you an employer? Check the ropriate box: Type of project (required): L.V] I am a employer with /S 4- E I am a general contractor and 1 ❑ ..e.. s lhave isted on ha e el sub-contractors 7. Remodeling construction employees (fu!l andor gar[-tfrnel_ .❑ l am a sole proprietor or partner- - L ct`6g ship and have no employees These sub-contractors have 8. 9 Demolition working for me in any capacity, employees and have workers' ,) 9 Building addition [No workers' comp. insurance comp. insurancel' < we arc a corporation anti its 10.0 Electrical repairs or additions required.] - ❑ i' officers have exercised their I I. repairs or additions 1.L I am a homeowner doing all work ❑ Plumbing myself [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] ' c. 152. §I(4), and we have no I } employees. No workers' Ii Other _ _ comp. insurance required.] -... . .ppicantthat checks box x I must also till out the section bl showing thci r workers'compensation polity information. ry mho submit this affidavit indicating they are doing all va,rk and Ihen hire outside contractors must subtit a new a ffidavit Indicating such. maneou that check thin box Duro attached an additional sheet uhowina the name ofthe sub-contractors and state whether or not those entities have -onne.c._ lits sub-contactor,have employees,they must provide their workers-camp.police number —1 dna an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site t);ormatmn. � snrance Company Name:_ 1^ Al /((" L'•7- t/) eiCataS . C'C.: .. Jay#or Self-ins. Lie. :/L ..t Ad, A 7O/OZ Q /t __ Expiration Date: 7/7 4/l- )1444 r 1(:b Site Address:( f/(.teill? di6, A�/1I�uv'/ /0 . ' ei City/State/Zip: Attach a copy of the workers' compensation poky r eclaration page(showing the policy number and expiration date) 1 ri'.ure to secure coverage as required under Section 25A of MGI. c. 152 can lead to the imposition of criminal penalties Mir, Erse up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a I' c t [up to 5250.00 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. -teI Ao hereby certify under the pains and 7n lties of perjury that the information provided above is t ue and correct. 1 ,. .}J C/ s _il;,Nay/t.._/{�/i. n !2 Dale: ♦ )/ I Bone#:F/' 17R CY7-_010 3 • Official use only. Do not write in this area, to be completed by city or town official. City or Town:_ Permit/License# 1. Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector • 6.Other • 1 Contact Person: Phone#: