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25C-251 (135) 54 FAIR ST-FAIRGROUNDS BP-2020-1236 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C-251 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING P E R M I T Permit# BP-2020-1236 Project# JS-2020-002092 Est. Cost: $2000.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor. License: Use Group: JOSEPH JA INSKI 057025 Lot Size(sq.ft.): Owner. HA PSHIRE FRANKLIN&HAMPDEN AGRICULTURAL SOCIETY Zoning: SC(100)/URB(l) Applicant: J SEPH JASINSKI AT. 54 FAIR ST FAIRGROUNDS Applicant Address: Phone: Insurance: 43 Fair St 413 527-7379 WC NORTHAMPTON MAO 1060 ISSUED ON:6/19/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-remove 2nd floor structure of old Money Room, 1 st floor to remain untouched 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 Si nature: Feer e: Date Paid: mount: Building 6/19/2020 0:00:00 100.00 212 Main Street,Ph ne(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner GL� Versionl.7 Commercial Building Permit May 15, 2000 v �-- Department use only 3 z City of Northampton Status of Permit: flfl Building Department Curb Cut/Driveway Permit - �� 0 212 Main Street Sewer/Septic Availability y� o rp Room 100 Water/Well Availability o' Northampton, MA 01060 Two Sets of Structural Plans 0 phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 Property Address: This section to be completed by office 47 Fair Street 6—YJ (41 7- Map `s . Lot 'K' unit Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: I IamPshirel-ranklin&HampdenAgriculturalSocieb PO Box 305 -Northampton, MA 01061 Name(Print) Current Mailing Address: (413) 584-2237 Signature Telephone 2.2 Authorized Agent: James Przypek PO Box 305 - Northampton, MA 01061 Name(Print) Current Mailing Address: (413) 584-2237 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $2,000.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of $0.00 Construction from 6 3. Plumbing $0.00 Building Permit Fee (� 4. Mechanical (HVAC) 5. Fire Protection $0.00 6. Total=0 +2 +3+4+5) Check Number p� This Section For Official Use Only Building Permit Number /✓r �ar/��� Date Issued Signa re: Buildi Commissioner/Inspector of Buildi Date �/C'�-0 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❑ Brief Description Remove 2nd floor structure.(roof,side walls and flooring)of old"Money Room"from horse racing,down to ceiling of first Of Proposed Work: floor and roof over.First floor to remain untouched. There is no electrical or plumbing.Current roof has rotten beyond repair. 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 ❑ 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 ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: Structure vacant for several years, some light storage items inside p 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 15f 3,600 1st 3,600 2nd 1,200 2nd 0 3rd 0 3 rd 0 4th 0 4th 0 Total Area (so 3,600 Total Proposed New Construction (so 3,600 Total Height(ft) 24 Total Height ft 14 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone[-] Municipal ❑ On site disposal system E] Versionl.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 24 14 Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW Q YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O 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 Q DON'T KNOW () YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O , Date Issued: C. Do any signs exist on the property? YES 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 NO Oi 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. Version 1.7 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 J&B Construction Not Applicable ❑ Company Name: Joe Jasinski Responsible In Charge of Construction 43 Fair Street -Northampton, MA 01060 Address/y LA �_ (413) 588-4773 nature Telephone 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 ® No e 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 my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date James Przypek 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 pains and penalties of perjury. James Przypek Print N714 � Signature of wner/Agent bate SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Joe Jasinski 057025 License Number 43 Fair Street -Northampton, MA 01060 06/05/2021 Address Expiration Date (413) 588-4773 Signatu Telephone w SIE- CTION 13-WORKFFdl 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 e No From: 7�C.l� ( L L'4((e c 7A� f 15�c AID To: Jonathan S. Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, 1 request that you grant a modification to waive the requirement for construction control of the project at because the work is of a minor nature,will not affect structural elements, health, accessibility, life or fire safety,and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, 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: The debris will be transported by: The debris will be received by: VSA GL �`` e Building permit number: Name of Permit Applicant r —Cc�-'e- Date Signature of Permit Applicant '\ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aanlicant Information Please Print Leeibly Name (Business/Organization/Individual):Hampshire Franklin and Hampden Agricultural Society Address:PO Box 305-54 Fair Street City/State/Zip:Northampton, MA 01061 Phone#:413-584-2237 Are you an employer?Check the appropriate boa: Type of project(required): 1.0 I am a employer with 7 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. 2 Demolition T. I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E] Building addition 4.M I am a homeowner and will he 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.E]Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.n 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. :Contractors 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:A.I.M. Mutual Insurance Company Policy#or Self-ins.Lic.#:AWC-400-7035317-2020A Expiration Date:02/04/2021 Job Site Address:54 Fair Street City/State/Zip:Northampton,MA01060 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. Ido hereby certify a er the pain penald of perjury that the information provided above is trues ann-d,correct. Si ature: GJ e C 7 Date: 47; Phone#:413-584-2X37 L' 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#: le !4Z., .. �, � « �. e n r, q�,' la' "ye'" „4 �� ' , �..... •w ��. ,�M �__� _ � A . ... ,,., .,�. .. ,a ...,a.. �,.,. �rW�;,u�,�y,�;: ..� yy... .�... _� i �_