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31A-076 (11)
� 6vFl Sr k'�1, 2T4 �6,v 144 f T�--- II I � � I N6 Ne 2�c�ve4 6 o DEMOLITION PLAN Av� FZ d,0 R 1 /4"= V-0" fl / FT \ JjI I ��j VIII II� 6 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: Building permit number: Name of Permit Applicant t Date Signature of Permit Applicant ALL-TEK BUILDERS INC. 88 Industry Ave., Spfld., Ma. 01104 (413) 736-0099; fax 736-0299 E-mail- alltekbuilders(&,,hotmail.com 8/5/14 TO: Northhampton Building Dept. ATT. Chuck Miller 212 Main St. Assistant Building Commissioner Northampton,Ma. 01060 RE. Waiver request I request that you grant a modification to waive the requirement for controlled construction for the project at 264 Elm St. in Northampton because the work is minor in nature, will not Affect health, accessibility, life&fire safety,or structural requirements and is impractical in that the cost of control construction is considerable when compared to the cost of proposed work. Thank you for this consideration. Respectfully, 6ud Brad Gabel All-tek Builders 88G Industry Ave. Springti-eld,Ma. The Commonwealth of Massachusetts -x Department of Industrial Accidents --+ Office of Investigations �. ` 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information �e ) -Please Print Leaibly Name (Business/Organization/Individual): � I� Su[ �t"7 �p 0.. _ Address: City/State/Zip Phone #: /- 46 0 Q Are you an employer? Check the aplpropriate box: Type of project(required): 1.❑ 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. ❑�eodelin- 11 onstruction 2.❑ I am a sole proprietor or..partner- listed on the attached sheet. 7. �Demolition — _ These sub-contractors have ship and have no employees 8. working for me in any capacity.n employees and have workers'. 9. Building addition [No workers' comp. insurance comp. msurance.$ ° required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F-1 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 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 thepolicy 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 foe insurance coverage verification. I do hereby cert and nrin a nd penalties of per• at the information provided above is true and correct. Signature: Date: Phone#: �-�- ? � k� 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 S.Plumbing Inspector 6. Other Contact Person: Phone#: w Version 1.7 Commercial Building Permit May 15,2000 4 SECTION 10-STRUCTURAL.PEER REVIEW.(780 CMR:;110 11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER:AUTHORIZATION-TO BE COMPLETED.WHEN. OWNERS AGENT OR CO TRACTO 'PPLIES FOR BUILDING PERMIT as Owner of the subject property w hereby authorize.' . act on my behalf,in all matters relative to work authorized by this building permit pplication. Si natur Ow r Date ..._.._r _......_, ._ .:... 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 penury,_ Print Name _ ... i Signature of Owner/Agent Date SECTION 12-CONSTRUCTION:SERVICES -• 10.1 Licensed Construction Supervisor: _ Not Applicable ❑ Name of License Holder:?u ......,1 ... .�- License Number Address Expiration e lure ✓ 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 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGSAND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT.TO 780 CMR 1,16(CONTAINING MORE THAN;35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: zp Not Applicable El_ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility } i Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address __.._,_._.. Registrabon Number__ I i Signature Telephone Expiration Date 3 _ _ Name Area of Responsibility _ Address Registration Number i ................. .,.._.._.......... ..... . ..._. ........: Signature Telephone Expiration Date . ..... _..., - _.._ .....,... . ._....__..._.._.............. ..__.._ _ . _........ .. . .............. Name Area of Responsibility Address Registration Number t Signature Telephone Expiration Date 9.3 General Contractor -------- Not Applicable ❑ Company Name: Responsible In Charge of Construction _ _._. Signa ure Telephone Version1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON.ZONING Existing Proposed Required by Zoning This column to lie filled in by Building Department Lot Size Frontage Setbacks Front Side L. __:_ I R.:. _. L:1_ _,__...J R:!'--j Rear Building Height Bldg. Square Footage }" ON i Open Space Footage % - _ (Lot area minus bldg&paved #ofParking Spaces - -,- -- ? L--' Fill: ;........ _... ..... ,. .._ (volume&Location) -• —• - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 -EYES, 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 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued ...........w.............,......r.,.,e .>.......i C. Do any signs exist on the property? YES 0 NO 0 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 0 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. � r Version 1.7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION.SERVICES FOR PROJECTS LESS THAN';35,000 CUBIC FEET OF ENCLOSED SPACE -r Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ ± Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief escrii tion here. Of Proposed Work. 6pw_S7V�Q 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 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 26 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ -_ -_, _ 3A ❑ 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 Specify:{W S Special Use ❑ Specify:, COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONSADDITIONS 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 _ SI __... .. _ 1 St _._... 2nd 2nd ..,_... 3rd .,._.. _..._..._..._.....__.._......,,� - 3rd _ _ .. _ .._... ».,.._ . .. 4tn 4tn Total Area (so Total Proposed New Construction s Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40, §54) 7.1 Flood,Zone,lnformation: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone E] Municipal ❑ On site disposal system❑ V / Versionl.7 Commercial Building Permit May 15,2000 Departure tuse,only 1h ty of Northampton status of Permit , O .� 2©� 'Iding Department curb Cuf/DBceway erm�t 12 Main Street Sewer/SepticA Vail a6�lrt}r Room 100 WaterM/ell Avarlabtllfy 0_ mpton, MA 01060 E\e Two Sets of Structurat Plans �j"�v-,,--�5h e 413-587-1240 Fax 413-587-1272 Plot/Site plans Othec Spec(fy 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 �/ r / � ► �/' � Map Lot Unit Zone Overlay District Elm St.'District CB District SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Re rd Name(Print) Current Mailing Address: Signature Tebec C(i1 �b`i�ra'N Telephone 2.2 Authorized A ent: no om- Name(Print) Current Mailing Address: Signature Telephone SECTION 3-:ESTIMATED:CONSTRUCTION!COSTS' Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building / (a) Building'Permit Fee 2. Electrical ..�. ..,,_..._ ._.(./�_'_.. .__._.._..._.�.�....... ._..,., ..,u.� .....,_,. (b).Estimated Total.Cost of C:onstruction from- 6 3. Plumbing Building Pe:rmit:Fee 4. Mechanical(HVAC) -° -- 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only,* Building Permit Number Date Issued _Signature:_ Building Commissioner/Inspector of Buildings Date File#BP-2015-0173 APPLICANT/CONTACT PERSON ALL-TEK BUILDERS INC ADDRESS/PHONE 88G INDUSTRY AVE SPRINGFIELD (413)736-0099 Q PROPERTY LOCATION 264 ELM ST-2ND FLR DR COCHRANE MAP 31A PARCEL 076 000 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 Fee Paid Typeof Construction: DEMO INTERIOR 2ND FLR OFFICE-DR COCHRANE'S New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 76435 3 sets of P1,ai<Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I F NATION 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 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 emolition Delay / 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. 264 ELM ST-2ND FLR DR COCHRANE BP-2015-0173 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 A-076 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-0173 Project# JS-2015-000308 Est.Cost: $6000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALL-TEK BUILDERS INC 76435 Lot Size(sq. ft.): Owner: DEMAIO AARON A Zoning: URB(100)/ Applicant: ALL-TEK BUILDERS INC AT. 264 ELM ST - 2ND FLR DR COCHRANE Applicant Address: Phone: Insurance: 88G INDUSTRY AVE (413) 736-0099 O WC SPRINGFIELDMA01104 ISSUED ON.811512014 0:00:00 TO PERFORM THE FOLLOWING WORK.DEMO INTERIOR 2ND FLR OFFICE - DR COCHRANE'S 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 8/15/2014 0:00:00 $55.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner