32A-246 (2) BRIDGE ST-BRIDGE ST CEMETERY BP-2019-1000
GIS s: COMMONWEALTH OF MASSACHUSETTS
Mao'Block:32A-246 CITY OF NORTHAMPTON
Lot .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
W.A. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeorv'Door Replacement BUILDING PERMIT
Permits BP-2019-1000
Proiect4 JS-2019-001654
ES[ Cost' $1000.00
Fee: 0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group CITY OF NORTHAMPTON CENTRAL SERVICES 054510
Lot Sint so.d.): 43995.60 Owner: NORTHAMPTON CITY OF
Zonine URC(99H Applicant: CITY OF NORTHAMPTON CENTRAL SERVICES
AT. BRIDGE ST - BRIDGE ST CEMETERY
Applicant Address: Phone: Insurance:
Memorial Hall (413) 557-1260 O
NORTHAMPTONMA01060 ISSUED ON:312712019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE EXTERIOR DOOR AND FRAME
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: Qit 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:
FeeTVDe: Date Paid: Amount:
Building 3/27/20190:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
boor-
Verion l.7 Commercial Building Permit Mav 15. 2000
Department use only
ity Northampton Status of Permit
2Q�9 ildi Department Curb Cuf/Dwsway-PennRto -
MQ� 1 r=RO 100 Water/Sell A afa5ilityy
12 aln Street Sew
erANell Avallabthly
1110t1 ton, MA 01060 Two Sets of Structural Plans
1 v0. -587=1240 Fax-413-587-1272 Plot/Srte Plans
OFPNo�'r Other Specify-
APPLIII 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 Prooeerm Adidnas: This section to be completed by office
Map Lot c1 TlF" Unit
'v'`(•��(`�i���5p(`Q,'�'(y � 1 Zone Oveday District
vV0evaE�r+rr_�- _._ ______.__ _. _.___. Elm St Distinct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
Name(P C tMalmg Address
h6.-W.10%
Signature Telephone
2.2 Auth ize A e
Name(Print) - - - - --�- Current Maring Address:- --
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1 (a)Building Permit Fez
2. Electrical (b) Estimated Total Cast of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Tool=(i +2+3 +4+5) Check Number
This Section For-Official Use Only
Building Permit Number Date
Issued
snnar_r
Dye
Version l.7 Commercial Building Permit.%Iap 1:,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs Additions ❑ Accessory Building❑
Exterior Alteration F1 Existing Ground Sign El New Signs❑ Roofing Change of Use❑ Other ❑
Brief Description Enter a brief description here. l�',PL"
Of Proposed Work:
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 p A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ I 2A _ ❑
E Educational ❑ I 2B ❑
F Factory ❑ F-1 p F-2 ❑ 2C ❑
H Hot Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ElR-1 F-1 R-21:1R-3 11SALlS Storage ❑ S-1 ElS-2 El SB
❑
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 OMR 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(SH
2,m
3p 3,e
_. __ 41'
41�
Total Area (ef) Total Proposed New Construction os!)
Total Height(fl) _.
Total Height It _
7.Wa[er Supply(M G.L.e 40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Cuts de Tood 20 nem jMunicipal ❑ On Iedisposa'system[f
Version L7 Commercial But l dins 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 D.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant) --
Registration Number
Andress ---
Expiration Data
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address P.e3stration Number
Signature Telephone Expreb.in Date
Name Area of Responsibility
Address Regstratipn Number
Signaler. Telephone Expration Date
Name Area of Responsibility
Atldress Reg stra[ion Number
Signature Telephone Exbration Date
Name Area of Responsibility
Addrss Reg stration Number
Signature Telephone Expiration Date
F
3 GlCtcctto♦rL/� ���.��Ml/ pSAmV ? Not Applicableof Constmction
5 , a�
it $i^na 2 _ 9ieahnne
Vera or,I 7 Commerxfal Build=Permit May 15, 2000 '
8. NORTHAMPTON ZONING
Escorting Proposed Required by Zoning
This oohvnn m 6e 511ed m 1)
Building Depanmem
Lot Size
Frcntese
Setbacks Front
Side L R:—_. L:.� R _...
Rear
Building Heiehr '-' - -
Bldg. Square Footage
Open Space Footage -
-
(Looareaminusbidsdpaved
narkinel - -
d of Pazkin¢Spaces '-'- �'
(volumed tnca,iam
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q 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 O DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued.
C. Do any signs exist on the property? YES 0 NO 0
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. Wtll the construction activity datarb(bearing, trading, excavation. or filing) over II acre or is i;can of a common slap
that will disturb over 1 acre? YES O NO O
IF YES, then a Norihamposs,, Storm Waler Ma.ragemopt Fernit from me DPW is requ pec.
The Commonwealth of Massachusetts
-- �.—: - Departmenta Itadustrial Accidents
Office of finvestiwations
600 R'ashina ort Street
Boston, MA 01111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders,/Contractors/Electricians/Plumbers
4Dplicant Information Please Print Legibly
Name (EusfnesrOrganiaanoa'Individual):
Add:ess
Citv/State/Zip: Phone »:
Are you an employer? Check the appropriate box: EEdd,�t..m
roject (required)
4. I am a googol contractor and I
}.❑ I am a employer with ❑ w conetmenonemployees (full andtor part-tme) : have hired rhe subcontractors
I am asole proprietor or partner- listed on the attache3 sheet. modelingshipndhaeoemployees These sub-contractors have molitionforme in any capacity. employees and have workers' ilding additionrkers' compinsmerecomp.insurancerequired.] 5. ❑ We azo a corporation and its ectrical repairs or additionsa homeowner doing all work officers have exercised their unbme repairs or additionsmself. Nowodcers' com . right of exemption per MGLy p of repairsinsurance required.] 1 c. lit, §1(4),and we have no
employees. [No workers' her
comlf insmance required]
'All applicant that checks box-1 must also 511 out the section below shoxirg their workerscompensa on po:icy information.
I Homeowners who submit this afldti,t i imcunitm they are domg all work and th o hire outside contrzaon mus:submit a rex-afficz,indicams such.
tiomctors den check this box mus:attached an additional sheet showing: t none of the sub-contacm-s and stare whether or not those entims have
emplovcsif the sub-conracmrs have employes,they must provide their workers'comp.policy number.
Jam an employer that is providing workers'compensanon insurance for my employees. Below is the polity an djob site
information.
Insmance Company Name:
Policy'or Self-ins. Lie. m: Expiration Date:
Job Sire Address- City/smte/zlp:
.Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as mounted[oder Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a
fine up to S 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. Be advised that a copy of this statement may be forwarded to the Office of
In,estiganom of the DLA for insurance coverage verification.
f do herebv terrify under rite pains and penalties ofperjup'that the information provided above is true and correct.
Sianamic Date'
Phone
70�(f,wi only. Do not write in this dreg to be completed by ci0•ar totyn offic'a'wn: PermioUcensehority(circle one):
1.Board of Health 2.Building Department 3. Cit -rosin Clerk 4.Electrical Inspector 5,Pfumbi_p_Inspector
6. Other
Contact person: Phone'.:
v
Version 1 Conunercial Building Pennit Mey 151000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.1 t)
I cdeoendent Structural Engineering Sl-uctural Peer Review Required Yes O No
SECTIONII -OWNER AUTHORIZATION-TO:BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property
hereby authorize
to
act on my behalf,in all matters relative to work authorized oy this building permit application
Signature of Owner Dials -
f' �rl�y �V �'VL3�1tY Q�,` fUCF'��' I YAMAL,b as Owne AuLlorizsd
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 pains and penalties of century, _. -
V�
anatu of0 er,' tint Cate
S TIO 12- N FIUITIINSERVIIES
10.1 Licensed
,on
ction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signalvre 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 prcvide this affidavit will res.;h
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes C No O
CITY OF NORTHAMPTON, MASSACHUSETTS
Central Services
Memorial Hall, 240 Main Street
Northampton,MA 01060
David Pomerantz (413)587-1238 Fax: (413)587-1248
Directorof Cama]Sa ica
To: Louis Hasbrouck,Building Commissioner
From: David Pomerantz
Date:. March 14, 2019
Re: Construction Control Waiver -
I request that you grant a modification to waive the requirement for construction control for
the project at the Bridge Street Cemetery, Bridge Street, Northampton, MA. The project
entails replacing an exterior door and frame at a building on the grounds.
I am requesting a construction control waiver 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.