32A-095 (2) 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: �("�z ��G
The debris will be transported by:
The debris will be received by: V
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
City of Northampton
� Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
�
. � Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Fax: 413-587-1272 Chuck Miller
Building Commissioner Phone: 413-587-1240 Assistant Commissioner
CONSTRUCTION CONTROL DOCUMENT
(For professional Engineers/Architects responsible for Entire Project)
Project Title: A,L fZAT 16 NS TO L�,5 Date: IS
Project Location: C)'12 tM � �T ST Map: Parcel: Zone:
Scope of Project: t N`TT—Q o�P. K F—W)V TO(S) r&P PL"S
In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6:
I, L,�j N N Cog"J_J�_ j_1C_F_ Mass. Registration# 53 13
Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised
the preparation of all design plans, computations and specifications concerning:
[VI"ENTIRE PROJECT
For the above named project and that to the best of my knowledge, such plans, computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices
and all applicable Laws for the proposed project.
Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that
the above mentioned portions of the work proceed in accordance with the documents approved for the building
permit and shall be responsible for the following as specified in Section 10.7.6.2.2:
1. Review of shop drawings, samples and other submittals of the contractor as required by the
construction documents as submitted for the building permit, and approval for the conformance
to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled materials.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with
the progress and quality of the work and to determine, in general, if the work is being performed
In a matter consistent with the construction documents.
I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent
comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory
completion and readiness of the project for occupancy. ,
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4signaturend Seal of Reg' red Professional vNo, 5313
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m DEPARTMENT OF BUILDIT(G INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFIi'IDAVIT
I, Pioneer Contractors
(licenscrJpertnittee} _ _
"'Ith a principal place of business/resideuce at.
—.P.O. aQx 1 1 45 Nnrthamptony MA 01-061 (phone«) T_ $6 5 49a
(&tn—UCity/st lrip)
do hereby certif)f, under the pains and penalties of perjury", tliat:
I am an employer providing the following work=er's colnpensanon coverage for my
employees working on this job:
Wcc 50059570120C1Z
Assaci at p-d Fmnl aye-r Tnslurance Cn
(Ins=Ce Company) (Policy Numt�er) --- -(E-kptration D=) .
O I aul a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation pohcies:
(Name of Contractor) (Insura.nc�e Company/Policy Number) ( iration Date)
r
(Name of Contractor) (Laurance Compauy/Pohcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PoUcy NtLmber) (E.i-piraboa Date)
(Name of Coat maor) (Inslurnce Company/Policy Number) (ExTiration Date)
(auam gdditioaal sheet ifnoc as to include iafonna.tion perbLining to all o_'txnctor.')
( ) I am a sole proprietor and have no one warldng for me.
( ) I am a home owner performing all the work myself.
NOTE:pi=zc be aware that wWJo homcowocrs who employ persam w do «r aoas>nctioa or npaior work ou a dvvclling of
not molt th-en throo units io ts'hicb the botneoworr raids of ea the grarods appur(cnarfl tbercto are not b'oacraUy ooa:i6c ed to be
cmployrra under tho vvarka's«mpensx4oa Act applimbon by a homcoava fora Uomo a or permit may aidcnoc the
legal aawa of an amployer under tho WorkzeL Compomatiaa Act
I undait d thst a oWy of this sriicmcrrl may bo roiwerded to tbo Dcponmrai of Iodxu risk Aocidw&Offioo of la ur Do for tho
Coverage vcnficstioa and that L'a=to ao=m covcrngo uUda soctioa 25A of MGL 152 can Icad to the inrpctsition of aiming1 penalties
000sisrmg of a fine of up to S 1,500.00 mxV-impriso of up to one year and civil pazattics in the form of it Stop Work Ordc and a
brio of S 100.00 a day agniasi me
For dgmWxiY-1 use oaty
Y/ / Permit Number
7 /�,( 2viap� Lot#
Si tort of LicetLSCelPcrmie
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 0 No G)
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
market9.5 LLC
I'------------------------ ----- —----------------------—------,as Owner of the subject property
Pioneer Contractors/David Claxton
hereby authorize------------------------------- -------------- ------------------to
act on my behalf,in all matters relative to work authorized by this building permit application.
------------------------------------------------------------
Signature of 019- Date
David Claxton
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 unde �ai�nsd Iti of jury..
------- V/� -_`!_---------------- --------------------------------------------------
Print Name ,�
----------?� --------------Y/Zk-------------------------------------
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
David Claxton CS-017890
Name of License Holder:
-------------- —
License Number
01/19/2016
------------------------------------------------------------- —
Address Expiration Date
/ 413.626.7267
------ -- -------------------------
---
Signature 1" - - 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 (F) No
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:
Lynn Rice/Rice Yun Architects Not Applicable ❑
------------------—--------- — ------—-------
Name(Registrant):
6 Crafts Avenue, Northampton, MA. 01060 Registration Number
---------------------------------------------------------------
Address
-------------------------
Expiration Date
– —--------------— -- ------
Signature Telephone
9.2 Registered Professional Engineer(s):
Ryan Helwig Structural
-------------------------------- -------------------- ------ -- ---------
Name Area of Responsibility
onsibilit Y
-------- ------------------------------------------------
Address Registration istration Number
--------------------------------------------------------------- ---------------------------
Signature Telephone Expiration Date
Julia Weatherby/Lindgren& Sharples Mechanical
------------------------------------------------------------- ----- -- --------------
Name Area of Responsibility
---------------—--------------------------------------- -- -------------------------
Address Registration Number
-------—-------------------------------------- ------------- --------------------------------
Signature Telephone Expiration Date
-------------------------------------------- ------ ------- --- ----------------
Name Area of Responsibility
Y
--------------------------—----------------------------------- ----------------------------
Address Registration Number
------------------------------------------ — --------------- --------------------------
Signature Telephone Expiration Date
----------------------------------------------------------- ----- ------------------
Name Area of Responsibility
-------------------------------------- -------- ----- -- ----------------------
Address Re g istration Number
---------------------------------------- --------- ---------------------
Signature Telephone Expiration Date
9.3 General Contractor
Pioneer Contractors
-------------------------- — -- ------- Not Applicable ❑
Company Name:
David Claxton
----------------- -- -------------- --------
Responsible In Charge of Construction
P.O. Box 1145, Northampton, MA
01061
---------------- - --- ------------------------
Address
413.626.7267
----------- --- - -- -
Signature Telephone
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
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 C) DONT KNOW Q YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW ® YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ® , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO e
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 ® NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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 El 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 description here.
Of Proposed Work:
Renovations ner plans- partitions & finishes- electrical- nlur
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 El 2A ❑
E Educational ❑ 2B I ❑
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:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Business Proposed Use Group: Business
Existing Hazard Index 780 CMR 34): 10W Proposed Hazard Index 780 CMR 34): 10W
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1St 3000 1 St
2nd 3000 2nd
3rd 3000 3rd
4tn
4tn
Total Area(so 9000 Total Proposed New Construction (so
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 0 Private ❑ Zone Outside Flood ZoneF] Municipal [E On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
_ r-1 Department use only
_ City of Northampton Status of Permit:
- 8 2015 212 Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
l>c ;� f ; --- -_ I Room 100 WaterlWell Availability _
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 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 llee� f7-i iV-s
1.1 Property Address: This section to be completed by office
Map Lot Unit
9 1/2 Market Street Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
market9.5 LLC 30 Hampton Avenue, Northampton, MAO 1060
Name(Print) W arY l LLq � Maim Pte,-, Current Mailing Address:
T 413.537.5793
Signature 1_ Telephone
2.2 Authorized Ager t:
Pioneer Contractors P.O. Box 1145,Northampton, MA 01061
Name(Print) Current Mailing Address:
413.586.5491
Signature -----_--------------- __ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 408,500.00 (a)Building Permit Fee
2. Electrical 42,000.00 (b)Estimated Total Cost of
Construction from 6
3. Plumbing 18 000.00 Building Permit Fee
4. Mechanical (HVAC) 1111 VW 156,500.00
5. Fire Protection 3 Ny
6. Total=(1 +2+3+4+5) •W Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
---------------------------------------------------
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0947
APPLICANT/CONTACT PERSON PIONEER CONTRACTORS
ADDRESS/PHONE PO Box 1145 NORTHAMPTON01061 (413)586-5491
PROPERTY LOCATION 9 1/2 MARKET ST
MAP 32A PARCEL 095 001 ZONE CB(99)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out AV! 13,752
Fee Paid
iyl2eof Construction: INTERIOR RENOVATIONS
New Construction
Non Structural interior renovations
Addition to Existing-
Accessory Structure
Buildinp,Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
Demolition 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.
9 1/2 MARKET ST BP-2015-0947
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-095 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-2015-0947
Project# JS-2015-001539
Est. Cost: $625000.00
Fee: $3750.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIONEER CONTRACTORS 017890
Lot Size(sq. ft.): 2700.72 Owner: MARKET9.5 LLC
Zoning: CB(99)/ Applicant: PIONEER CONTRACTORS
AT: 9 1/2 MARKET ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413)586-5491 Workers Compensation
NORTHAMPTONMA01061 ISSUED ON.5/8/2015 0:00:00
TO PERFORM THE FOLLOWING WORK.INTERIOR RENOVATIONS
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 5/8/2015 0:00:00 $3750.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner