Untitled 41 MARKET ST BP-2017-0662
Cis#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A-075 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Stair BUILDING PERMIT
Permit# BP-2017-0662
Project# JS-2017-001084
Est.Cost: $4300R0
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: EDWARD RICKEY 96159
Lot Siie(sn. e.): 3659.04 (inn
Zoning_URCL1 OD( Applicant: EDWARD RICKEY
AT: 41 MARKET ST
Applicant Address: Phone: Insurance:
P O BOR 62 (413)695-7059
WILLIAMSBURGMA01096 ISSUED ON:1IJ15/2016 0:00:00
TO PERFORM THE FOLLOWING WORK REPAIR ENTRY STAIRS & SMALL ROOF OVER
BASEMENT ENTRY
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspectorof Wiring D.Y.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House tt 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 ANI) REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 11/15/2016 0:00:00 SI00.00
212 Main Street, Phone(413)587-1240.Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
i ) - Version1.7 Commercial Buildint Permit May 15,2000
[ . . epa
NOV X 4 2 ` 1 D
City of Northampton Status M
Building Department Curb Pemtirtmt ent use onty
�_---I� 212 Main Street Sewer/Septicpv�a28bfity
Room 100 water/Well Availability M
Northampton, MA 01060 Two Sets of Structural Plans
__
�r
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
1.1 Property Address: This section to be completed by office
— 44eie [// --70a4 —t. Map Lot Unit
Northampton,MA / !!`��",
Zone Overlay District
Hm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Michael &Denise Shea 41 N Loudville Rd, Florence,MA 01062
Name(Print) Current Mailing Address:
,"9 (413) 582-1417
Signature :f .. '/ /+�IL elephene
22 Authorized Agent
Name(Print) Current Mailing Address:
signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 9 3(,c, oo (a)Building Permit Fee
2. Electrical Tr (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) y,'{Qo, 00 Check Number 33( I ;e . / •
This Section For Official Use Only
Building Permit Number Date
issued
/ /moi�,/�Signature:/77:64100. A ... / J
Building in. miasiorarnn Date` l �j��
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 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing() Change of Use❑ Other 0
Brief Description Repair entry stairs and small roof over basement entry.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 IA ��❑
A4 0 A-5 0 IB 0
B Business ❑ _ 2A 0
E Educational ❑ _ 28 ' 0
F Factory 0 F-1 0 F-2 0 2C 0 _
H High Hazard 0 _ 3A ❑
I Institutional 0 I.1 ❑ 1-2 0 1-3 0 38 0
M Mercantile 0 4 0
R Residential 0 R-i ❑ R-2 0 R-3 0 5A 0
5 Storage 0 SA 0 S-2 0 58 0
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:
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(sf)
1'h
1`r
2m 2m
3b 3re
4th 4m
Total Area(sf) Total Proposed New Construction(sf)
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 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
S. NOR7'AAMPlON ZONING
Existing Proposed Required by Zoning
This column to be fined in by
Building Dcparmut
Lot Size
Frontage 4_
Setbacks ]''font
Fide L: R: L: It:
Rear
Building Height
Bldg.Square Footage
Open Space Footage °o
(Lot area minus bldg&paved
parting) ..._
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document k
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained O , Date Issued:
C. Do any signs exist on the property? YES O 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 O NO V
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
The Commonwealth ofMassachusetts
,_ Department of Industrial
I Neil'
.131-71 1 Congress Street, Suite 100
Boston, MA 02114-2017
ti
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information +� Please Print Lezibly
Name (Business/Organization:Individual); !.a/l42.0.7�
Address: P. An 62 C//J
.
City/State/Zi.: .,.. , w ..,._ a" Phone #: -„ - 705'7
Are you an employer? Check the apt o t nate box: Type of project(required):
1.0 I am a employer with 4. 0 I am a general contractor and I
_;mployees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. [t Remodeling
ship and have no employees These sub-contractors have v- 0 Demolition
working for me in any capacity. employees and have workers'
9- 0 Building addition
[No workers' camp. insurance comp. insurance.,
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' cow right of exemption per MGL.
Y ➢- 12.0 Roof repairs
insurance required.] ' c. 152, ys 1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'_Any applicant that checks box 81 must also fill out the section below showing their workers'compensation policy information.
r 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 orthe sub-contractors and state whether or not those entities have
employees. H the sub-contactors have employees.they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance far my employees Below is the polity and job the
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 S 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 5250.00 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 paints and penalties of perjury that the information provided above is true and correct.
Signature: _ i ., / !. Date: /fir'-/‘
Phon•#: /3-.cl — orAw
..
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: `T 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 150k
Li
Address of the work: treet Northampton, Ma
The debris will be transported by: Jon Levin
The debris will be received by: Valley Recycle
Building permit number:
Name of Permit Applicant Michael & Denise Shea
2//e/ & vsR d / A -
Date Signature of Permit Applicant
Version1.7 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 CONTRACTORO } APPLIES
�FOR BUILDING PERMIT
7 ..Y f`.����,,('' . I/? S Jt.a ,as Owner of the subject property ,
hereby/a_utthorize C —.... to
act on my behalf,in all matters relative toks authorized by this building permit application.
\ lilJOT�� - !J-/Y-4
reofOwner Date
I, , as Owner/Authorized
Agent hereby dedare 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
0,1 Licensed Construction Supervisor "rte, 'f �f Not Applicable
f Name of Llc nae Hostler: C.eYL4t**^ ,Z [/ CI
t/1./4R.y..✓43-Ct C, y ,��'`��, Cant—
1 (7 // License Number
P. 4z - • 0076 964.5'9
Address Expiration Date
1\ Signature / Telephone
�SECTIIONN 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MAL C,152,¢25C(8))
Workers Compensation Insurance affil it must be completed and submitted with this application.Failure to provide this affidavit will result
in the denial of the issuance of the .ding permit.
Signed Affidavit Attached Yes No 0
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 30,000 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
Signature Telephone Expiration Date
Name .�...... Area of Responslbfiity
Address Registration Number
Si Expiration
..
nature Telephone � Expiretion Uate
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
79Steace
3 General Contract�orr / /7/���, �411..}�' �GG.GZU?Glare, 4 i... ... .at Applicable ID1
Company Name: cif f
Responsible Charge of Cation
4 6.2 ,Ird coned 1 ,,/ 21911 0/CU
AEdress _/
!.'C C� 9/3.69s'-7c5
Signature Telephone
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Edward Rickey & Co.
PO Box 62
Williamsburg, MA 01096
413.695.7059
I request that you grant a modification to waive the requirement for control construction for the Egress
stairs at 41 Market Street 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.Thank you for your
consideration. "Mass Amendments,sections 107.1 allows for an exclusion from control construction for
this project"
Respectfully,
Edward Rickey
Edward Rickey&Co.
PO Box 62
Williamsburg, MA 01096