25C-251 Carriage House Demo 2014-03-13File # BP-2014-0942
APPLICANT/CONTACf PERSON HAMPSHIRE FRANKLIN & HAMPDEN AGRICULTURAL SOCIETY
ADDRESSIPHONE POBOX 305 NORTHAMPTON (413) 584-2237 0
PROPERTY LOCATION FAIR ST -FAIRGROUNDS
MAP 25C PARCEL 251 001 ZONE SC{lOO)IURB(l)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled outllNJ~ ,J,h.q 0
Fee Paid llL'-fd2.6 'll?!. of,
TypeofConstruction:.DEMOLISH OLD CARRIAGE HOUSE STRUCfURE
New Construction
Non Structural interiorxe=no"-v'-'a=ti=o=ns=--____________________ _
Addition to Existing
Accessory Structure
Building Plans~In""c"_!lu""d""e~d:'-_________________________ _
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON TIDS APPLICATION BASED ON
INFORMATION PRESENTED:
__ Approved __ Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project:_~ __ ~_Site PlanAND/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* _~~ __ 0 __ ~
___ 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 Connnission ~~~ __ Permit from CB Architecture Connnittee
___ Permit from Elm Street Connnission
_--,Vo:'---..Demolition Delay ~
b~-Signature of Building Official
____ Permit DPW Storm Water Management
Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain aU 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 ofMGL 40A. Contact Office of
Planning & Development for more information.
·Statua of Penn it:
Curb Cut/Driveway Pennit _~~~ ___ -'-.
Sewer/Septic Availability..;......:..;......:_~-'----'-~ __
WalerlWeIiAvailability_.,..,..-,. __ ,-_~ __
Two Seta of Structural Plans'----,--____ -
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 I
This section to be completed by office
1.1 Property Address: f54~F AlR STREET::BmLniNOis ONTHjfB:RiDGE~;
iSTREET OLD FERRY CORNER OF THE i
if AIRGROUNDS. BOOK 3977-66 (1992) :
\ ~
Map Lot Unit
Zone Overlay District
Elm St. District
t------~-~I SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
, i j ""._"'~""~ ' • ..-_~_.~ ,-v ~~. __ ,,~",~ _~ ~ __ .~~~_'._"~_<_~_"""'-~'" _""~_~-_~_~rl~~-~.~_£_""H>_"_'-~_""~ .. _~~ ~~~~_""h",",~ .... ,..-.-_____ ~~o~,_.~"""_"¥ _ _'-__ ~"PM'._p,,_~ .... • ~ CB District
2.1 Owner of Record:
lHAMPSHIRE, FRANKLiN&jIAMPi5ENAGR~;
!_~~_,. ___ ._~_~,",~ __ ,_;,">"''''F"""'r,,. ___ ~._ """. __ . __ ",~,,_. ~~~~_-.>"'""".,_,,~~r.~ .. ~ _______ ~_~""-~_""n~ __ """",."~_ ~~"'" >c ___ "",,~,._~~ ___ uj
Name (Print)
Signature
2.2 Authorized Agent:
~~~~~~~~!;~~li~~:~·Qg~~~~QK~=~~":.~· •. "~~~~~=~·!
Name (Print)
Signature
SEC'rION 3 -ESTIMATED CONSTRUCTION COSTS 1-
Item Estimated Cost (Dollars) to be
completed bv oermit applicant
Telephone
'"".",£~~_,§~~!2,~Q~!fI!\~,I9~,_~:~_ ,.,_.
Current Mailina A .......
i(4~!~) 584-2237
Telephone
Official Use Only
! .. -.""~ ..
1. Building
2. Electrical
3. Plumbing
c: 4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5)
Building Pennit Number
Signature:
Building Commissioner/Inspector of Buildings
(a) Building Permit Fee
I (b) Estimated Total Cost of
Construction from (6) i., .. ""." .. , .. . ~, ....
] Building Permit Fee
Check Number IJ'7{'() ~O-
This Section For Official Use Onlv
Date
Issued
Date
l
f
~'
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations D Existing Wall Signs t:a Demolition D Repairs 0 Additions 0 Accessory Building D
Exterior Alteration D Existing Ground Sign o New Signs D Roofing D Change of Use D other D
Brief Description :Dmv.[oLiTIONoF~oLD~cARR.iAGE-HOUSE«STRucTi:J.RE""'-""-'''~~-"'~~''''-'--'~'''-''~''''''''''''';
Of Proposed work:"",,, ,. """J
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE l
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 D A-2 D A-3 0 1A 0 0 A-4 D A-5 0 1B D
B Business 0 2A 0
E Educational D 2B I 0
F Factory D F-1 D F-2 0 2C D
H High Hazard 0 3A D
I Institutional D 1-1 D 1-2 0 1-3 0 3B D
M Mercantile D 4 D
R Residential D R-1 0 R-2 0 R-3 0 SA D
S Storage D S-1 0 S-2 0 5B D
U Utility D Specify: '
M Mixed Use 0 Specify:
S Special Use 0 Specify: i
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: r,.,." ..... _._ .. ~._"."'_ ... ,,_."'_ .. __ ., _.,_~_'-,.~_~~,_,._._ .. ,,~,., ____ ._"'_. __ , Proposed Use Group: [,'''''' ____ ,., •. ,'',,.'' __ ''''.'',.,.' ",_ .. , •. ',~"".'_"'_"'''_''
Existing Hazard Index 780 CMR 34):i ""'".''' "m.,
Proposed Hazard Index 780 CMR 34): l !
SECTION 6 BUILDING HEIGHT AND AREA I
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
j 1st t "-"1
2nd 1 ;
3rd !, ___ "' .. _,. ___ .,, __ ~"'_,,_,_., .. __ , ___ " __ ... __ ,,, __ .J 3rd 1
~rl 4th i 1 ,,~,
Total Area (sf) 1""._"~,_,."_._ .. ~_~_. __ .. ____ ._,,._,.,,. __ ,,"1 Total Proposed N~w._~qI!§1~1tmj9l!J~fL_~.,._
~ )
t"''''A_W'O''C~~' ___ . ~.~'¥' ,if" __ """'"'' ~ ~,,_~ ... __ ~. ".¥""",,:
7. Water Supply (M.G.L. c. 40, § 54)
Public D Private D 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Zone r='::.~~-"~:~5 Outside Flood ZoneD ,Municipal D On site disposal systemD
V ersionl.7 Connnercial Building Pennit May 15, 2000
rS=-;-:::N":":O=-=R=-=THAM=. :;;-:-::-::PT==O;:::-;N~·-;;Z:;::O~NIN~G~. -,
Lot Size
Fronta e
SeU,acks Front
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
arkin
# of Parkin S aces
Fill:
volume & Location
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
A. Has a Spedal PermitlVariance /Finding ever been issued for/on the site?
NO 0 DONi KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONi KNOW 0
'~'"'""=-n·"·_q~"~."·-''''-'·--~~~-~"",,,-'''''''-M""'_"~7
IF YES: enter Book \ : Pagel and / or Document # '.-"~. "'""'''""''"'.~ .-] , ... ~"" .•....•. -.
B. Does the site contain a brook, body of water or wetlands? NO 0 DONi KNOW 0 YES 0
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 <!)
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0
IF YES, describe Size, type and location:
NO <9
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 0 NO 0 -
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:
Number
Expiration Date
Signature
9.2 Registered Professional Engineer(s):
Telephone
Signature
9.3 General Contractor
Not Applicable 0
Telephone
Version1.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
No 0
I, -==========;;;..:::.:.=============:=.:;;:========;::;:::':., as Owner of the subject property
hereby
act on my behalf, in all matters relative to work authorized by this building permit applicatio,!~~_ . _.".. •. __ .'"........_..__ .. _._.,~ •. ~
Signature of Owner Date
---------------------------------~-----------
Bruce R Shallcross I, ,_.-.. --.. ~.-.. ..... .-..... _ .... --..
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
SigQ!'l.!!.ll!lQ~rJDeQ~i!l§L'i!f.!~J.l~!!i~19J~.lLJ?1J:!];lri.l!ry.'____ .• _ .• "" .. _. ___ ... _ ..... _~_._. __ ..• ~._ •. ___ ... _~~ _____ .. _~ .... ~ .. _._ ... _~_ .. ~ ... __ .. _._ .. _._ ..•. _ .• _ ................ ,
;.-~~~.--.~ ... -. ~===.::;::::=""===-.=----="~ ... =~ .. "'=-.--.-=.~ .•. -= ... -.. =~--.= .... '.-=.---.=-.... =-.... =.-.. ' .. = ... ~ .=, ..... =--.... =., .. _= .... -_._.'"'--. --
Print Name
Signature of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Constru~~lirt.!lJ_P!!"..~~~~ ___ . ____ , .. _~ Not Applicable 0
Name of License Holder ;'.1 ============-::::==========
License Number
Expiration Date
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c.1S2, § 2SC(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 0 No 0
• " ~WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
. INFORMATION PAGE
Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970
(800) 876-2765 NCCI NO 40959
POLICY NO. r wcc·506~50041 06·2014A
PRIOR NO. IWCC5004106o12QTs--__
ITEM
1. The Insured: Hamp, Frank & Hamp Ag Soc
DBA: Three County Fair
Mailing address: POBox 305
Northampton, MA 01061
Legal Entity Type: Other
Other workplaces not shown above: See Location
FEIN: **-***6394
2. The policy period is from 02/04/2014 to Jl~/il,![?J!15 _ 12:01 a.m. standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers' Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 1,000,000 each accident
Bodily Injury by Disease $ ---1 ;DooJ)oo policy limit
Bodily Injury by Disease $ 1,000,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 A
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
J-----~ .---..
INTRA 33851
Code
No.
Estimated
Total Annual
Remuneration
Per $100
Of
Remuneration
INTER SE CLASS CODE SCHEDU E
Minimum Premium $309
[
Total Estimated Annual Premium
Deposit Premium
MA Assessment Chg.
$2,208.00 x 3.4000%
This policy, including all endorsements, is hereby countersigned by
----A~~~~------
Service Office:
54 Third Avenue
Burlington MA 01803
WC ~O 00 01 A (7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
"",,,tI with its oermission.
Estimated
Annual
Premium
$2,691
$2,766
$75