32A-140 (9) 109 MAIN ST BP-2019-0129
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma -.Block:32A- 140 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Categorv:renovation BUILDING PERMIT
Permit BP-2019-0129
Project# JS-2019-000207
Est.Cost:$61000.00
Fee:$427.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: PIONEER CONTRACTORS 017890
Lot Size(sp.8.): 11325.60 Owner: TRIDENT REALTY CORP
Zonine:CB(I00 / Applicant. PIONEER CONTRACTORS
AT. 109 MAIN ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586-5491 Workers Compensation
NORTHAMPTON MA01061 ISSUED ON.81Z,2018 0:00:00
TO PERFORM THE FOLL 0 WING WOM-I N STAL L WI N DOW, INTERIOR PARTI0NS,
PLUMBING AND ELECTRIC
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: 001: 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 Shmature:
FeeType: Date Paid: Amount:
Building 8/220180:00:00 $427.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2019-0129
APPLICANT/CONTACT PERSON PIONEER CONTRACTORS 1
ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491Gp� I �(l�
PROPERTY LOCATION 109 MAIN ST �J
MAP 32A PARCEL 140 001 ZONE CB000
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT �-
Fee Paid
Building Permit Filled out
Fee Paid
Tvpeof Construction: INSTALL WINDOW,INTERIOR PARTIONS,PLUMBING AND ELECTRIC
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FgEWWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFF 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
c lition Delay
Si of Buil in tal Dat /
Note:Issuance of a ing 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 information.
Version 1.7 Cammerciel Boldine Permit May 15, 2000
Department use only
Ci y of Northampton Status of Permit:
JUL 3 1 2018 BU Iding Department Curb Cut/Driveway Permit
12 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT OF BUILDING INSPBcnolNort ampton, MA 01060 Two Sets of Structural Plans
NOPreamPloe, 10607_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 Property Address. This section to be completed by office
109 Main Street, Ground Floor Map �j111" Lot l `-� unit
Zone Overlay District
Elm SL District CB District
h--
i SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
"rridcnt RJealty Corp. 150 Main Street
Nome(Poor) rCi e Ael A /)) e,' w, '�t Current Ma'Jing Address.
(413) 582-9970
S.cnalmes 1 j� ¢�✓_.�. Telephone
2.2 Authorized Agent:
Pioneer Contiactoi slDavid Claxton PO Box 1145,Northampton MA 01061
Name(Prion / I
Current Meiling Address
(41 '
Vly�� (413) 586-5491 �
Sgnatwe _ Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completetl by permit applicant
I 111. Building $41,000.00 (a) Building Permit Fee
2. Electrical (b) r,t-r ed Total Cost of
$12,000.00 Construction from e
3. Plumbing $_S Building Permit Fee,500.00
4. Mechanical (HVAC) `7
5 Fire Protection $2,500.00
5. Total=(1 +2 +3 +4 + 51 ��� Check Number
This Section For Official Use
Only
Built dllig Permit Number to
Led
Signal e- r^ ///
misslonsr/Insp cto of Buildin� i Date /� //
J
Version 7 Commercial Building Pel'mit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition El Repairs El Additions ❑ Accessory Building El
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing El Change of Use❑ Other ❑
Brief Description Per plan s'ubmittcd. install window, interior partitions, plumbing and electric.
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1S El
B Business 0 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 ❑
M Mercantile ❑ 1 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 F-1S-2 ❑ 5B ❑
U Utility I-] Specify.
M t.1ixad Use ❑ Specify:
S Special Use ❑ Specify:
r COMi'LE fE 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 BICE USE ONLY
Floor Area per Floor (sf)
1" 9,413
2"° 9,413 2"'
3," 5,817 3,e
a"
41�
Total Area (sl) 7,643 Total Proposed New Construction (st)
Totel Height(ft)
Total Height P
r Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Private ❑ Zone Outside Flood Zone❑ Municipal ❑i Onsite disposal system❑
Version 1 7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZON]NG
Existing Proposed Required by Zoning
11i....... ,be tilledin by
❑ulldmc Depamna,l
Lot Size
Frontaue
Setbacks Front
Side L. R:
Rear
Building I leight
IIdg. Square Footage
Open Space Footage
0 of arca minus bW_&pnvW
rarkiwJ
ofParkingSpaces
Fill.
n-owwae m L,,,n,,,,1
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONTKNOW O YES O
IF YES: enter Book Page and/or Document N
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E_ Will the conshuctlon activity disturb(clearing, grading,excavation, or filling) over 1 acre or is it pan of a common plan
that will disturb over 1 acre? YES O NO O
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 760 CMR 116 (CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Kuhn Riddle Arehtiects, Amherst MA Not Applicable ❑
Name(Registrant)
Kuhn Riddle Arehtiects, Amherst MA Registration Number
Address
(413)259-1630 Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Jacob Smith, South Deerfield MA
Name Area of Responsibility
Address Registration Number
(413) 397-3441
Signature Telephone Expiration Date
Name Area of Responsibility
Andress Registration Number
Signature Telephone Expiration Date
Name Area of pattens Ibllity
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Pioneer Contractors, Northampton MA Not Applicable ❑
Company Name'.
Responsible In Charge of Construdion
D6Vtd C(axt0
Address
) {/rr� A (413) 626-7267
Signature Telephone
Vcrsion 1.7 Commercial Building Permit Max, 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(760 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 -OWNER AUTHORIZATION -TO BECOMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Tridan Realty Corp.
I, as Owner of the subject property
hereby authorize Pioneer Contractors/David Claxton to
act on my ban alf.in all at relative to work authorized by this building permit application.
Signature of Owner / / Data
a
I David Claxton as JAn /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
/ 1le
I Signature o tuner/Agent Data
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder David Claxton 17890
License Number
110 Box 1145 Northampton MA 01061 01/19/2020
Address / Expiration Date
vn (413) 626-7267
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 O No O
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: I l29 �Vw' S�
The debris will be transported by: -�)vseo, 'R�
The debris will be received by: ✓VA�2tl DNl
Building permit number: r� / y
Name of Permit Applicant Pl pv gy__sL. 611tcl J�
2qd � *
Date 7/2OV Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-20777
www.nsass.gov/dia
NI orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
AladicaustInformation Plemse Print Le 'blv
Name (cosiPell/0,aanieedice, andividuel): Qt Unf,P�' ('1.YfGC�17f5
Address: I. O ' I" ohi�—
City/State/Zip: oj)— Phone#: U 13 " S Vo S' (
Are you en employer?Check the appri,vatie,box: Type of project(required):
1101amvemployerwhh 3 emple,ces(full andsel,ait-time)' 7. ❑New construction
2 F I am a sole proprietor or pannarship and have no employees working for me in $. [gRemadeling
unycapcity.[Noworkerswmp.'Province required.]
s.
3_Fll am a homeowner doin gvll work myself.[No workers'camp-insmmncerequire [' 9. ❑Demong ad
d_
4.❑1 an a homeowner and x'ill be hiring contractors to conduct all work on my property. I will 10 E]Holding addition
insur,that all contractors either have workerscompensation insurance true sole 11.❑Electrical repairs or additions
proprietors with no employees. 12 [7 Plumbing repairs or addition,
5 l am a general contractor and l have Load the sub-contractors listed on the attached sheen 13.�ROOf repairs
Thesesubavmractms have employees and have worker wmp-in resur
6.❑Weare a corporatwn and its ofYmers have examined Chair right of exemption per MGL c 14.❑Other
152, 441 and we have no employees.[No wmkus'wmp.insurance reauirol l
Any applicant that checks box pl must also fill out the section below showing their workers'compensation policy nomination,
a Homeowners who submit this atbdavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
:Caneaetmsthat check this box most attached an additional sheet showing the name orthe sub contractors and state whether or no Baric entities have
entplayeas. If the sub-mntrvcma Leve employees,they must provide their workers amp-policyntinei
I am an employer that is providing workers'compensation auderencefor my employees Below is Illegality andjob site
information.
Insurance Company Name: l.Pl ' f
Policy N or Self-ins.Lic.#' W� J�66e7Jy—�w��' n Expiration Date: l7 30 I p,
Job Site Address: OpACf 7�' ACity/State/Zip:
Attach a copy of the workers'compensation policy declaration page(shoving the policy number and exp ation date).
Failure to secure Coverage as required under MOL c. 152, $25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator,A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify n ert ep ns n allies ofperjure that the inforenationprovided above is true and correct.
Signature Date'
Phone N' Li .5 R— « /
Official use only. Do not write in this area,to be completed by city or lawn 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 k: