23A-055 Fitzgerald Realty Corporation
Fitzgeraldproperties123 @gmail.com
Dear Building Department,
I request that you grant a modification to waive the requirement for control
construction for the project at 45-47 Maple St, in Florence 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.
Respectfully,
Harold Fitz:erald AP/
• raid Realty Co •r. e
37 Mary Jane Lane
Florence, MA 01062
P.O. BOX 60445 • FLORENCE, MA 01062 • T:413-586-2529 • F:413-586-0256
The Commonwealth of Massachusetts
Department of Industrial Accidents
`;,i Office of Investigations
11,1 1 ., 600 Washington Street
Boston, MA 02111:
} www.mass.gov/dig
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.❑V] I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or_partner
listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub contractors have 8. ❑Demolition
working for me in any ca p aci ty employees and have workers'.
9. Building addition
[No workers' comp.insurance comp.insurance. ❑Building
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. officers have their Plumbing repairs or additions
❑ I am a homeowner doing all work ave exerc eir 11.❑
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
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: _
Policy#or Self-ins. Lic.#:�1 � �'E i' c?2.R!5- = X34 Expiration Date: /0 -- /g- --a ,l C�
Job Site Address 73 7 l(.4 V��'� � Vl City/State/Zip: > ,c J� r � ,p/p
Attach a copy of the workers' cdmpensation 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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 1-' l . _. Date: / — & or s
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.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Version1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780,CMR 110.11) .
w
Independent Structural Engineering Structural Peer Review Required . Yes 0 No C
SECTION 11 -OWNER AUTHORIZATION!-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,as Owner of the subject property
hereby authorize
act on my behalf, in all matters relative to work authorized by this building permit application. _µ___ ____
Signature of Owner .. �YnMF1w .•�WH Date
I, __.-. __ _ ___. __ _ __..M l ,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 penaltieSMof,perlury. „ .,,-. _... _m.
i
Print Name ,._....__
i
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION:SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder.'.._1 �..__,.. ' ., 6 .._. _...__...
License Number
I
Address v7 7 i / ,44,00� _ c Expiration Date
-N s �.-_ c?-, —IS- — (9--0 LC-
Signa e ( Telephone
SECTION 13- ORKERS'`CO PENSATION'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
Version1.7 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 EI LOSED SPACE)
9.1 Registered Architect:
._ * ? Not Applicable ❑
Name(Registrant): _._. _ ._ M
Registration Number
Address i .__ _..., .._ ,..__........:
Expiration Date
__ _.___i
Signature Telephone
9.2 Registered Professional Engineer(s):
[ i
Name • Area of Responsibility
_.._.__.r __._.__..__..____..,. _M_. �. _ __ _ ______1 ._ __._._ __..._....___._.._....._.__......_....._.._.___.._....
t
Address Registration Number
Signature Telephone Expiration Date
I j
Name Area of Responsibility
Ie
Address • Registration Number
i
Signature Telephone Expiration Date ��a�� �� __._..__
.
_,-.... -.... .„....,....»................,...,..... .,.vs»....r.w.,+....« ,....,,.....,..........r..........� ..w.w,«+,.wo.......n.....+,n.r.+.ry......w..wn�,.....w..�.«..n...w ..«n-r...........n.«_.....dw+` ..y.�.-..,,w- ....._.�. __.m.....a..«.,.,.. .,..._..
Name. Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name .,_ __ Area of Responsibility
Address Registration Number
9 _.,. ._ _.... . 1.m. „
Signature Telephone Expiration Date
9.3 General Contractor
•
Not Applicable ❑
Company Name:
_ _ _ _ i
Responsible In Charge of Construction �� � __.._._._... _�_��� ._._......___,,.,....
_.Address _ _
I t
Signature Telephone
•
^
^
Vozsion1.7C000mooial Building Permit May 15,2000
& - - ^
'�-r-��-�7���� '� '
Existing ' � Proposed� . . Required by Zoning ,
_
Building Department
Lot Size — ' _ I ; ----- -------�
__� _�
Frontage L�___-�__��__ __� �___-_ ____= L_____-
Setbacks Front � _7 ' ' -� F-'-�
` �___/
F---l� � � r---�
�i�� ��� ' aL-_-� �i _� }�L___) �___: L___�
( l ! / '
7 ^ -�
Rear c__-_� "
'
Building Height ----� F---1 �---,
"=a" [ �_] ___�
Bldg. Square Footage [-_-� 96 r--- � } �---'
- % .
-�
(Lot area minus um^&nu,� ; _-]' i __� L = r_ j -
�--�
parking)
l. | - -�
�__ 1 ` ' . ^' �__� | ^
#of�a6do�3pucnx ' -� -
Fill: '
� _
(volume&cu�nvn .
A. Has nSpeci Permit/Variance/Finding ever been �suedfor/on
the site?
' NO e DON7KNOV 0 YES 0
� ]
date��/�� issued: I - �
IF YES: Was the permit recorded at the Registry of Deeds?
p' ^'
NO 0
DONT KNOW 0 YES
and/or Document#
IF YES: enter Book
B. Does the site contain a brook, body of water or wetlands? NO (2( DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obta ned from the Conservation Commission?
Needs tobeobtaned Obtained �-\ Issued:obtained �_w��� Ob~a~ v��
, Date
v~�^/
C. Do any dgnsedstnn the prope� ��property? YES �_/ NO � �y
IF YES, describe size, type and location:
��~'~
D. Are there any proposed changes tooradd �nnsof�Qns intended for the prope�y? YES � l NO �^�
----
�—� IF YES, describe size, type and location:
E. Will the c natrucdnn activity disturb(clearing,grading, or tilling)over 1 acre orisb part nfa common plan
that will disturb over 1 acre? YES `^�� l NO K*`~��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Almimplit
'
Version1.7 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 C9' Change of Use❑ Other❑
Brief Description `Enter a�br1ief description here.
Of Proposed Work: !rv► Y �3 /....- 5If/■-e -2-(Ad"FL G4` /� "4� re Dr
h
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ID A-2 ❑ . A-3 ❑ 1A I ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B - r ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 0 S-2 ❑ 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify: .....a.� .., ......_..._ ..... ._._._ ,. . ._.___._......__.,.-.............__,..._....
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: ._ __.__.:__w.�. ,._.._______ _ I Proposed Use Group: ! __.,_....-__. ___ , _ _....___�_._. ?
Existing Hazard Index 780 CMR 34): :.,___ ._�__ .._,_ __ Proposed Hazard Index 780 CMR 34):1____________,_ __
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY,
Floor Area per Floor(sf)
._. -,..w._.....,.,
2nd w.
2nd i
3rd _..__:. . 3`� ... __ _.
4th _____ ._._.:_,_._._. .._...._...., € 4th ...
Total Area s
( f) Total Proposed New Construction(sfl
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 0 Zone „.,,.,___,,,= Outside Flood Zone[] Municipal ❑ On site disposal system El
•
Versionl.7 Commercial Building.Permit Ma 15,2000
{ CU i I. orthampton
t BUIM i ± Department
1 NOV 2013 2: aln Street e i *iiiNp' z Deppat ni e t sea,O�nl
e
4.o- ,'status cf it i � � 0 ' A
ar , ri fib. i, ap w2c}v Y s w,�3 s i.,k Z
°
q
Curb CutfDnveVy Permtt n >A I A is ,a
SewerlSept»Aaifabtly M ` ' ' {,
4, � .K k } 8 i Ro.m 100 UateNUekayatfability
Electnc Plamb,ng
&G Oi-t + •n MA 01060 Twal Sets of StructiiratlPlans
Nortreuh�tu..-MAI r : - -,0 Fax 413-587-1272 'PlotfSite Prans _ 1. ;. 4
:Other Specify } s tx.q,
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
Map Lot Unit
/�7�p� i r �� ' ! Zone Overlay District
Z L G"
ETmSt:District CB District
SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT .
2.1 Owner of Record:
j1 , r?
,' ,,r,..,4 -41 ._ M _ .._,a ... __ __. . _..... �:... t v
;'rint I - Current Mailing Addres _s i ndi . ...i/
/ ���/ /0,% i Telephone .. . i
1E '
__....... .._«..._...»....,�_.......+.......»....-........mss - ...�...� ......«.._,»........,.-................»..,_
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official!Use Only
completed by permit applicant
1. Building n D) (a)Building Permit.Fee
2. Electrical ;-----'------"7 (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 \ )tI . (
This Section!For,Official Use Only
Building Permit Number Date
-Issued
Signature:
Building Commissioner/Inspector_of Buildings Date
r
File#BP-2014-0589
APPLICANT/CONTACT PERSON RUILI MA
ADDRESS/PHONE 37 MARY JANE LANE FLORENCE (413)586-2529
PROPERTY LOCATION 33 MAPLE ST
MAP 23A PARCEL 055 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 41/
Fee Paid
Typeof Construction: REPAIR 2ND FLR REAR PORCH ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 070307
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ION PRESENTED:
pproved 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 Deeds 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
Molopay
Signature of B. ding fficial Da e
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.
33 MAPLE ST BP-2014-0589
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-055 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit# BP-2014-0589
Project# JS-2014-000989
Est.Cost: $500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RUILI MA 070307
Lot Size(sq. ft.): 32190.84 Owner: FITZGERALD REALTY CORPORATION
Zoning: URB(100)/ Applicant: RUILI MA
AT: 33 MAPLE ST
Applicant Address: Phone: Insurance:
37 MARY JANE LANE (413) 586-2529 WC
FLORENCEMA01062 ISSUED ON:11/12/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR 2ND FLR REAR PORCH ROOF
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 11/12/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner