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22B-043 (26)
296 NONOTUCK ST-BODO CHOC BP-2018-1229 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao: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) Cateawv�ALTERATION BUILDING PERMIT Permit# BP-2018-1229 Project# JS-2018-002193 Est. Cost:$3000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: CHARLES BURKE 076290 Lot Size(sp.ft.): 130680.00 Owner: NONOTUCK MILL LLC zoning: Sl(I10)/WP(73)/URA(2)/ Applicant. CHARLES BURKE AT. 296 NONOTUCK ST - BOHO CHOC Applicant Address: Phone: Insurance: 21 BROAD HILL RD (413) 548-8166 WC LEVERETTMA01054 ISSUED ON.512112078 0.00:00 TO PERFORM THE FOLLOWING WORKADDING 3 NON LOADING BEARING PARTITIONS 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: FeeTvoe: Date Paid: Amount: Building 5/21/2018 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2018-1229 APPLICANT/CONTACT PERSON CHARLES BURKE ADDRESS/PHONE 21 BROAD HILL RD LEVE':ETT (4' )548-8166 PROPERTY LOCATION 296 NONOTUCK ST-BOV�O CHO— MAP 22B PARCEL 043 001 ZONE SKI l0)/WP(73;/U&2y THIS SECTION F0-1 OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvteof Construction: ADDING 3 NO G BEARING PARTITIONS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 076290 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INIPPRIANIATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARDTERMIT 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 moltbon Delay more ofBuildin 'tial Date Note: Issuance of a ting per 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 information. F / Versioi Commercial uildiB n Pe mit May 15,2000 sP / i Department use only City Northampton Status of Permit MAY 21 PJM Ildi 9Department Curb Cur/DriawayPermit 212 ain Street Sewer/Septic Availability —7 R om 100 Water/Well Avarlabllty. FP: OF nunowclnsPr1 M- 11 nAmPioN.MAo+ am ton, MA01060 Two Sats oP Structural Plans I, one 3-587-1240 Fax 413-587-1272 Plot/Site Plane 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 640-1 $-tz z 4 1.1 Property Address. This section to be completed by office a" L C tjo n o- -r�%,/14c k - Map of o� 15 Lot 0 y3 Unit Ll9 RQ h�-'Q. t MN � lOto�1 Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ao►>oTu�k _cn.tc I:yt `d94 Nome�ralC sr Name(Poop Current Mailing Address: Rorentat mi • Oto t. 2. Signature Telephone y(,p qll- b 2.2 Authorize ent: Name(Print) Current Mailing Address: f�teruoct MA • Olo` SL Signature Telephone ( a SECTION 3-9VIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $ 3000 ^ (a)Building Permit Fee 2. Electrical (b)Estimated Total Cast of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) / 5. Fire Protection 6. Total= 2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Sig Bui ' ammissionerll Iter of Buildings L Date Gl.' J c1'y I l.-2 'J V'/ Version L7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE A. + , Interior Alterations ❑ Existing Wall Signs ❑ Demolition[] Repairs❑ Addilionsx Accessory Building El Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rooting❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. 3 NQT-3 Lo>Ab6�rrn Of Proposed Work: Itj I cr\/ S'p�.c',L 1 aT✓f l(jY'; QY1 Wly ,. U SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ElA-3 El 1A ❑ A4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 28 ❑ F Factory F-1 ❑ F-2 JA 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ I-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ 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(so 1` 1m 3� _. 3" 41, 4th Total Area(so Total Proposed New Construction (so Total Height(ft) _. Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood.Zone Information: 7.3 SewaQe.Disposal System: Public jK Private E] I Zone Outside Flood Zone❑ Municipal 81 On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning ih,IyY_ his wlumn to be filIW in by '�V Building De ,aunt Lot Size Frontage --- Setbacks Front Side L. R:_. L: R Rear Building Heigh[ Bldg. Square Footage Open Space Footage - (Lot vee no.bldg&paved akin #of Parking Spaces -- volume&Location) --- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW o YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © 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 C) YES O IF YES, has a permit been or need to be obtained from the Conservation Commission?P/44 Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES 1 11-- NO O IFYES, describesize, typeand location: NeNe�vct� /i D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: " E. Will the construction activity disturb(clearing, gradinexcavation, or filling)over 1 acre or is it part of a common plan that will disturb over l acre? YES O NOS IF YES,then a Northampton Storm Water Management Permit from the DPW is required. F 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: � �A Not Applicable lA Sce A Na�egisiranp: Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Regisuabon 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 L-.In I �j ` AIZ Q5< J�UIs... L Not Applicable ❑ Company Name: SPrnY Responsible In Charge of Constru on zi `/ a L '^Y6'1 to Addres tii3-sy8 -8� � Signatu Telephone Ir Versimi Commercial Building Pencil May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineenng Structural Peer Review Required Yes © No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ` p I, �OSGQA R4 N.�.[.J�� .._ as Owner Of the Subject property C�14iCl.,r hereby authorize � / to act on my ehalf, in all afters relative to work authorized by this building permit application. (` Sigmaue.fidh., Dale Y I VQ4hlR g1k.• , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are nue and accurate,to the best of my knowledge and belief. Signed under t e pains d penalties of perjury. Tf' o o� Print Name _. S- ZI - +� Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: L { Not LApplicable ❑ Name of License Holder C..d.A YL.L.�. S 1�UR1C GJ—D7(ep� p. License Number 2� -tea l FI CP i2d. Dere vv1 O�oS to -Zz_ t4 Atltlress Expiration Date Signature V 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 the building permit. Signed Affidavit Attached Yes No O i 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: z°)L G on c>�-vE rib � l oy&yyc� The debris will be transported by: LjAee�,,ja clit c C�zi» The debris will be received by: V a �1 un 1 cl/C-)M q Building permit number: Name of Permit Applicant CAAk45 'BLIP k-e Date Signature of Permit Applicant lV The Commonwealth ofMassaehusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02714-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: " ]A fC L1G$ ),A)K)C,6 Address: ZI Aj p City/State/Zip: ' QQ-!",c, 1'Yl Phone#: 3 ' O Are you an employer?Check the appropriate box: B mess Type(required): 1.❑ I am a employer with employees(full and/ 5. Retail or part-time).* 6. ❑RestaurantBar/Eating Establishment z,y I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) G/ employees working for me In any capacity. [No workers' comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. El Entertainment their right of exemption per c. 152,ss'1(4),and we have 10.g Manufacturing no employees. [No workers' comp.insurance required]* I1.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp.insurance req.] 12.❑Other 'My applicant Dat checks box#I must also fill uur rhe am,Fn below showing their workers'compensation policy information. —Ifrhe co aahle officers have exempted themselves,bur rhe -tram iun has ether employees,a workers'compemsation policy c requved and such an organaaron should cheek bets#L I am an employer that is pro/ytd,-7 workers'co pensa`fion insurance for my employees. Below is the policy information. Insurance Company Name:/ rj.�,-�, c7 tN A Insurer's Address: City/State/Zip: Q Policy#or Self-ins.Lia# W Ur 3 )1�1 ••y�� Expiration Date: 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 fete up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of 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. Ido hereby ce u/ p pena(n o er'ury that the information provided above its true and correct S mature' Date: S Phone 4: NI3 J CJ V I & �e sr 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/fown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.m s:.go.;aia . e Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer.or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. Han LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, at the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. Clot or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permit/license number which will be used as a reference number,in addition,an applicant that must submit multiple permit license applications in any given year, need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia F..Rc,c,xi 02-21-I5 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY INSURANCE POLICY—INFORMATION PAGE /HER: POLICY NO: WCT3139M ,IN STREET AMERICA ASSURANCE COMPANY 601 TOUCHTON ROAD EAST RENEWAL OF: WCT3134M 'U ITE 3400 CKSONVILLE, FL 32245-6000 NCCI Company No: 27103 Account No: CACT3139M ITEM 1.NAMED INSURED AND MAILING ADDRESS: AGENCY NAME AND ADDRESS: CHARLES BURKE ENCHARTER INS LLC CL SC 21 BROAD HILL RD LEVERETT MA 01054-9707 25 UNIVERSITY DR AMHERST, MA 01002 AGENCYPHONENO.: (866) 415-5391 AGENCY NO.: 204031 LEGAL.ENTITY: INDIVIDUAL OTHER WORKPLACES NOT SHOWN ABOVE: (See Workers Compensation Location Schedule) ITEM 2. POLICYPERIOD: From: 01-23-2018 To: 01-23-2019 Effective 12:01 A.M. Standard Time at the Insured's mailing address. ITEM 3. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers' Liability Insurance: Part Two of the policy applies to work in each stale listed in Item 3.A. The limits of liability under Part.Two are: Bodily Injury by Accident: $ 100, 000 each accident Bodily Injury by Disease: $ 500, 000 policy limit Bodily Injury by Disease: $ 100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states,if any, listed here: all states except: ND, OH, WA, WY and states designated In ITEM 3A of the information page. D. This Policy includes these Endorsements and Schedules: Sae Schedule of Forms and Endorsements. ITEM 4. PREMIUM: The premium for this Policy will be determined by our Mano'fs of Rules, Classifications, Rates and Rating Plans. All information required on the Workers Compensation Classification Schedule is subject to s'eritication and change by audit. Please see Classification Schedule. Total Estimated Minimum Premium: $ 216 Annual Premium: $ 841 Audit Period: ANNUAL Date: 12-15-2017 Countersigned by WC 000001 A Copyright 198]Nsiiorei Couroii on Carty,ereation ksurarre MSVNFD COPY Charles Burke / Burke Builders May 20, 2018 City of Northampton Building Department 212 Main Street, Rm 100 Northampton, MA 01060 1 request that you grant a modification to waive the requirement for control construction for BOHO Chocolate LLC and the installation of three non-load bearing partitions at 296C Nonotuck St., Florence MA 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, i Ch s B 3e 21 Broad Hill Rd Leverett, MA 01054 413-548-8166 S� I� •�_7 C'I'C[,� ""�s��'b � hk'•Z, � .`1 ,2�s , t• �' �_.eT--� 5 : L pI s ■ � 5 Z I2 R ,Ib 5 LI 1 ,a ET ,8I �,,1�S.II pp