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32A-184 81 BRIDGE ST BP-2017-0578 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A- 184 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Skylight BUILDING PERMIT Permit# BP-2017-0578 Project# JS-2017-000939 Est. Cost: $2800.00 Fee: S 100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BELISARIO BURT 100030 Lot Size(sq.ft.): 25395.48 Owner: HYDE CAROL Zoning: URC(100)/ Applicant: BELISARIO BURT AT: 81 BRIDGE ST Applicant Address: Phone: Insurance: 31 EXETER ST (413) 222-2914 EASTHAMPTONMA01027 ISSUED ON:1/4/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVING 2 SKYLIGHTS & REPLACING SECTION WITH NEW ROOF 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 1/4/2017 0:00:00 $100.00 212 Main Street.Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0578 APPLICANT/CONTACT PERSON BELISARIO BURT ADDRESS/PHONE 31 EXETER ST EASTHAMPTON (413)222-2914 PROPERTY LOCATION 81 BRIDGE ST MAP 32A PARCEL 184 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST �� CLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: REMOVING 2 SKYLIGHTS& REPLACING SECTION WITH NEW ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 100030 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 •- •oli '•. Imlay 701— Signa ure of Building Oficial 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 or Planning&Development for more information. aa - Version l 7 Commercial Budding Permit May 15,2000 Department use only I r- City of Northampton Status of Permit: Building Department 212 Main Street Curb Cut'Ddvesvay Permit Sewer/Septio Availability OUQ 1 I Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans_ ig one 413-587-1240 Fax 4135&7-1272 Plot/Sas 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 I SECTION 1 -SITE INFORMATION 1.1 Property Address This section to be completed by office a8�4 ` H tidy S.cl. {. . Map Lot Unit PO O jFif+jill jilt 10'7 `t 0 0t 06 0 Zone Overlay District 1' //—/ _ - - Elm St District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED/ AGENT 2,1 Owner of Record: / o/ fitly Name(Print) ffL... fiJ. / Current Mailing Address: Signature _. Telephone 2.2 Authorized Agent: 31 Sttdek i Name(Font) s r, O,,{jli-02 VVV�u y-/ Crtnen aN ((dress /( a04irk-r y yl /74 0/0 Z 9 Signature ! (/ Telephone kg _ 27 7 - i y at f SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant __ ,. 1. Building .2 D D !1 (a) Building Permit Fee 2. Electrical , (b)'estimated Total Cost of Construction from(6) _. . ... 3. Plumbing Building Permit Fee 4. Mather cat(HVAC) - 0 0 5 Fire Protection 6. Total=(1 +2+3 +4+5) p7aO Check Number iii!!!""" This Section For Official Use Only Building Permit Number Date Issued Signatu /�7f/ec Suil• -a m ssion- Inspect'of BUJ clings Date VersionI 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 Additions ❑ Accessory Building Exterior Alteration 0 Existing Ground Sign 0 New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Enterna brief description here. / ./ �e Of Proposed Work '...y/A (/Ylol�f✓f�... //CC/�1Rs f '�eta,,� $/'^![,„„, 0 � ✓-fO .. 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 1A I ❑ ❑ A-4 ❑ A-5 0 ( 1B 0 B Business ❑ 2A ❑ E Educational ❑ 26 0 F Factory ❑ F-1 ❑ F-2 ❑ 2C 0 H High Hazard 0 3A ❑ I Institutional ❑ I-1 E 1-2 0 1-3 ❑ 3B ❑ M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 58 ❑ U Utility ❑ specify. M Mixed Use ❑ Specify S Special Use 0 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) 2nd 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 7 Private ❑ Zone___,_,_.. Outside Flood Zone El 1 Municipal 0 On site disposal system Ve[son1.7 Commercial Budding Permit May 15, 2000 8- NORTHAMPTON ZONING Existing Proposed Required by Zoning Buil column to be ntled 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 bide&paved __.. narking) _._. _._.... m of Parking Spaces -. - - Fill: _ .. _ .. (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW YES Q IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO "e/ DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO er IF YES, describe size, type and location D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO IF YES, describe size, type and location: E Will the construction activity disturb(clearing,grading,excav n,or filling)over 1 acre or is it part of a common plan that will disturb over I acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May I5, 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 Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Acdress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor �/ /L{( 1 /pq//' u .�( /`�elidgat/H,J11 I U _ `�(�. . . _... Nat Applicable 0 C���555"'mpany Name: s+ Responsible/In'Charge of Construction rt 31 Address Sign . Telephone 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 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 _.. __ _ to act on my behalf,in all matters relative to work authorized by this building permit'application. Signature of Owner Date 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 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 RR��� i/n/ Not Applicablepplic `E❑ Name ofLicenseHolder: �,�/{/✓✓ - IJGGsartc2 gier( 10 O % 0 31 / �0L lz(� plod! Po D/02 ; License Number Address Expiration Date �' /3 2221 / fp/23/20/--7 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 build, ermit. Signed Affidavit Attached Yes No 0 The Commonwealth of Massachusetts 5 Department of Industrial Accidents '3- = Office of Investigations:7271 ' -n, t-.t r 600 Pitasi ingeon Street Boston, MA 02111 egww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors,/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiou/lndividual)I Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: ' Type of project(required): LE I am a employer with 4. I am a general contractor and S b_ 0 New construction employees(full an- or part-time).° have hired the sub-contractors 2.RI I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have a. ❑ Demolition workingfor me in anycapacity. employees and have workers' P Ty 9. ri Building addition [No workers' eo_mp.insurance comp. insurance.+ required.) d. l I \Ve are a corporation and its 10.E Elect-kcal repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LD Plumbing repairs or additions • myself [No workers' comp. right of exemption per MGL 120Roof repairs insurance required.]r c. 152, §1(4),and we have no employees.[No workers l 13.0 Other i comp. insurance required.) •Any applicant that checks box e: must also fill out lie sec5onbelow showing their workers'compensation policy information. °Homeowners who submit this affidavit indicatng they arng ail work and then hire outside contractors must submit a new affidavit indicants:,such. 'Conractors that check this ho[must attached an additions.:sheet showing the narm of the sub-contactors and state whether or not those entities have enpioyees. Ifinesub-contractors have enplover,they must provide their workers'Cott .policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inform anon. insurance Company Name:,_, _. Policy#or Self-ins.Lie. 'd: 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 ofa tine up to$1,500.00 and/yione-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine or up to$250.00 a day against a- violator, Be advised that a copy of this statement maybe forwarded to the Office of Investigations of th.”f• for ' - ance coverage verification. IA Date'do hereby cal • us and penalties of per hay that the Information provided above is true and correct. — ,�A Signature. �. _ `'�Phone#: _ 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 b. 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 disposal77facility, as defined by MGL c 111, S 150A. D Address of the work: I rLc� The debris will be transported by: 6,4 lfaelo-7 The debris will be received by: &'o/% Let c/y1 Building permit number: Name of Permit Applicant / C 2 �' - 1 Date Signature of Permit Applicant