32A-137 (4) 37MAIN ST-LUCKY'S BP-2016-1209
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 137 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2016-1209
Project# JS-2016-002077
Est. Cost: $2000.00
Fee: $100.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: PATRICK GALVIN 013977
Lot Size(sq. ft.): 6664.68 Owner: 39 MAIN STREET LLC
Zoning: CB(100) Applicant: PATRICK GALVIN
AT. 37MAIN ST - LUCKY'S
Applicant Address: Phone: Insurance:
95 NORTH MAPLE ST (413) 253-6585 O WC
HADLEYMA01035 ISSUED ON:4/14/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-STUCCO KNEEWAL BELOW WINDOW
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 4/14/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Version 1.7 Commercial Building Permit May 15,2000
Department use only
®\� ity Northampton Status of Permit:
' a �D it 1 g Department Curb Cut/Driveway Permit
`O 12 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
F
v Northampton, MA 01060 Two Sets of Structural,Plans
o`f one 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
1.1 Property Address: This section to be completed by office
Map Lot Unit
CS Zone Overlay District
__._.. _..... __... Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) / Current Mailing Address.
ignature Telephone
2.2 Authorized Agent:
( c��Ce ....
Name(Print) _ S'� l �j /►'lir
L ,' ,1 Current Mailing Address. _.
Signature Telephone
SECTION 3-E IMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
Z o�L
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) J Check Number
-- -- --This_Section_For_Official-Use_Onl
Building Permit Number Date
Issued
Signature: 101.2
f
ft 6 G
Building Commissioner/Inspector of Buildings Date , i
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 ❑ 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
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 ® 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I 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 E-1Specify:
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):1 Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
1st
1st
2nd
2nd ........
3rd
3rd _....
4th ..-_.
4`h
Total Area(sf) Total Proposed New Construction(sf)
T _
._...................._..
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 Outside Flood Zone❑ Municipal ❑ On site disposal system❑
I
Version 1.7 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:. .-.m...... 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 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book Page and/or Document#
S. Does the site contain a brook, body of water or wetlands? NO 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:
_..
C. Do any signs exist on the property? YES NO O
�. .
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
IFYES,—describe size-,-type and location:
E. Will the construction activity disturb(clearing,grading, ex avation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
........ ._. ...... .._. .. ..._._.._ _ _ ...._.. ._.. __ ..._...... _.
Address Registration Number
i
Signature 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
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
i
y Not Applicable El
--Company-Name: --—
Responsible In Charge of Construction
Address
Signatur ' Telephone
i
The Commonwealth �J_Massachusetts
Department of Industrial Accidents
+ j Office of Inve$til ations
- 600 Washington Street
Boston, MAI 02111
www.mass.9ov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
t
Name (Business/Organization/Individual): �� I.J S S��S N\&-so
a ,
Address: J,
City/State/Zip: Phone#: kA R 2 S3,G T
Are you an employer? Check t appropriate 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. New construction
2.[r 1 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.❑ Electrical repairs or additions
❑ officers have exercised their I L Plumbing repairs or additions
�. I am a homeowner doing all work ❑
myself. [No workers' comp. right of exemption per MGL 12.7 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.
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.#: Z T-g3Expiration Date: z/10J
Job Site Address:— nC, 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. l52 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 nde airs nd en Ities ofperjury that the information provided above is true and correct.
Sip-nature: Date: L l
Phone#: — -
Of use only. Do not write in this area, to be completed by city or town offzciaL
City or Town: Permit/License#
I
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#:
i
I
i
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) —7
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
as Owner of the subject property
hereby authorize _.. ........
act o my behalf, i ve to Ygk autho ' by this building permit application.
ignature of Owner Date
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 penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
_. _..... _.....__ ._.
Name of License Holder ..._ .(r�( ....._, /�.� ..... _.__
License Number
it
Address— Expiration Date
Signature Telephone (,(4 /tot
SECTION)3-WOR ER COMPENSAT SURANCE 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
Galvin&Sons Masonry and Construction
Commissioner Hasbrouck 4/13/2016
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the Luckys
Tattoo knee wall resurface at 37 MainStreet in Northampton 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. All work
will be completed within the prescriptive requirements of 780 CMR.Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
Jason Galvin
Galvin&Sons Masonry and Construction
95NorthMaple Street
Hadley MA 01035