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16C-013 (3)
272 SPRING ST BP-2020-0615 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16C-013 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2020-0615 Proiect# JS-2020-001030 Est.Cost: $16000.00 Fee: $224.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ALAN LEONE 60627 Lot Size(sq.ft.): 87120.00 Owner. LOVELAND- PANDORA BETH Zoning: URA(100)/WSP(100)/ Applicant. ALAN LEONE AT. 272 SPRING ST Applicant Address: Phone: Insurance: 200 BOARDMAN ST (413) 563-3431 SOLE PROPRIETOR BELCH ERTOWNMAO 1007 ISSUED ON:11/12/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 23 REPLACEMENT WINDOWS AND SHEETROCK PORCH 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 Deaartment 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: FeeTyae: Date Paid: Amount: Building 11/12;'2019 0:00:00 $224.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 FltutivLu Department use only -- city' of Northampton Status of Permit: 1 Building Department Curb Cut/Driveway Permit NOV 2 2019 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability DFPT OF SUILDING INSPECTIO lorthampton, MA 01060 Two Sets of Structural Plans NORTHA%4rTON.otiortac413-5 7-1240 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 /619— ao- P 1.1 Property Address. This section to be completed by office , -7R -7 R Sn� -7 Map l C Lot I Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name nt) Current Mailing Address: C d OIce _ i�>> �a - 7i ��r Signa - Telephone 2.2 Authorized Agent: I��► Loo Ic= 'kV BoN2v mAh $f— nelcdecIaLj Name(Print) Current Mailing Address: or 0 Q-, 413 —563 —35E3 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 000 , 00 (a) Building Permit Fee i 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Feet 4. Mechanical (HVAC) (/1 C/ 5. Fire Protection /ice 6. Total =0 +2 + 3+4+5) Check Number This Section For Official Use Only `J1 Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ED— Brief Description Enter a brief description here. 1414416& w I D Of Proposed Work: 5ffLoet 1? j (fv6 (1 11 CoA0 1firUt, P()P— H y sr 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 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-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(sf) 151 St 2nd 2nd 3rd 3rd 4 4th th Total Area (so Total Proposed New Construction (sf) Total Height(ft) Total Height ft 7.Water,0upply(M.G.L.c.40, §54) 7.1 Flood Zone Information: F7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood ZoneE] unicipal POn site disposal system[:]_ 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 O SECTION 11 -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 y behalf, all afters relaove-to—w-ork a orized by this building permit application. Signature of Owner 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 pain and penalties of perjury. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Jet of License Holder: L&d ot ` .5 (0 C-) ro a ,;;, License Number env Q��RD ►'►'1�''� S�- (;e(clfe01v0) 3130`a ( Address Expiration Date ct�. ::�� 1-03 56 3 I Signature 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 provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes 0 No 0 Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage 'V Open Space Footage V (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a S ecial Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 DON'T 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: 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 1 acre? YES O NO O 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: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor LC oti c- cP K pk>n +ky Not Applicable ❑ Company Name: � 14 q LC0Y1L Responsible In Charge of Construction Address � Q `f13 s63 -3 q3 Signature Telephone 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: ��7� PR (, 14 6 S The debris will be transported by: V S 'q The debris will be received by: U S I� VA-S 7��1 Building permit number: Name of Permit Applicant L o- Oc= Cil P_ P6'r7 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 t Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anolicant Information pp Please Print Leeibly Name (Business/Organization/Individual): L Address: �,©o bo+eD MA�v1 ST- City/State/Zip: R Q 1 C H e le 1y w,1 M+ of o©/Phone#: Lt f 3 -16j -3 Y 3 Are you an employer?Check the appropriate boa: Type of project(required): 1.[3 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.�am a sole proprietor or partnership and have no employees working for me in $, �odeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]1 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sigllature• 2. 44t:`L Date: ( l l T3Phone#• 3 -563 -3y3 / 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 Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: