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32a-142 (8) - I t File K BP-2016-0701 APPLICANT/CONTACT PERSON GENE BOROWSKI fl ADDRESS/PHONE 117 SUNNYMEADE AVE CHICOPEE01020-1780(413)687-3777 PROPERTY LOCATION 48 MAIN ST MAP 32A PARCEL 142 001 ZONE CB(A-00)/ THIS SECTION FOR OFFICIAL OSE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid FePin ermit Filled out 1f/5— 0/ Fee Paid ((OO / Tvpeof Construction:_REMOVE 2 NON-BEARING 2ND FLR BEAMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building laps Included: Owner/Statement or License 106527 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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. Version 1.7 Commercial Building Permit May 15,2000 RECER'E7 Departmamuse only lty1Northampton Status ofPent uiIdngDepartment Curb CuaonvewayPermit 2� 212 Main Street Sewe75apac Avaaab4ty Room 100 watenweg Availability orP^C:::::!:- ' .',:77 -NCAtha npton, MA 01060 Two Sets of Structural Plans phone 413-56/I 1240 Fax 413-587-1272 PbUSite 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 PropallY,A�,dyyd��rese: �This section to be completed by office 4 /fiat, 5-f-- Map ,UI1 Lot 194' Unit r f i attf JCs,' /W, © ( Zee° Zone Overlay District/vd / Elm St DUMct Ca District SECTION 2-PROPERTY OWNERSHIP!AUTHORIZED AGENT 2.1 Owner of kale/IAA/5 / l.,------ Name(Print) ding Address: t P9 2OS Ur`{��j�(` �44gen F'fl ./''''-- ----- Signature ature i (�✓' 4 Telephone Vic - 1 Il 71 - ) 11 a.2 Autho-If. Melt Ge 4aro"0,42°6 ex, 6,44,500 117 -561-4-7_2/ 4p .le l (74; 4 Name(Prim) Current Milling Ada (9 ) A7--377 ] Signature 6.- Telephone SECTION 3-ESTIMA CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only comp) ted by permit applicant 1, Building q� a) (a)Building Permit Fee 2. Eledrital JJ (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 Jg /(j it Ito _ This Section For Official Use Only Building Permit Number Date Issued Signature: Budding Commissioner/Inspector of Buildings Date Version 1.7 Commercial Building Permit May 15,2000 SECTION 4.CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations MExlsting Wall Signs 0 Demomiont Repair:❑ Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing Change of Use❑ Other 0 Brief Description Enter a brief description here. 5 t ,nw+e {" 3r) #00-,a lir,J f'r5 Of Proposed Work: 2 1 ,C/Ser — C/ SECTION 5.USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-I 0 A-2 0 A-3 0 IA 0 ppL,� A-4 0 AS 0 iB 0 B Business F&- 2A 0 E Edncatonal 0 2B � Q F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A ❑ I Institutional ❑ I-1 0 I.2 0 1-3 0 38 0 M Mercantile 0 4 ❑ R Residential 0 R-I 0 R-2 0 R-3 0 SA ❑ S Storage 0 S-1 0 S-2 0 51l1 0 U utility ❑ Specify: M Mixed Use Q 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: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 0 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st " /l!960 2nd ,/_C�� / � 2m 3'd 3n th 4th 4 Total Area(si) Total Proposed New Construction(sf) Total Height(ft) Total Height ft P.Water uPPIY(M.G.L c.40,1 54) 7.1o Flood Zone Informside Mu Sewage pns it System: Public �.� Private 0 Zone Outside Flood Zone MunicipalTf`A'''''"On site disposal system Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building nepamnent Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot arca minus bldg&paved packing) it of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Findi g ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOWal_ YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and Location: 3 /x 7/ D. Are there any proposed changes to or additions of signs intended for the property? YES O NO e}_- IF YES, describe size, type and location: /" E. Will the construction activity disturb(clearing,grading,gnravation,or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial.Ruldmg Permit May 15,2006 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 115(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Regissafon Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responstgity Address Registration Number Signature Telephone Expiration Date Name Area of Responsibity Address Registration Number Signature Telephone Expiation Date 9.3 General Contractor 2 {d lGt-%rE tEfince4 [ r'�E? /,%.,,L 4� Not Applicable 0 Company Name: Responsible In Charge of Construction /77 50r7,2 4i CA ; ' res& �7.r 4 Cys- r37�7 Signa 1+h Telephone Version!.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 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,as Owner of the subject property hereby authorize gene !/p/'O zen-AJC/ C -r, to act on m half,in all matters relat've to work authorized by this building permit application. Si gnat f Owner Date l I, -�'� ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knovAedge and belief. Signed,Iunder the pains and penalties of perjury. ' 1 G/-ati XL • Print Name V // / /lS Signatu Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisonrr/SJ / Not Applicable ❑ Name of License Heider 7 C en-e ✓iv-reya syk License Number //77 5�n-r /�c;Z. /Y CS_ 10 65 21 Atldres,s�/ Expiration Date 7T� � (�r65)6� 37�j )z/z3/i ff IS Si nalu Tetephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.152,§25C(e)) 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 i-- No 0 X2�.\ The Commonwealth of Massachusetts Department of Industrial Accidents E—dip , Office of Investigations a =.. €�' . la-2- . 1 Congress Street, Suite 100 _, i,d Boston,MA 02114-2017 `" ' www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information f 1 /� Please Print Legibly Name (Business/Organization/Individual): &/n ,J e'r�7 J c fti^'3t'-,v -Ina., �"1' Address: // -7/ .SG.,7. Pc.A— S City/State/Zip:C_-yz e J `�117Et Phone#:f 1f j\ . 7--S") 1 } Are you" an employer? Cheik thea ropriate box: Type of project(required): I.qcl, am a employer with _ 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in anycapacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp.insurance required] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 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' 13.0 Other_ comp.insurance required] 'Any applicant that checks box#1 must also 611 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. IConnactms that check this box must atmched an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contncas have employees,they must provide their worker camp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins. Lie. #: 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 for insurance coverage verification. I do hereby certify un r the pai a penalties o', jury that the information provided above Ins �and�correct aianature: .-:cam ✓,SCJ%' -- ^� -r-7�~ Date: ,l/ S Phone#: Cy� .../j �"67- ? / /7._.... Official use only. Do not write in this area,to be completed by city or town official. i City or Town: Permit/License# Issuuing 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: 91 ///k ' 54- /' // The debris will be transported by: x/52 c ,f 40,d , /4 The debris will be received by: / M-,�.., it.., Building permit number: Name of Permit Applicant `t_ X�._-_ e ; e ...Grv1< ///- /C %.6., ✓ Date Signaturc/./- of Permit Applicant 11/18/2015 City of Nu-them03n Mal-Re:Beams S,), `bIPATaiyi (MY Of Louis Hasbrouck <Ihasbrouck@northamptonma.gov> Re: Beams 1 message Louis Hasbrouck <Ihasbrouck@northamptonma.gov> Wed, Sep 30, 2015 at 10:16 AM To: Hinge <hinge.aaronk@yahoo.com> Aaron, No email from Tris. I have time next week; have Tris get the email to me, and make sure you submit a building permit application. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax On Fri, Sep 25, 2015 at 3:09 PM, Hinge <hinge.aaronk@yahoo.com> wrote: Hey Louis, wondering if you saw the Email from Tris? Can you come inspect today by chance, really looking to make moves on this ASAP. Thank you, Aaron Kater Hinge (Owner/GM/Talent Buyer/Productions) (413) 387-3571 hnps://mail.google.com/mal/ca/u/O?ui=2&k=ec5f19a5/e&view=pt89=hirge.aaronk%4 yahoo.can&qs=true&searcfr=query&th=1501e9cdOcd23314&sirnk 150... 1/1