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32A-099
2 BRIDGE ST BP-2012-0051 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Bloc 32A - 099 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Masonry Repair BUILDING PERMIT Permit # BP- 2012 -0051 Proiect # JS -2012- 00007_7_ Est. Cost: $20000.00 Fee: $120.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEVIN O'BRIEN 081383 Lot Size(sq. ft.): 1698.84 Owner. O'BRIEN JEAN CLARK AND OTHERS C/O 2 BRIDGE STREET LLC Zoning: CB(100) / Applicant: KEVIN O'BRIEN AT. 2 BRIDGE ST Applicant Address: Phone: Insurance: P O BOX 183 (413) 296 -4511 WILLIAMSBURGMA01096 ISSUED ON.7115120110:00:00 TO PERFORM THE FOLLOWING WORK.-Structural Masonry Repair Final structural drawings required before final inspection 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 7/15/20110:00:00 $120.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner r Versionl.7 Commercial Building Permit May 15, 2000 ©epar.....P se only E� EQ �IV City of Northampton Stalftttelt� t z bn Building Department Cufb Cuf/Drmeway Pertrtt Z 212 Main Street SerrerCS "epttrA�atfafrlrty ` I i Room 100 U1/a "terIA! IRvattabtht} aPecTi orthampton, MA 01060 Twq Sets ofSfructutaFlat�s J3- 587 -1240 Fax 413- 587 -1272 Ploi/Slte Plans r Other Specify b r 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 Property Address This section to be completed by office _ ... a 11_..m -15- re 1-+ _ 'Bra _ m Z. r'� O� C c� �-� Map Lot Unit /' NOr'�'�t R �-�, •/ SJ Zone Overlay District dw_. . .._ ., _w._.. .4 - w �.4. _ Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name Print Current Mailing Address: Signature L�7 Telephone 2.2 Authorized Agent: le Name (Print) Current Mailinq Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit app licant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3+4+5) Check Number This Section For Official Use Onl Building Permit Number Date Issued Signature: / Buil& 11gCommissioner/InsIlector J Buildings Date Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 P CUBIC FEET OF ENCLOSED S P A C E i Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory r uilding ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other Brief Description ;Enter a brief description here."'' Of Proposed Work:';. 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 0 B Business ❑ 2A ❑ E Educational ❑ 2B �" ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1 -2 ❑ 1 -3 ❑ 38 M Mercantile ❑ 4 R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility Speci fy' ❑ 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) __. _w 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) 1 St _ 1 st 2nd .. _ , _.. ._ .... _ ...,.... _, . 2nd r 3rd 3r th th _.. ..._..._ .. ,.__.. _. _ 4 Total Area (sf) Total Proposed New Construction (sf) w Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone, information: 7.3 Sewage Disposal System: Public ❑ Private E] Zone „ _ Outside Flood Zone[] Municipal [] On site disposal system[] _ Version 1.7 Commercial Building Permit May 15, 2000 S. 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 ... _ ,... _... - a. Rear` Building Height Bldg. Square Footage __. _ _ _..... 9'0 Open Space Footage _ _ % (Lot area minus bldg & paved # of Parkin Spaces -- Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 y DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES, 0 IF YES: enter Book ` Page and /or Document # B. Does the site contain a brook, body of water , or wetlands? NO 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtain6d,from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES 0 N0, 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 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 0 NO 0 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): r __.. > ; Name ✓ Area of Responsibility ag 1)rate � . � Address Registration Number xgy y�9Y Signature Telephone Expiration Date Name Area of Responsibility Address Registraton Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone _ Expiration 9 p p' on Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor CU t�A te. r Not Applicable ❑ I Company Name: I Responsible In Charge of Construction Address Si u e Telephone Version 1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 1,10.11)! Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT l as Owner of the subject property hereby authorize _ d. _,_..... ....�._ _.._. _ _ .. , a ... �_�__ _. _ _._ ..�to � act on my behalf, in all matters relative to work authorized by this building permit application Signature of Own r Date as,Ow4uthorized 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 penury ..... u Print Name Signature f Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Hol B f{ t -,n License Number s Address Expiration Date Signature Telephone \� 3 " 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 �T ` The Commonwealth of Massachusetts ` Department of In dustrial Accidents Office of Investigations 600 Washington Street Y -- Boston, MA 02111 x www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): Address: City /State /Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I a a employer with 4. ❑ I am a general contractor and I 2. e pIoyees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction l m a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10. F Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. ]Other pnt-r l/Cr�A1 s 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 nacre 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 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 certify nder the pain andpenalties ofperjury that the information provided above is t ue and correct. Signature: Date: z /Z:E Phone #: Of 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 #: CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: The debris will be transported by: nc.,..) ne,r W1 "4 SAnOtG /YarT �t++'tP4mr� l��ad�u The debris will be received at: r L o v h 4 rubbu6 Signa�77 e of erm" Applicant Date / Building Permit Number: