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18D-026 (58) 55 DAMON RD-DUNKIN DONUTS BP-2018-1365 GIs a: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-026 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv:NEW COMMERCIAL BUILDING BUILDING PERMIT Permit BP-2018-1365 Proiect# JS-2018-002423 Est Cost: $460000.00 Fee: $3220.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: STEVEN RIBEIRO 074975 Lot Size(sn.Fill: 61419.60 Owner: SARDiNHA EMANUEL zoning:GI(100)/ Applicant. STEVEN RIBEIRO AT. 55 DAMON RD - DUNKIN DONUTS ApplicantAddress: Phone: Insurance: 20 RICHARD CIRCLE (508) 889-46610 WC SEEKONKMA02771 ISSUED ON.612912018 0.00:00 TO PERFORM THE FOLLOWING WORK: NEW COMMERCIAL BUILDING 2550 SF 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 6/29/2018 0:00:00 $3220.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File ft BP.2018-1365 qc-�p,jJJ5 � '& LJ APPLICANT/CONTACT PERSON STEV N RIBE5 ADDRESS/PHONE 20 RICHARD CIRCL SEEK NK (508)889-4661 P PROPERTY LOCATION 55 DAMON RD-DUNKIN ONUFS MAP 18D PARCEL 026 001 ZONE GIO 00V �06&f2t­t THIS SECTION FOR OFFICIAL USE ONLY. PERMII APPLUCATION CHECKLIST d ENCLOSED REQ��TE ---� /1W;,,J ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 1 - '7 a Fee Paid / Typeof Construction- NEW CONSTRUCTION OF DUNKIN DON F5? New Construction Non Structural interior renovations Addition to Existing JJ) Accessory Structure I I Buildine Plans Included: Owmer/Statement or License 074975 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) 1 PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Pin 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 / 9 JZJ� Eel Signature of Building 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 ane granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. RECEIVED Version 1.7 Commercial Building Permit May 15,2000 Department use only JUN2City of Northampton Status of Permit:0 2019 Building Department Curb CWDdveway Permit 212 Main Street Sewer/Septic Availability DEPT OF BUILDIND INSPECTIDN5 Room 100 Water/Well Availability NORTNAMPTorv.MA otao rthampton, MA 01060 Two Sets of Structural 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 jzt 1.1 Property Address: This section to be completed by office 55 batilA _ n — Map Lot Unit �tt��` DZ)_��'S Zone Overlay District DZ r` Elm SL District CB Dbtrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ,,++ '' & tf �+.l Name(Pont) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Clwf/C�Ci yt YGS Sylw QeQ �/l Qom, w+N Name(Print) Current Mailing Address: 7rtV 3af 2�sy Signature Telephone SECTION 3-E (MATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bennilapplicant 1. Building j S 1 ove • 00 (a)Building Permit Fee 2. Electrical yaOUc •v0 (b)Estimated Total Cost of Construction from 6 3. Plumbing 38CCo . ro Building Permit Fee 4. Mechanical(HVAC) "a0 Z,9 coy cu �/ 5. Fire Protection 6. Total=(1 +2+3+4+5) bb COC . 00 Check Number 7 This Section For OHiclal Use Only Building Permit Number Date Issued Signature: Building Commissionerarepector of Buildings Date Version 1.7 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 ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change ofr Use❑ Other❑ "` Brief Description Enter a brief description here. ji C&10Lon^ a-T D-A,k-, N. +-% Of Proposed Work: PLe r P`.A SECTION 5-USE GROUP AND CONSTRUCTION TYPE Ii USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 A-3 El1A El A4 ❑ A-5 ❑ 1B ❑ B Business I 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 [(?y 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 si 1. 2 a 2'0 3" P m 4m 4 Total Area(so Total Proposed New Construction(sf) Total Height(h) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zane Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versioml.7 Commercial Building Permit May 15,2000 B. NORTHAMPTON ZONING Existing Proposed Required by Zoning n a column to be filled in by Building Department tot Size Frontage Setbacks From Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Int area minus bldg&paved parking) #ofParking Spaces Fill: volume&Ideation A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO d DON'T KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ©' DON'TKNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO G", DON'T KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O Datelssued: C. Do any signs exist on the property. YES O NO 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excav on,or filling)over 1 acre or is it part oda common plan that will disturb over 1 acre? YES O NO 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 Ar chitect ,1- 1rttyr.,.v,:rr. SSS. Not Applicable ❑ Name(Registrant): I Q S S TeFn ^err rverl Registration Number Atldress Expiration Date Signature Telephone 9.2 Registered Professional Engmeer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Atltlress 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 4dia ar..� 13u,'kj.-s Not Applicable Company Name: GI I � 1v eae aS Responsible In Charge of Construction I W" Address Ing ae( L3 sy Signature Telephone Versim l.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11( Independent Structural Engineering Structural Peer Review Required Yes O No - SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETEDWHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, CO'. 44 as Owner of the subject property hereby authorize C/r r'`G't I�S to act on Cmmyy-behal all ma rs relative to work authorized by this building permit application. 6 7-11 Signature of Owner � te Date 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 and belief Signed under the aips in aloes of perjury. Print Name ��/-YY /AL�ttl(frro [ Signature of OwnenAgent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction SuopCe'�Irv'so�_r.. (� Not Applicable ❑ Name of License Holder: _gt"'en R' iq�iti CS - 07y97S License Number 10 Address �7 Expiration ate 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 YesGr� No O 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: S5 ++nen POL The debris will be transported by: NER The debris will be received by: 1UE Q Building permit number: Name of Permit Applicant Cbff Pie,,. tT C Date Si nature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.goP/dia Ww.rkers'Couropermation Insurance Affidavit-.Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ®® Please Print Leeibly Name (Business/OrganiratioMndividml): ' ,^, e'"l .diriS Address: N(o rJ $X� l�C-- City/State/Zipj�/j ]oath M4 47172.# Phone #: Sok Amyou mployeRCheektheappopribox: an ll 'ta Type of project(required): I. maemployerwilh�cmployees(full and/or parttime).' 7, e.construction x❑I am a sole propricmr or partnership and have no employees working for me in $. ❑ Remodeling anycapide, [No workerscompno mance expired) 9. ❑ Demolition 3 am ahomeowner doing all work myself [No workere'con, insurance required.]' 4.❑1 em a homeowner she will be hiring contractors to corded all work m my propeay. ]will I O❑ Building addition ems etlatallcontacmrseitMrMvewnrkers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5,❑I am a general contractrawd l have hired the subcontractoa listed on the attached sheet 13.�ROOf repairs These sub connactors have employees and have workers'comp.insurance.[ b_❑We are a corporation add its officers have exercised their right ofexcreptiun per MGL c 14.❑Other 152.§1(4),and ww have no employees[No workeri wmp. insuraucerequired] "Any applicant that checks box#1 mot also fill out the section below showing then workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and than hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box most attached an additional sheet showing the name ofthe sub contractors and state whether or net these entities have employees Trade suhcormaemre have employees,they must provide then workers'comp.policy number. 7 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I�' po /vS Policy#or Self-ins. Lic.#: Y(--Y O7 'J 33r,4(e4 / Expiration Date:_ ) / Job Site Address: SS L Ascem a. City/State/Zip: rl/ AJ patr/ce , lh*,-. Attach a copy ofthe 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 fine up to$1,500.00 and/orone-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy ofthis statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. /da hereby certify under[ paains�and penalties ofperjury that the injnrmation provided above is true and correct. S ignatme' �r"� Date: Y Phone#: ?7� a-i '2-3SV 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 Ins peetor 5.Plumbing Inspector b.Other Contact Person: Phone#: City of Northampton Massachusetts oaPEaT " OF 7 LOINO INSPECTIONS '11'1 IYin B , • NUNACi010 BuilGirg e� aomthemycon, Nr. 01060 INSPECTOR Louis Hasbrouck Fax: 413-587-1272 Chuck Miller Building Commissioner Phone:413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (Fw ff M1sWorel ErplmerWAmhhe responsibW i Enike PrOaa) Project Title: New Dunkin' Donuts Date: May 30, 2018 Project Location55 Damon Road, Northampton, MA Map:_Parcel:_Zone:_ Scopeof Project:New one story ground-up freestanding building. In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.8: lJohn A. Aharonian, R.A. Mass. Registration# 8551 Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [4 ENTIRE PROJECT For the above named project and that to the best of my knowledge,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.8.2.2: 1. Review of shop drawings,samples and other submittals of the contractor as required by the Construction documents as submitted for the building permit,and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 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,in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official,a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. , rye Fl+n„ Signature and Seal of Registered Professional o. eGS; mcrs.uo i`ti'�: 30th Day of May 20 18 ':.� 1�;- Commonwealth of Massachusetts �j Division of Professional Licensure Board of Building Regulations and Standards Constrai r "P rvisor CS-074975 spires:07106120'16 1 l STEVEN RIB[ARO 20 RICHARD DIRCLE _ SEEKONK MA QiJ17 Corrlrrlissloner ✓" 612212018 City of Northampton Mail-55 Damon Rd City Of i d Louis Hasbrouck<Ihasbrouck@northamptonma.gov> 55 Damon Rd 1 message Louis Hasbrouck <Ihasbrouck@northamptonma.gov> Fri, Jun 22, 2018 at 3:50 PM To: Vfcdonuts<vfcdonuts@aol.com> Cc: David Gardner<dgardner@northamptonma.gov>, David Veleta<dveleta@northamptonma.gov> Mr. Sardinha, As near as I can tell, the storm water O&M agreement didn't ever get recorded at the registry of deeds. It is a condition of DPW storm water permit approval.The site engineer said you were going to do that. It needs to happen before we can issue the permit for the Dunkin Donut building. Also, the site engineer was supposed to send a copy of the video footage from the drain line to the DPW; he said he was sending it about 2 weeks ago. Can you ask him about that? Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413)587-1240 office (413)587-1272 fax https:llmail.google.com/mail/ca/u/0/?ui=2&ik=ec5fl9a57e&jsverKYMBrjF 19M.en.&cbl=gmail_fe_180617.14_p4&view=pt&search=sent&th=164290c... 1/1