32A-138 (114) 73 BRIDGE ST-#5 BP-2007-1161
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32A- 138 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-1161
Project# JS-2007-001855
Est. Cost: $6500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: ALAN D WALLACE 007401
Lot Size/sq.ft.):- Owner: KRAMER ETHAN
Zoning: URC Applicant: ALAN D WALLACE
AT: 73 BRIDGE ST -#5
Applicant Address: Phone: Insurance:
143 RIVER RD (413) 863-9749 WC
GILLMA01354 ISSUED ON:6/5/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATE & DRYWALL BASEMENT WALLS &
CEILING & ENCLOSE BASEMENT STAIRS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough:(/ kk 7 House# Foundation:
Ate-
Driveway Final:
Final: � Final:
7/22/p
S Rough Frame: 6tc O(1.2 (6.7 tv14t 5
rs-
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: fide' f42 r J
Final: Smoke: Final: OK a$/US/b&' L - 13
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy r/-^-s 4X_,
p � Signature:
FeeType: Date Paid: Amount:
Building 6/5/2007 0:00:00 $50.001109
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File 4 BP-2007-1161
APPLICANT/CONTACT PERSON ALAN D WALLACE
ADDRESS/PHONE 143 RIVER RD GILL (413) 863-9749
PROPERTY LOCATION 73 BRIDGE ST-NS
MAP 32A PARCEL 138 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /`e, (� �,,r
Fee Paid !/ ] f'
T e onstmction: INSULA lE&DRYWALL BASEMENT WALLS&CEILING&ENCLOSE BASEMENT
STAIRS ....,
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 007401
3 sets of Plans t Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 CR Architecture Committee
Permit from Elm Stree ommission ^j
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 grunting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information_
_ Version1.7 Commercial Building Per�a`C'Remit May 15, 2000
S :DeParGne0t4sQooly
City of Northampton , r Sod° a _ a _
ysa s4 er i. C _�
Building Department �� � e d=Ct�snv_e�wa Pemxr>
212 Main Street SawedS€p tc>wa4abcrtp- + ' "4�e
Room 100 'NerdW 'Ava
tilgG7ity''` '*+
Northampton, MA 01060 'AM' 2 7 e Sfnvin awn1ans - e .
phone 413-58/-1240 Fax 413-587-1272
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 (
'. SITEINFORMATIN -
- This section tote com/f "etedb office
'11 Property Address O_
n . # Map Lot Uni✓ j
nertivi
_
/ mNSrj /91 oCe4 Zone Overlay nisenct
--- -- -- ,Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP!AUTHORIZED AGENT
,/ 2.1 Owner of Record: L
"333vikAe 5z .�b irng4jAp-at6
Name(Print/ ' Current Mailing Address:
413 LOC— coi
r (
Signature _ ,� 3' Telephone
2.2 Author"r A•ent:
Name(Pdnit Cvrtent Magna Address:
Signature telephone
SECTION:3-ESTIMATED CONSTRUCTION COSTS
Rem Estimated Cost(Dollar)to be Official Use Only
completed by oermit applicant
1. Building Salo (a)Building Perna Fee
2 Electrical Cato (b)Estimated total Oast of
Construction from(61
3. Plumbing Building.PermitFee
4. Mechanical(HVAC}
5.Fire Protection
6. Total=(1 +2+3 +4+5) ' t. Coo :Check Number /70-77
This Section For Official Use Only
Building Permit Number' Date
lasued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl 7 Commercial Building Permit May 15,2000
pECTION 4-CONSTRUCTION SERVICES FORPROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED, SPACE
Interior Alterations ILK;-slating Wall Signs 0 Demolition❑ Repairs❑ Additions 0 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. J L j��1 ,j
Of Proposed Work Lob'/ ) ) i Jo �.I_ ) - hroh"1: / b(5 "1'v'^' 4ro "Gl N'1 w9�� car
SECTION 5-USE GROUP/AN0.D CONSTRUCTION TYPE sa 5p'r�f�>r- -.�.�-r -t 9 5/�i"�
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 ❑ IA 1 0
_..._._....- _.... -. A-4 _.E] A-5 ❑ 1B ❑
B Business ❑ . .._... ...—... _... .-. __ —_.2A 0
E Educational 028 I ❑
F Factory ❑.. F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A ❑
Institutional 0 1.1 0 1-2 ❑ 1-3 0 3E 0
M Mercantile 0 4 ❑�
R Residential ' R-1 ❑ R-2 0 R-3 0 5A ❑
S Storage 0 S-1 ❑ S-2 0 5B ❑
U Utility > ❑ Specify:
M Mixed Use ❑ Specify
S Special Use 0 Specify -... .... —_
COMPLETE THIS,SECTION IF EXMSTING BUll DING UNDERGOING RENOVATIONS,ADOmONS AND/OR CHANGE IN USE
Existing Use Group: .._., ' I Proposed Use Group:
Existing Hazard Index 760 CMR 34): i I Proposed Hazard Index 780 CMR 34):
SECTIONS-BUILDING HEIGHT-ANDAREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION '3}�?„y DFFGEUSE ONy_
s., £ ;-.1;07-1g22.22-1,
Floor Area per Floor(s1) a` ^=
t -".r
i
2o5.
3'° 3m adA ;'T t '
TZt' S
�...-� 3Y2�� ?, x
L
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❑
Version) 7 Commercial Building Permit May 15,2000
8 NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in.by
Building Depamnent
Lot Size
Frontage
Setbacks Front
Side L R:.— ; L. R', '..
Rear
BuildingtS _ _. .__ __ . . __—_ . __— __. __- _
Bldg.Square Footage % _
Open Space Footage _
(Lot area
minus bldg&paved
Parking)
#of Parking Spaces --
'
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document €
B. Does the site contain a brook, body of water or wetlands? NO Q 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 0
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 Q
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 Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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)
SI Registered Architect
"-- '—, Not Applicable El
Name(Registrant): --- - _
Regist2tlan Number
Address _ ....... _...
-- "' Expiration Date
atignabure Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address
RarjistraSon NumWr
Signature Telephone Expiration Date
Name Ana of Responsib4ity
Address RegiaVafien Number
Signature ...... .... TeLephone Expiration Date
Name Area of ResponsibiXty
Address Regustration Number
Signature Telephone Expiration Date
9.3 General Contractor
II
Not Applicable El
Company Name:
Responsble to Charge of Construction
J�f3 Ri'Attie /id._ o-,i , fl1 i5 ej?5`/
Attire
9'3 -$3-9719
Signature `__ wTelephone
Version 1.7 Commercial Buildine Permit May Id. 2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) J
Independent Structural Engineering Structural Peer Review Required Yes Q No 0
SECTION11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
'MINERS AGENT OR CONTRACTOR APPLIES FOR BUILDING-PERMIT _ `
Y SPI" GLR mi€ 2-
L _ _-. ____ as Owner of the subject property
hereby seine ize ..._. .. LfN w� Lf/}CLE fo
act on my behalf,in t rz til es feiaty,i•work authoriz d by this budding pend application. _ F_J/
ti
signature of Owner FALase, Dat.
..__._ _. __. ______ _ ..... as Owner/Authnrzetl
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 end penalties of gertiLh'r_ �.,... _..._ i
Print Name
Signature of Ownee'Agent Date
SECTION 12-CONSTRUCTIONSERVICES
10.1 Licensed Constructi*n Supervisor: Not Appiicabie 0
1 Name of License Holder ../11-4 n .:_ — 00 7 / o
License Number
vq 3 /3, Ref (nt MA v�3S_T 1211ys
Address-� Expiration Date ..
///•Jy/, tit�4�F...c.,.,. / 44 3 -97_Y_9
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 veil result
in the denial of the issuance of the buil 'ng permit.(�
Signed Affidavit Attached Yes No L.1
(9-T ip pi PortIFAIIIptcw.
M
DEPAItTN.ENT OP ❑UIID fNG INS P£CT1018 \ _
212 Ma:n SLrcct ' Municipal Du:Id„h
iw`orrham.pton, Mnc.s. 01060 •'-'
W01UGER,'S COfrI ENSATION EvSURANCE AFT-LOA VIT
.,
(11 Ccnscfxrmi ncc)
9.611.2yin p :; p:a<s-ePbusio“sLts.cenee-a:—.
(ohoncl
(svml/cij/saSd6z3P)
do hereby certify, under [he pans and penalties UPperjury, a h.-
( } I am an employer providing the Following w^or':cr's Compersaoon coverage I01 Pay
emplovices womrig on this job_
f_sc-mc Com sr.v) (Poiic:Ncmhcr; - (6.2(61,=lion Dar_)
O I am a sole proprietor, genera] coou actor or homeowner (circle one) and have hued
the cooeaciors bstei below who hzv0 rine follo-w:rig worker's connen_cnon poGoes.M
(Incom _ Cmnp r r-L:c Numl<:) 016,67.16.27. DmC
(N l ConL'Qor) (L2ruzc Como a(Pobc. Nut's) (C .".on Darm)
(M4pine of Comaoor) QaWSinc Coupzr5'?o1;cm. LL:_ [jrnGo] Dale)
(N-me of Contractor) (Insurnc Comcavy/PoLicy Numoc) (EAwL(6.uon Dale)
-Lcronn._oa -. smns to...=cocoon)
) I a n a sole proprietor and have no nue worang for me_
O I am home owner performing all the vrork myself-
NOTE:plcx wK dboy tobJ1c E6666o..rn6.to.-wlnp"..sca a d.;�
not _thort t„esa.ea hr =fib=co mmac =y2tortynyaottacoob. dl.co'n.-.eek
.,,y.lor-t LLrdc i&..a*t..2. m Ac(GL192. (5)1,oppboa3oo H•eonm=-•r It:L( c or to., 2y Cf V=
cgl of u C1107/01'unda�Eu Wo tya CoC2qpnavo;At
I uo4==v34 2n a copy of Lti.cv'a--r=sty:b fo-ncNed u Wa 13-cpevaal O6o of Isa.rvns 10:6
mvcve.v.rcim cd flu Llujc e u..t'wv� ;mPo 15 A of MOT_l5]co ed w Jct u r-cdm of ''-:°"°°1 pca:L,
fsof c in=of LT to$130000..'d'o ec-.i.cr-- of-up to os yv a.a:o.A.1 pca.Jeroc=of.Sop woh Ott u+d.
fmo on`I W.W aly tpic
raem..e.--„,:.-an✓y,
P iwi: NumXXS
_ I hiapn_ L9l
]
Simmms of Umnsv1fm
P< 1uU Dane .
ACORD CERTIFICATE OF LIABILITY INSURANCE 05/0/200 1
PRODUCER (413)773-9913 FAX (413)774-5708 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Berkshire Insurance Group/MassOne ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P. 0. Box 638 HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
117 Main St.
Greenfield, MA 01302 INSURERS AFFORDING COVERAGE NAIC#
TNSGRED Alan D. Wallace ." INSURERA. NGM Insurance Co. 14788
143 River Road INSURERS. Associated Employers Insurance
Gill, MA 01376 INSURERC:
INSURER 0'.
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS.
JSR ADM POLICY EFFECTIVE POLICY EXPIRATION
.I laa IYPE OF INSURANCE POLICY NUMBER DATE nommen DATE(MWJOD(YYI LIMITS
GENERAL LIABILITY MPSO4290 04/08/2007 04/08/2008 EACH OCCURRENCE $ 300,000
X COMMERCIAL GENERA/.LIABILITY DAMAGE TO RENTED $ 500,000
PRFMISFS,Fn nrmmnel
CLAIMS MADE X ;OCCUR MED EXP(Any one person) 1 10,000
A PERSONAL&ALN INJURY 'S 300,000
GENERAL AGGREGATE $ 600,000
GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 600,000
—
POLICY PRO-ELT LOC ...
AUTOMOBILE LIABILRY
COMBANEeneD SINGLE LIMIT $
ANY AUTO
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILYaccrd INJURY $
NONOWNED AUTOS (PeracLktt+¢
^' El {Per
DAMAGE $
/Per accident)
GARAGE LIABILITY AUTO ONLY.EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY AGG S
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
E
■ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WCC5002169012007 04/25/2007 04/25/2008wCSTArlLt 0TR
EMPLOTERS'LIABILItt E.L EACH ACCIDENT $ 100,000
B ANY PROPRIETGRPARTNER/EXECUYIVE
OFFICER/MEMBER EXCLUDED' E.L DISEASE n EA EMPLOYEE $ 100,000
H yes,dente ander
SPECIALPROVISIONStepry E L DISEASE$POLICY Lein $ 500,000
OTHER
OESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES,EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS
'reject: 73 Bridge Street #5, Northampton, MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THECERTIFICATE HOLDER NAMED TO THE LEFT.
City of Northampton BUT FALURE TO MNL SUCH NOTICE SHALL IMPOSE NOOSLIGATION OR LIABILITY
Main ajtreet ; /ZEDNY KIND UPORESENT TIVE .I ADEN REPRESENTATIVES.
Northampton, MA 01060 a ioaueD REo-RESENTATIVE`
ACORD 25(2001108) K)ACORD CORPORATION 1988
IIRY-29-P0,07 87!9fi F&R1:Ala! WALLACE
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