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23A-114 (4) �_,._ .-��( } �,�! �-�� jj C 1 ��S �� '� s �� E f I �, � d �� 1 V�)2 V) Aix) City of Northampton Building Department STREETLIGHT .FINANCIAL Plan Review DRAWN BY.FINANCIAL l v 212 Main Street BROADWAY OFFICE INTERIORS28,6* � Northampton, MA 01060 13'10 1/4' 14'3" 9'1" '2"' � 9116115 + rim O m 1 3 ¢ ' s r 4 9'4" " , E 13'71/4" s '0"' T10" 29'11" - 21'0' 10'S 314" 1 � 9/28/15 Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 Inspector Hasbrouck, In accordance with the Massachusetts State Building Code,780 CMR§ 107.6.1 (5), l request that you grant a modification to waive the requirement for construction control for the project located at 8 Main St in Florence MA.This project consist of the construction of 2 new offices inside the existing building The work is of a minor nature,will not affect accessibility, life and fire safety,structural requirements and can be done in accordance with the prescriptive requirements of the code. Construction control is impractical for this project because the cost of control construction is considerable when compared to the cost of the proposed work.Thank you for your consideration. Respectfully, W catew M a4,e k/III W Marek Construction Inc Westhampton Ma 01027 (413)977 9539 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 1 Congress Street, Suite 100 Boston, MA 02114-2017 2 "v0v www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): mauv_ — Address: "?3 &XH,,r R9 City/State/Zip:L�e�, tc� MIC 014> Phone# Y N Are you an employer?Check the appropriate box: Type of project(required): l.(+I am a employer with L 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am 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.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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.F Other comp. insurance required.] Any applicant that checks box#I 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. ,?.—C Insurance Company Name: �� Policy#or Self-ins. Lic. #: WCC SW \�I 1a�0�O�' Expiration Date: Job Site Address: 1� IV6.(I\ 51 City/State/Zip:6 ' 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 under the pains and pen ies of perjury that the information provided ab h/1 ve is true and correct. Si nature: Date: 1d 5 Phone#: W- 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#: 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: 1 a f The debris will be transported by: We m+a+f -�- rr The debris will be received by: Building permit number: r Name of Permit Applicant t? — Date Signature of Permit Applicant Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Gilbert F. Ehmke, EVP, acting on behalf of Greenfield Cooperative Bank-- as Owner of the subject property hereby aut rite Walter Marek/W. Marek Inc. — to act on my b ers relative to work authorized by this building permit application. 110/01/2015 Signature o o ner Date Gilbert F. Ehmke, VP, acting on behalf of Greenfield Cooperative Bank 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. Si ned under the pains Ad penalties of perjury. Gilbert F. Ehmk cutive Vice President, acting on behalf of Greenfield Cooperative Bank Print Name 6aul Y 10/01/2015 Signature of Owner/Ag nt Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction_ Supervisor: Not Applicable [I Name of License Holder:�WCA� � -- — � ___.� ow w Ics Licens Nurn er Jr 0 VC04 I ' Address (' Expiration Date Signature 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 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: — Not Applicable ❑ Name(Registrant): Registration Number Address g � � Expiration Date i Signature Telephone 9.2 Registered Professional Engineers) s Name Area of Responsibility Address — I Registration Number Signature I 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 t— - —---- ------.. ------------- ---- ---— ---- Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible,in Charge of Constructi -- U Address ignature 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 �— E— Fronta e — -� ' J Setbacks Front 171 ��—��0 Side L:0 R:= L:hA R:= L� Rear Building Height -- Bldg.Square Footage % Open Space Footage rr � __ 0 (( ll (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 O DONT KNOW © YES O IF YES, date issued: I 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 O DONT KNOW O YES O 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 ® NO O IF YES, describe size, type and location: —_�-Sj (~ q f✓Ogl �-�; D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O IF YES, describe size, type and location: uCe. *4�v WdL A . ar peo HS sc� WaM Jn sl e U E. Will the construction activity disturb(clearing,grading,excavation,or fling)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. 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__❑ De ' ' Repairs[I Additions Accessory Building El Exterior Alteration ❑"Existing Ground Signer New Signs❑ Room hange of Use❑ Other❑ Brief Descriptio'?, Construction/Addition two (2)new inter' r offices. �,. 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 ❑ 113 ❑ B Business 2A ❑ E Educational ❑ 26 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ 1 Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A El S Storage ❑ S-1 El S-2 El 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: ._ _______-__.__—_—� Proposed Use Group: — t Existing Hazard Index 780 CMR 34):� Proposed Hazard Index 780 CMR 34): I I SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) St 2nd 2nd .. ... —.._.._-_.-.— -_ 3rd r d --- -- 4th --.._..--. 4cn Total Area(sf) _ Total Propose New Construction sf_) u 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 ❑ Zone L_ = Outside Flood Zone[:] Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 f Northampton D it ng Department OCT 7 Main Street oom 100 plwotric.Plumbing&Gas pton, MA 01060 pRha 240 Fax 413-587-1272 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 8 Main Street Map Lot Unit; Florence, Massachusetts 01062 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Greenfield Coopera e Bank, successor by 67 King Street,Northampton, MA 01060--� Name(Print) merger with th n Cooperative Bank Current Mailing Address: _ Gilbert F.Ehmke,Ex vi i e C O and Treasurer (413) 584-4474 —_ Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailino Address: _ Signature �--� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com leted by ermit applicant 1. Building LL§P � (a)Building Permit Fee F � 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection t_ 6. Total=0 +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-2016-0471 APPLICANT/CONTACT PERSON WALTER MAREK III ADDRESS/PHONE 73 SOUTHAMPTON RD WESTHAMPTON01027(413)527-7667 Q PROPERTY LOCATION 8 MAIN ST MAP 23A PARCEL 114 001 ZONE GB(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 Tyneof Construction: RENOVATE OFFICE SPACE FOR 2 NEW OFFICES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 055201 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF�pproved TION PRESENTED: 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 Demo ' ' n lay Signature of Building fficial 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. 8 MAIN ST BP-2016-0471 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A- 114 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-2016-0471 Project# JS-2016-000778 Est. Cost: $9800.00 Fee:$100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WALTER MAREK III 055201 Lot Size(sq.ft.): 19645.56 Owner: Northampton Cooperative bank Zoning: GB(100)/ Applicant: WALTER MAREK III AT. 8 MAIN ST Applicant Address: Phone: Insurance: 73 SOUTHAMPTON RD (413) 527-7667 O Workers Compensation WESTHAMPTONMA01027 ISSUED ON:1011312015 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE OFFICE SPACE FOR 2 NEW OFFICES 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 10/13/2015 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner