32C-044 (25) 76 PLEASANT ST BP-2018-1215
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-044 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category'ALTERATION BUILDING PERMIT
Permit# BP-2018-1215
Project# JS-2018-002173
Est Cost: $15000.00
Fee: $105.00 PERMISSION IS HEREBY GRANTED TO.-
Const
O.Const.Class: Contractor., License:
Use Group: HENRY ORSZULAK 108603
Lot Siae(sn.R.): 7492.32 Owner: SURER PROPERTIES LLC
Zoning:CB(100)/ Applicant: HENRY ORSZULAK
AT. 76 PLEASANT ST
Applicant Address: Phone: Insurance:
380 WESTFIELD ST WC
WEST SPRINGFIELDMA01090 ISSUED ON:5/2112018 0:00:00
TO PERFORM THE FOLLOWING WORK REMOVE CEILING AND NON STRUCTUAL WALL
PARTITIONS
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: Oo1• Insulation:
Finan 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 5/21/2018 0:00:00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File N BP-2018-1215
wTTO
APPLICANT/CONTACT PERSON HENRY ORSZULAK
ADDRESSIPHONE 380 WESTFIELD ST WEST SPRINGFIELD
PROPERTY LOCATION 76 PLEASANT ST
MAP 32C PARCEL 044 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMOVE CEILING AND N STRUCT L WALL PARTITIONS
New Construction
Non Structural interior renovations
Addition to Existin
Accesso Structure
Building Plans Included
Owner/Statement or License 108603
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
proved_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
Demolition Delay
/.il Z
1 IN
gnaam o Btu di �ffrcia Date
Note:Issuance 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.
want fb s-farif '7f5AY'
Versionl.7 Comrnercial BuildingPermit May 15,2000 U a5C 2 Ma 160
usean[y �1
ity fNorthampton Status of Pemit
wild g Department Cum CWDIN""PemsT
8 208 21 Main Street Aoom 100['r,.VAY
T OF BUILDING Il 51he pton, MA 01060ORTHAMPT .tah + 240 Fax 413-587-1272 Pbusda Plans-
Other Speciy
tansOtherSpeciy
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: g This section to be completed by office
_...__ Map IIiAV Lot L/ Unit
Zone Overlay District
J ��fA.s 9-N % $�/1S£�. ._.. Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
71f5 ,c« .. Pd.. inn `lel l�< /�� . ,
Name(Print) Current Mailing Address U' ( d L7
Signature Telephone
2.2 Authorized Adent:
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
Com leted by permit applicant
1. Building (a)Building Permit Fee
I�D.O. _ O .__. �._....
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) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Commissioner ctor of Buildings Dale S 2/
a"l : prS � rUIC LSrnc . Com
Vernonl 7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolititi Repairs Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work:
PA_ Noel sr�+cPky c n/Aw 7gk'T1lta.J
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1S ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
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'. __ ._. .. Proposed Use Group
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(so
2"a 2ra _. _.... .....
_ ._..
Total Area (sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height It
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public � Private ❑ Zone _,,,_ Outside Flood Zone Munici palm On site disposal system❑
Versmol.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No O
SECTION II -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, _L 2 1 C_ x.1.__- 1 14..4A.SAi_ __._ _._. ___... , as Owner of the subject property
hereby authorize #JNe"y O !' ZZ14 L WA 0,i SS/eVj_ CS
//L) to
act on my�bjhatIf all mSa�tars relative to work authorized by this building permit application
Signa ure o� f Owner Z Data
G/4NLt-1121!;w( L ^YjG .._. as OwneOAuthorized
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 ubder� s and penalties. _.. ..
Print Name _.._
Signature of OwnedAgenl are
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable r7❑
Name of License Holder ((W'A _x Q� SzcI L!4k—
License Number
,peso L✓frr ii£�� s.-nss, t�s� s?a G �s� � _�A _pyor- l
Address ExniraUo
�gnatu
Tel
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 building permit.
Signed Affidavit Attached Yes No O
�` The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.govldia
WW.vkers'Compwfifisatisvn Insurance davit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING.AUTHORITY.
Aprifictimlifformsubm Pleasse Print Legibly
Name (Business/OrganizatioMndividual):�/o/O.( 644✓!L'f S /R! G
i
Address: l,.lSS. /f .c _/t FF r
City/State/Zip:4)$$%6'2e2/4i'/f4S M," Phoneh:
Are you an employer'!Check the appropriate box:
�/ Type of project(required):
I.J3Lamacm,w,wrwah O mipwyees(full a,wor par[-rime}' 7. ❑New construction
2.❑1 an a sole proprietor or parmenhip'and have no employees working for me ne $, ❑ Remodeling
any rapacity.[No workerscomp.iourence mquved.] 9. ❑Demolition
21 am a homeowner doing all work myself[No workers comp.insutmce obtained.]I
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition
e ut that all contractors either have workers comptmacon instance or are sale 11.❑Electrical repairs or additions
pmprielers with no employees. 12.❑Plumbing repairs or additions
5 I am a,emend contractor and 1 have hired he sub-contrnetors listed on the attached sheet.
These xul .dcru+ors Faye amplorees van lave workas'cnmp. me.: 13.E]Roofrepairs
6 F1 We are a mr,wramn and its officers have e.verceed their right of exemption per MGL c. 14_❑Other
152,§1(4),and we have no employees.[No workers compcontact ree ulred.]
`Any applicant hat checks box#1 mus[also fill out the section below showing their worker'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors most submit a new affidavit indicating such.
ICmntrac[ors that check this box mus[attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the wb<on[me ms have employees,they most provide[heir workns'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: lrh4q,414 1A)5,it1?g41%(C Jr /C c7 I�
Policy#or Self-ins.Lic.#: G S triol E{Q 06 aQ�2 -G Expiration Date:,6f 2 /d
Job Site Address: 74CrZ59{Hpd h City/State/Zipotbd//Fs9H 2 -�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a foe 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby ce/rti/fJder the pains and penalties of perjury that the information provided above is hue and correct
S- stood: Date: S Z '5
Phone# y! 7`4 3 -2 X 6 3
Of use only. Do not write in this area,to be completed by city or town offciat
City or Town: Permit/License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
4C�d CERTIFICATE OF LIABILITY INSURANCE ce05117/2018S
THIS CERTIFICATE u ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIMO
REPRESENTATIVE OR PRODUCER,AND WE CERTIFICATE HOLDER.
IMPORTANT: H the cert)ews,holder Is an ADDITIONAL INSURED,the Policy(les)must have ADDITIONAL INSURED provlabns or be andornd.
If SUBROGATION IS WANED,subject to the terms and conditions of the policy,Danser,polleles may require an endorsement A statement on
this certificate don not confer rights to the certificate holler In Ileu of such endenanM s).
rnoouceRNeill S Neil Imminence Agency Inc IioNse Datl R Jerry
viF
662 Riverdale Street 413-]32413] .473-]31E329
West Springfield,MA 01089 tlj�neillins.cmn
wbYlre AProRWxo covEwle xAce
WSURIIRA: SAFETY INSURANCE COMPANY 39454
WauRED MOR Services Inc www s: Chubb InsuranceCo CHU
PO Box 977
West SpringfieM,MAOIO90 WRIKERC:
wsuRlRD:
wauneR E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAIMS.
Wm MIMNdUMYCE A R P0UKYMMMaaR ev LJMrrd
A MMMMIALOENeRULu V BNWO018719 01/232018 183/2019 EACH OCCURRENCE $ 1.000.000
CIAI ISAMDE 5A OCCUR P S 100.000
MEOEXP I $ 5.000
PERSOMLSADVmILPY f 1,000,000
GENLAGGREWTEU ITN LIES PER. GENERAL AGGREGATE f 2,000.000
POLIcr �ITKT ❑LOL PRODUCTS-COMPIWAGG f 2.000,000
s
NfreMOW4E UAaILm s
AWAUTO SONLY INJURY IPA Dxron) S
OWNED SLHEWLED DOOLYINJURY(P M nnl f
AUTOS ONLY N cs flry OAMME
AIUTOSRE.ONLY AUTOSON_Y f
f
UMNIUALJN OCCUR EACH OCCURRENCE f
MMUNE COMM —E AGGREGATE f
CEO I I RETEMION f f
gvJOR"As cowDJunar 8582UB-0G297223 11878017 11878018 AT
ANDEPOLMIRAP MI YiN
ANYPROPP1=:NARTNE.EGUTNE - x1A EL EACH ACCIDENT $ 1DO.000
or CERMEMBER EXCLWE% 1DD.gUg
nAL50M In Nm E.LOISEASE EAEMKOYEE f
IIp CryvlMunElr
DESCRIKKA OF OPERATICNSIxAM E.L.g6FlSE PWCY OMIT f 500,000
OEACNTON OF CPUUmNA I LOWTONS I VwnCLES ACORDtW,AMNkvI"oM„M,n.yw anvii Iff n&We.M nrdi
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
212 Main Street ACCORDANCE WTRI THE POLICY PROVISIONS.
Northampton,MA 01060 CN A
AUTNowuofleveFaEx
81198&2015ACORDCORPORATION. Allrlghbraasrved.
ACORD 26(2013103) The ACORD name and logo aro registered marks of ACORD
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: 16 fc s Atg ✓ � S rt£ ,
The debris will be transported by: 4e z- u/ e t f
The debris will be received by: If,, z- A✓¢t -
Building permit number:
Name of Permit Applicant S5Vr/icr5 /.-/ C—
/"Y /�
Date ignature of Permit Applicant
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j6 PLEASANT ST_
EXISTING FIRST FLOOR PLAN NORTHAMPTON MA SMWCE
e M, 5,413 SQ. FT. "` - EMST16 rsxr aL a Rm F .2fi
MOR Services Inc.
Commercial General Contractors
380 Westfield Street
West Springfield MA,
Tel, 413-363-2863
Fax. 413-363-9371
henry@morservicesinacom
I request that you grant a modification to waive the requirement for control construction for the (Minor
demolition project V floor)at (76 Pleasant street) in Northampton because the work is of a minor
nature,will not affect health,accessibility, life and fire safety, or structural requirements and is
impractical in that the cost of control construction is considerable when compared to the cost of the
proposed work.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an
exclusion from control construction for this project'
Respectfully,
Henry Orszulak
MOR Services Inc,
380 Westfield Street
West Springfield MA,01089