32A-185 (9) 89 BRIDGE ST BP-2017-0191
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 185 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:demolition BUILDING PERMIT
Permit# BP-2017-0191
Project# JS-2016-002484
Est.Cost: $40000.00
Fee: $200.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MATTHEW CAMPAGNARI 076047
Lot Size(s9. ft.): 14810.40 Owner: SHAW DONALD M
Zoning: URC(I00)/ Applicant: MATTHEW CAMPAGNARI
AT: 89 BRIDGE ST
Applicant Address: Phone: Insurance:
128 FEDERAL ST (413) 237-5872
S P R I N G F I E L D MA01105 ISSUED ON:12/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:DEMOLISH BUILDING
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 12/1/2016 0:00:00 $200.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0191
APPLICANT/CONTACT PERSON MATTHEW CAMPAGNARI
ADDRESS/PHONE 128 FEDERAL ST SPRINGFIELD01105 (413)237-5872
PROPERTY LOCATION 89 BRIDGE ST
MAP 32A PARCEL 185 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
/9a2
ENCrL` O ECD REQUIRED DATE
ZONING FORM FILLED OUT (
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLISH BUILDING
New Construction
Non Structural interior renovations
Addition to Existim
Accessory Structure
Building Plans Included:
Owner/Statement or License 076047
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
7IN OR TION PRESENTED:
pproved 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
re .I" ,
/�_/1?17
Signa ure tiler ffcial
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 infonnation.
42 9
14,77.- -
s"'-�"� '<_ !t .,:z..
Version! 7 Commercial Building Penne May 15,2000
` Department use only
Girt of Northampton Status of Permit:'
2O« B tiding Department Curb Cut/Driveway Permit -
bear prease,,, 212 Main Street Sewer/Septic Availability .,.,
eUmgal,.P7cr.' `ar',_^ns Room 100 WaterNYell Availability
M4' ''° o hampton, MA 01060 Two Sets of Structural Plans
phone 413-5871240 Fax 413-587-1272 PlotMite 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
err'. /bet612-ItGG %t
Zone Overlay District
--- --- --- —' Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ailej Tbito LGA /zgr/e44 en- mc /Vac
Name(Print) Current Mating Address:
237 5B72__
Signature _aof ,t L1 A./. - Telephone -.-. _ . .
2.2 Authorized Agent:
"Or 'ut m, /es azekpi
.gr 5.mc1- to's*C
Name(Print) Current Moiling Address yyyy
2,32,
Signature I� r/' telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 1 /0 000 (a)Building Permit Fee
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) 40, OOO Check Number /b,. � . OD
This Section For Official Use Only
Building_ Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Version L7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 38000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 DemolitionRepairs❑ Additions ❑ Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofing Change of Use Other 0
Brief Description Enter a brief description here.
Of Proposed Work:
dtGtt/u44 of �ttsrny� Bv<16
SECTION 5•USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) I CONSTRUCTION TYPE
A Assembly ...❑ A 0 A-2 0 A-3 ❑ IA 0
A-4 0 A-5 ❑ lB 0
B Business Q 2A ❑
E Educational ❑ 28 0
F Factory 0 F-t ❑ F-2 ❑ 2C j 0
H High Hazard 0 3A J ❑ ,
I Institutional ❑ I-1 ❑ 1-2 ❑ I-3 ❑ 3B ❑
M Mercantile ❑ 4 0
R Residential 0 R-t 0 R-2 J ❑ _..._ R-3 0 SA ❑
s Storage ❑ s_t ❑ S-2 0 58 0
U llfiliry Q Specify
M Mixed Use ❑ Specify:
S Special Use ❑ Specify. _ y - �....
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{sr)
- -_. tm _...
1" -.... -
2'°
4n 4th
Total Area Gsf) Total Proposed New Construction(si)
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 ❑ Zone _ Outside Flood Zone Municipal 0 On site disposal systems
t
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
Frontage
Setbacks Front
Side
Rear -
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
narking)
d of Parking Spaces -- -_
(vobvne&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Regist of Deeds?
NO Q DONT KNOW YES 0
IF YES: enter Book Page and/or Document/t
B. Does the site contain a brook, body of water or wetlands? NO Qt."— DONT KNOW Q YES Q
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
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ( NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exca ion,or filling)over t acre or is 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.
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 0
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
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
_..._ _..._.... ..___.. __.._ _._ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature 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 3 No 3
SECTION II -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
•
, a lA*oo"44/ .'"!ig e_ayAv r.{-- 1(C ....___ _.. 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.
PrimN mem _
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction
�ASS��u�//p�ee{M/�,ss��oIr': 11 ����// Not
AApplicable 0
Name of License Holder [x{x�/'TQ1l1�W t�1/J '16194[. _ ds 0760c
License Number
/2-8 a 5% SPFuj 4M69 O /O <14.0
Acorns Expiration Date
237. 6C37-2.-
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 No 3
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
- 600 Washington Street
Boston, MA 02711
www.nzass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information �,t /� Please Print Legibly
Name [Business/Organization/Individual): IAT ��A., ea,67� LLC_
Address: 178 /G dg4 5i
City/State/Zip: '5) 4 t7/60E Phone#: 232 /7?
Are you an employer?Check the appropriate boa: 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-connactos 6. New consnvetiom
2.❑ I em a sole proprietor or partner- listed on the attached sheet 7. ❑ Rerno cling
ship and have no employees These sub-contractors have g. ' emolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' cora insurance came. insurance.]p' - 10.❑ Electrical repairs or additions
xrequired.] 5. 11.4e are a corporation and its
3.❑ Jam a homeowner doing all work officers have exercised their 11.❑Plumbing repzirs or additions
myself [No workers' comp. right of exemption perMGL 12.❑ Roof repairs
insurance required.]t c. 152, §1(4), and we have no
employees.[No workers' 13.❑ Other
comp.insurance required.] f
*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 subcontractors have employees,they must provide the 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.#: 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 certi oder the s and penalties of perjury that the information providedaboveis true and correct.
Signature: ZV/ Date: L' 4•
Phone#: 237• `J V72
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 150k
Address of the work: 67. ��/' /32s4GC 57-, I/p Alip
The debris will be transported by: nii2g4&Ur T✓LUCkJ.vc
The debris will be received by: _Z0(1.6 T Ge%-2
Building permit number:
Name of Permit Applicant affm. 67/0442; �Y%t3&cctOl &t-
act-
LG-l3, ct- /6 aft
Date Signature of Permit Applicant