32C-001 (75) ISO MAIN ST-SUITE 365 BP-2019-1027
GIs#' COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-001 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category:renovation BUILDING PERMIT
perglit# BP-2019-1027
Proicot# JS-2019-001683
Est.Cost:$13700.00
Fee:$98.00 PERMISSION IS HEREBY GRANTED TO.
Const,Class: Contractor: License:
Use Group: MARK SMITH 104325
Lot Size(sa. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG
Zoning: CB(100)/ Applicant: MARK SMITH
AT: 150 MAIN ST- SUITE 365
Applicant Address: Phone: Insurance:
5 ANNA ST (413)531-7342 WC
WAREMA01082 ISSUED ON.312712019 0:00:00
TO PERFORM THE FOLLOWING WORK.RENO OF EXISTING OFFICE
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 32720190:00:00 $98.00
212 Main Street,Phone(413)587-1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
File q BP-2019-1027
APPLICANT/CONTACT PERSON MARK SMITH
` ADDRESSIPHONE 5 ANNA ST WARE (413)531-7342
PROPERTY LOCATION 150 MAIN ST-SUITE 365
MAP 32C PARCEL 001 001 ZONE CB(IOOV
THIS SECTION FOR OFFICIAL.USE ONLY:
PERMIT APPLICATION CHECKLIST
SED REQUIRED DATE
ZONINGFILLEDUT
Fee Paid
Building it Filled out
Fee Paid
Tvveof Construction, RENO OF EYJSTTNGI
New Construction
Non Structural interim renovations
Addition to Existing
Accessory Struc r
Building Plans Included:
Owner/Statement or License 104325
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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(keds 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
3 -u +
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 are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
Versionl.7 Commercial Buildinit Permit May 15,2000
Department use only
REC27-1
01 orthampton statue of Permit.
ing Department Curb CuVDnw ay Permit -
2 ain Street Sewer/Septic Availability
LIAR Ro m 100 Water/Well Availability
mp On, MA 01060 Two Sets of Structural Plans
0 Fax 413-567-1272 Plot/Site Plans
OFA-`o=Dmi nwr,ias=EcnouS 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
1.1 Proeerly Address: This section to be completed by office
Thornes Marketplace Map :�Dk C Lot 001 Unit
150 Main Street Suite 6 zone Overlay District
Northampton MA 01060
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Richard Madowitz Hampshire Property Management Group 0
Name(Print) CurrentMailing Address:
(413)582-9970
Signature —al Lit Telephone
2.2 Authorized Aeent:
Mark Smith_ _ _ '�{(„rrtp S-h. fAA OIow—
Name(Print) Current Mailing Address:
(413)531-7342
Signature Telephone
SECTION 3•ESTIMATED CONSTRUCTION COSTA
Item Estimated Cost(Dollars)w be Official Use Only
completed by permitapplicant
1. Building I?)r-1 (a)Building Permit Fee
2. Electrical ! (b)Estimated Total Coat of
Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) 9f
5. Fire Protection
S. Total= 1 +2+3+4+5) Check Number of
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissionedlnepeclar of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 36,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑+ Existing Wall Signs ❑ Demolition El Repairs ID Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ other❑
Brief Description '.Renovation of existing office to improve premises.Use will not change.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly1:1A-1 11A-2 ❑ A-3 111A 13
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
LIT
❑ I-1 ❑ I-2 11 1.3 113B
M Mercarltile 4 ❑
R Residential ❑ I R-1 ❑ R-2 ❑ RJ ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U U51dy ❑ 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
Total Area(s1) Total Proposed New Col nsbuctionlsf)
Total Height(ft)
Total Height It
7.Water Supply(M.G.L.c.40,§64) 7.7 Fleod_Zone Information: 7.3 Sewage Disposal System:
Public 0 Private ❑ Zone Outside Flood Zone[] Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
Thu column b h filled in by
Building De,,ann t
Lot Size --.J L_.
Frontage 0 0
Setbacks From
Side L:t I R,= L:0
Rem
Building Height
Bldg.Square Footage L� O % O O
Open Space Footage �_ % O O
Op area mine bldg a paved C
erkin
#of Parking Spaces
Fill:
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
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 Pagel and/or Document#,
B. Does the site contain a brook, body of water or wetlands? NO O 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: !Not within scope of work
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. 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 t acre? YES O NO O
IF YES,Nen a Northampton Storrs Water Management Permit from the DPW is required.
Vendonl.7 Commercial Building Permit May 15,2000
SECTION S.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 16,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Arehimet
Emily Estes 19 Allison St, Northampton, MA 01060, USA Not Applicable ❑
Name(Registri l): _
Emily Estes 19 Allison St, Northampton,.MA 0100,USA _ _ Registration Number
Address
(413) 320-6199 Expiration Date
Signature Telephone
9.2 Registemul Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
_J
Name _ Area of Responsibility
L
A cess Registration Number I
J
Signature Telephone Expiration Date
NameArea of Resporeidlily
Aotlress Registration Number
l
Signature Telephone Expiration Date J
NameArea of ResponsibiNy
L.
Morass Registration Number
C
Signalure Telephone Expiration Dale
9.3 GeMnl Contractor
Mark Smith Not Applicanle,0
Company Name:__—
!Woodsmiths Inc
Respon_dble In Charge of Construction
15 Anna St Ware,MA 01082
Address
413 531-7342
Signal" Telep"
Versionl.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 Q
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I Richard Madowitz as Owner of the subject property
hereby authorize.Mark Smith _ _ —=to
act on my behalf,inall tter6 rela�work authorized by this building permit application. _ q
/ 119
Signature of Omer Date
Mark Smith as C ne,/Authonzed
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 perjury.
iMark Smith
Prim Nemo cr
jL 3h8 f
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Summisor: Not Applicable O
Name o1 License Homer.Mark Smith 0
5 10L17'Z5
License Number
5 Anna St Warq 01 On Z ,�i (�{
Address Expiration Da
) 531-7432
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.151251
25C(B))
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 mlit.
Signed Affidavit Attached Yes O No 0
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, f
as defined by MGL c 111 , S 150A.
Address of the work: 15D fgjt,\) Sf. N( 9AAj{ '--
The debris will be transported by:
r EIrS r ��i5�
The debris will be received by:
Building permit number:
Name of Permit ApplicantAf� tTl{
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigadans
1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electiiciaus/Plumbers
Avialicant Information ♦� ( Please Print Le ibl
Name (Business/Organization/Individual): Wr -syt .ter+ 'bm I Wf7oD wy-ws
Address: S Qnln1 A S
Ci /State/Zi : pd5.. MA- 0I0ZAr6ne#: 3 1-Z3 42
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and I
employees (full and/or part-time).- have hired the sub-contractors 6. ❑New construction
2.C9 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These subcontractors have g, ❑ Demolition
workingfor me in an capacity. employees and have workers'
Y ra ty t 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §l(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
Any applicant that checks box le l most also fill out the section below showing their workers'compensation policy information.
t Bomcowners who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContranums that check this be.must attached an additional sheet slowing the name of the sub-contmaors and state whether or not those entities have
employees. If the subcontractors have employees.they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance far my emplgvees. Below is the polio and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: b(P201(vl(..t�i3Expiration Date:]
Job Site Address: lav kAl/v S- McrTJIp K&p4-olj City/State/zip: MA--
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cedify an ler she painsan�dj,�nahmes of perjury that the information provided above is true and correct.
$igttature """1 �'
Dole,
Phone
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.Badding Department 3.City/Tawn Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persom Phone#:
Initial Construction Control Document
Ufl
Tobe submitted with the building permit application by a
Registered Design Professionalfor work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Thnmes Narketplatt,swt365 Date: 03/19/19
Property Address: 150 Main Street,Northampton,MA 01060.
Project: Check(x)one or both as applicable: New construction x Existing Construction
Project description: Interior nun incationa to allow room 365 to M rented in•profwsiood once auiu. Reiocate i
Interior loon,HVAC alterations to separate the system from adjoining omse,and minor
electrical and Bnbh material changes.
1, Emily Estes Baillargeon,MA Registration Number:50838 Expiration date:8/31/19 ,am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
x Architectural Structural Mechanical
Fire Protection Electrical Other.
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780
CMR), and accepted engineering practices for the proposed project. 1 understand and agree that i (or my
designee)shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2 Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner
consistent with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with
pertinent comments,in a form acceptable to the building official.
f a
Upon completion of the work,I shall submit to the building official a'Final Construct f W.
o ,las `moo
Enter in the space to the right a"wet" or �W
electronic signature and seal: nu.pica,
Phone number:(413)320.8199 Email:enfly®estesarchiect con OF
Building Official Use Only
Building Ofndal Namr. Permit No.: Dat..
Not 1.Ind tate with an Y project design platy,computations and specifications that you prepared or dircawy supervised.If'otM is
chosen,provide a descrip0on.
Version 01 01 ]019
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