22B-043 (22) 296 NONOTUCK ST BP-2017-1016
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22B-043 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2017-1016
Project# JS-2017-001576
Est.Cost: $12000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
UseGrouo: DAVID VREELAND 46317
Lot Size(sq.ft.): 130680.00 Owner: NONOTUCK MILL LLC
Zoning: Spu0)/WP(73)/URA(2)/ Applicant: DAVID VREELAND
AT: 296 NONOTUCK ST,
Applicant Address: Phone: Insurance:
116 RIVER RD (413) 624-0126
LEYD ENMA01337 ISSUED ON:3/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT INTERIOR PARTITIONS, WOODEN
PLATFORM, INSULATION AND CEILING FINISH
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/4 Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: O1: 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 3/22/2017 0:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File F BP-2017-1016
APPLICANT/CONTACT PERSON DAVID VREELAND
ADDRESS/PHONE 116 RIVER RD LEYDEN (413)624-0126
PROPERTY LOCATION 296 NONOTUCK ST
MAP 226 PARCEL 043 001 ZONE Sl(110)/WP(731/URA(2)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONIN FORM FILLED OUT
Fee P it tie
Hui!din,.Permit Filled out
Fee Paid
Tvpeof Construction; CONSTRUCT INTERIOR PARTITIO S,WOODEN PLATFORM, INSULATION AND
CEILING FINISH
New construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License 46317
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
/ _ /j . 3)47
Signature of Building Official Date
Note: Issuance ofa 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 MGI.40A.Contact Office of
Planning& Development for more information.
°V
Version!.?Commercial Building Permit May IS,2000
Departrnent use only
/ City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Seplic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
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 Properly Address. This section to be completed by office
296 WOWcr Jc'cc �. Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
tJotrvrucic r'/W•, LA-La
Name(Print) Current Mailing Address:
srptf 4oO*t429(. NaJOjUC.KST: OPOb2
Signature -)- !. -.-_a Telephone N
(3 - 5 ca •-J'/TJ
2.2 Authorized Agent:
(U� ti"a- kb 5 I NG
Name(Print) Current Mailing Address.
Mil-MteW eoutpou -rr('� 56 HI, u 6E WA'j', tj , is- - r'p ,MA
Signature .041-2-1-1,„ % Telephone 9/3 - tic -4$97- 0/6/3
SECTION 3-ESTIMATED CONSTRU ON COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 12 coo (a)Building Permit Fee
2. Electrical Tb *is ' U44 rat? (b)Estimated Total Cost of
ttU)PR Ala:P 0M AQ f 1(A11I)N Construction from(6)
3 Plumbing 4fnAe .43 {1le0/C Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total r(1 +2+3+4+5) Check Number 46
r7((j /(lo
This Section For Official Use Only
Building Permit Number Date
Issued
Signature.
Building Commissioner/Inspector of Buildings Date
V crsionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35.000
CUBIC FEET OF ENCLOSED SPACE
Interior Adoration 0 Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions 0 Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign El New Signs)] Roofing❑ Change of Use❑ Other
Brief Description Enter a brief description here. 1'1t15 l ciaacf- eeriiiis -RE cadeA 7oti wreem
Of Proposed Work: flrR7YTPIJS, wdmersj pterr}bem, 11144.49lt+/ Rt", czwlle F1t1l5}) ,
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 0
A-4 ❑ A-5 ❑ 1B ❑
B Business ® 2A ❑
E Educational 0 2B ❑
F Factory ❑ F-1 0 F-2 0 2C I ❑
H High Hazard 0 3A 0
I Institutional 0 1-1 0 1-2 ❑ 1-3 0 3B Fl
M Mercantile 0 4 El
R Residential 0 R-1 ❑ R-2 0 R-3 0 5A 0
S Storage ❑ S-1 ❑ S-2 ❑ 5B
I 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: f'Ut> Proposed Use Group: i`ailia%
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)
it )14H0 1' 0
2"a
2n°
3b 3,e
4" 4m
Total Area(sf) )14 RP Total Proposed New Construction(sf)
0
Total Height(ft) )6I
Total Height ft I COI
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Private❑ Zone R Outside Flood Zonen Municipal 0 On site disposal systema
Version I.7 Commercial Building Peimit 15 lay 15,ME
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to he tilled in by
Building Department
Lot Size tee cnre pV4N '%%4C-No CIF/art
Prontugc 4a4rre pas)
Setbacks Front
Side L: R L: R _
SES
Rear SI t4
PIi+N
Building Height A.0t
Bldg. Square Footage tf NUv too lr4R'o
Open Space Footage ...515E
Om area morns hldy&pari4 I It
pa,6n2) "pert.)
k of Parking Spaces S r
Fill: N0146
plume Se Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O 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
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued: - Ifo 43/425106
�q F10p171WU oQ aCttrsu /
C. Do any signs exist on the property? YES O NO 1d
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O
IF YES, describe size, type and location: -p G� uenentp wive h ptgaenzhr
?p . Ca'fT1
E. VMI 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
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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Vorsionl.7 Commercial Building Permit May 15,20(X)
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 760 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):
n45\/(V Vrr
Namel— pq�
VOR
� ,� � `,p Area
�of Responsibility � (•
vs\ 'may' J_ I a haft IRVW lVlxxr T+ 1017'
Address Registration Number
413• IA69)11
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 Regisoadon Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable Et
Company Name: -y_
�e}1yt.,c1., Wim'
Responsible In Charge of Construction "A✓t0� •
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 C) No
SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
- Th.��..,,__KO. CH.P�II;ti as Owner of the subject property
hereby authorize M)li ' tew Pa OIJSa.iucr-r- to
act on my behalf.in all matters relative to work authorized by this building permit application.
Signature or 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.
Pini Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor Not Appticable fl
Name of License Holder
license Number
Address Expiration Date
Signature T iephone
I SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M&.L.c.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 SD No 0
'+ The Commonwealth of Massachusetts
•
Department of Industrial Accidents
F �— S
as iI - Office of Investigations
- , Congress Street,Suite 100
;;. 1 Boston,MA 02114-2017
www.maa'sgovldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electdciarts/Piumbers
Applicant Information Please Print Legibly
Name (13usinessOrganizationindi.iduall: Yy4? CA�^t v� 'ars •
Address: /55 tt e, -
CitdState/Zip: Phone #:
Are you an employer?Check the appropriate box:
Type of project(required):
t_0 (am a euploi or uith 4 a 1 am a genera!contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6 a New mnsu:uuon
2.e. I am a sole proprietor or partner- listed on Ute attached sheet, 7. S Remodeling
ship and have no employees These sub-contractors have g, ®Demolition
stoking I'or me in an' capacihemployees and have workers' ppqq
inswancc. 9- t..+Building addition
(No bonkers'comp.insurancecomp
required >./4 We are a corporation and its I0.0 Electrical repairs or additions
3 10 1 am a homeowner doing all wort officers have exercised their ii.0 Plumbing repairs or additions
iso sell[No workers comp. n alit of exemption per MOL 2 Roof repairs
insurance required.I - c 152,§1(4),and we have no
employeesNo workers' 13.3 Other
compinsurance required.)
".1vq applhant that checks hoc el mot also fill out the section below showing their workers'compensation polio information.
I tom who%chine this affidavit indicating they are doing all work and then hire outside contractors m l mhmit a new affidavit indicating such.
Condom that that check this box must attached an additional sheet showing the name of the sub-contractors and state ulicher or not those solitus have
unplm cps If thesubcoMra4ms have employers.the mini provide their workers'comp policy number.
t am an employer that iv providing nvrkers'annpemation insurance for my enrplovves. Below is the policy and job ske
information.
Insurance Comport( Name:
Polis) fl or Self-ins. Lie ft' Espimtion Dole_ _.
Job Site Address: .......City/State/Zip.
Attach a copy of the workers' compensation policy declaration page(showing the polity number and expiration date).
Failure to secure coverage as required under Section 25A of MGI,a 152 can lead to the imposition of criminal penalties ofa
tine up to S1500 00 and/or one-}eat imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a line
of up to$250 00 a day against the violator_ Be advised that a copy of this statement may he forwarded to the Office of
Ins estigations of the DIA Ibr insurance coverage verification.
I do hereby certify under� -athe poi and petiee of perjury that the information provided above its true and correct.
limjtun: ,4,4 S.. I/l/�r _- Date: yty, 7-
Phoned: I1Y"' 116� 94"12
Official are only. Do not write In this area,to be completed by city or town official
City or Town: _Permit/License 4
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
i6.Other
Contact Person: Phone N:
Department of Industrial Accidents
Office of Investigations-Dept.153
=a
ri ri I Congress Street,Suite 100,Boston,Massachusetts achuts 02114-2017
t F- .� h //www.mass v/dia
"-y ttP: 8o InvetJSWO ID#:
AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE
OFFICERS OR DIRECTORS
Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, §1(4)by adding the following paragraph:
"This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of
the issued and outstanding stock of the corporation.Notwithstanding section 46.these provisions shall
apply only if the corporate officer provides the commissioner of industrial accidents with a written
waiver of his rights under this chapter.Said commissioner shall promulgate regulations to carry out the
purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set
forth in section 25C"
Pursuant to M.G.L.c. 152, §1(4) as amended,l/W e the undersigned officers of:
`>ti? CoriaK 7 $j (W . � 53, 11EZ TAGc Wt4Yi 1o4t 'R iew MA 0/37)
(Na of Corporation and Address)
each holding at least 25%of the issued and outstanding stock in said corporation,do hereby invoke the
right to be exempt from the provisions of M.G.L.c. 152,§25A and therefore are not required to carry a
workers' compensation policy covering the undersigned corporate officer(s)or director(s). 1/We the
undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L.C. 152 for
any injuries that may be sustained while in the employ of the above-named corporation.
Further.Uwe the undersigned do understand that,should the above-named corporation hire or have in
its employ any employee(s) in addition to the undersigned corporate officer(s)or director(s),said
corporation is required to obtain workers` compensation coverage for the employee(s) as prescribed by
M.G.L.c. 152, §25A.
IIWc the undersigned have read and understand the statements and obligations as delineated above and
Uwe have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or
not to be exempt from the provisions of M.G.L.c. 152.
Signed under the pains and penalties of perjury:
9 r 1z erper Z / /?
Signature 7 Pn t Name&Title Ir Z —
Date mm/ /vyyyi
I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name&Title Date(inm/ddiyyyyl
❑ I wish to exercise my fight of exemption or ❑ I wish NOT to exercise my right of exemption
Signature Print Name&Title Date(mMdd/yyyy)
❑ I wish to exercise my right of exemption or ❑ (wish NOT to exercise my nght of exemption
Sienamre Print Name&Title Date(mm/dd/yyyy:
❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption
Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Instructions
on back. Form ts3—7OA10
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: 7 ti Li WOWCT1ULA& '.
The debris will be transported by: cipatc, cargItei
The debris will be received by: MTa-.II —1C. 5Et✓ILF S
Building permit number:
Name of Permit Applicant YUf? Cates R494gF.RS t ; x
NltorfeW ' ounterr. ( i1?JERt(
( 1 AttAK
Date Signature of Permit Applicant
�\ Initial Construction Control Document
l€ ft To be submitted with the building permit application by a
q*Cr. V4,
.. Registered Design Professional
• for work per the 8'h edition of the
+., Massachusetts State Building Code,780 CMR,Section 107.6.2
Project Title: Yup Coffee Roasters Date: 3/10/17
Property Address: 292 Nonotuck St.,Florence,MA 01062
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: The construction of interior partitions and insulating and finishing the ceiling
I,David Vreeland,MA Registration Number 46317, Expiration date: 6/30/18 ,am a registered design professional, and
hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
Entire Project X Architectural X Structural Mechanical
Fite Protection Electrical X Other:Construction Control
for the above named project and that such plans,computations and specifications meet the applicable provisions of the
Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee)shall perform the necessary professional services and be present on the
construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or
electronic signature and seal: 3H of/t/
kte
of DAVEID A. 41
�� YREUND
u cm, w
No.46317
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Phone number.413-624-0126 Email:dvreeland@verizonnet -b. .-7 () )
Building Official Use Only �s-�-�-t
Building Official Name: Permit No.: Date:
Note I.Indicate with an'x'project design plans,amputations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.
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Jeswald Design Associates
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Phone: 1413) 369-4242 • Fax X413; 369-4314
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P:-ar.3: (4131 369-4242 • Fax(413)369-4314
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