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43 Finn St demo permit.pdfFile# BP-2019-0814 APPLICANT/CONTACT PERSON JASON HEILMAN ADDRESS/PHONE 26 SOUTH RD HEATH (413) 345-9048 PROPERTY LOCATION 43 FINN ST MAP 24D PARCEL 202 001 ZONE URC(IOO}/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid T eof Construction: DEMO BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 187368 3 sets of Plans/ Plot Plan REQUIRED DA TE THE FOLLOWINI~CTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION SENTED: __ 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 Ht 5TOf2lC-Ctrn,i /'llll S-g Co N sr:!&aiW d, e/t 9 Date I 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 information. JAN 1 6 2019 Versionl .7 Commercial Buildin Permit Ma 15, 2000 of ~rthampton Buil _ing bepartment 2 2 Mtin Street Room 100 Department use only Status of Permit: Curb Cut/Driveway Pennlt ______ _ Sewer/Septic Availability _______ _ pton, MA 01060 IL-~~:=~~~~~~-1240 Fax 413-587-1272 Water/Well Avallablllty. __ ------"....:.-...;:...::.......-- Two Sets Of StruettJral Plans . ...;.:;._-+.::-=::-:-::;;:;:--~, Plot/Site Plans. ____ _ • -· ·., Other Specify APPLICATION TO CONSTRUCT, REPAIR,-RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 • SITE INFORMATION .ANY BUILDING 1.1 PropertyAddress: Thia section to be completed by office 0 43 f,;n S\. ~,;(t'\-)()..W\~'<.,"', MP! 010<.:,o Map Zone ;iv/0 1----------------------=El~m St District SECTION 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT Lot Overlay District CB District Unit ic /.l ;; ~-(}i(Q Jvl(I flJ -flu1-(!I. c~~ -/Vl A_-o/6 62. SECTION3• Item 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Building Pennit Number Signature: Estimated Cost (Dollars) to be com feted b ermit a licant Current Malllrfg Address: -~,L~ ~i 11_~!_-... ----. Telephone Telephone Official Use Only (a) Bullding Permit Fee (b) Estimated Total Cost of Construction from 6 Building Permit Fee :& / 5 00 Check Number , This Section For Official Use Onl Date Issued Building Commissioner/Inspector of Buildings Date me, ra...@Jph bet,ld.l~. et>fY\. jQ:1. ® j p\-\ ~~\ \d_l~. <:ID<Yv'- Versionl .7 Commercial Building Permit May 15, 2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations O Existing Wall Signs ~ Demolition D Repairs D Additions D Accessory Building 0 Exterior Alteration O Existing Ground Sign D New Signs D Roofing D Change of Use 0 Other D Brief Description Of \)~Y'I\. G or t/'t> t,(l Y\ ~-Bv, \ C' \ "-)-- Proposed Work: N'\ u., l ·h ·~..r"u\ w ~rr...rlm.M ~ -iAvflNT' u I SECTION 5 • USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly D A-1 0 A-2 0 A-3 ill 1A 0 A-4 0 A-5 D 1B D B Business 0 2A 0 E Educational D 2B D F Factory D F-1 0 F-2 D 2C D H Hh:ih Hazard 0 3A D I Institutional D 1-1 D 1-2 D 1-3 D 38 D M Mercantile D ,, 4 D R Residential El R-1 0 R-2 g R-3 D SA ~ S Storage D S-1 0 S-2 D SB 0 U Utility 0 Specify: j I M Mixed Use D Specify: I I S Special Use D Specify: j I COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: lk..he....cle.aof c\ rom~~f.\ el 1.. J I Proposed Use Group: I I fi Existing Hazard Index 780 CMR 34): I I Proposed Hazard Index 780 CMR 34): I I SECTION 6 BUILDING HEIGHT AND AREA I BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) ' 1st I I 1st I ~/l -• ~ '" 9(l~A I I 2"d I II ~~H~ I znd I 3rd Lii~ I 3rd I I 4th I I 4th I I 1-3~~ I Total Area (sf) I l../0, 11 y I Total Proposed New Construction lsfl I I I Total Height (ft) I ~o' Total Height ft I I 7. Wat61upply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private D Zone I I Outside Flood ZoneO Municipal O On site disposal system O Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING I Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I • 30'1 flry-p<:... 11 11 Frontage I ;l nC . 0-'5 I II Setbacks Front [IT] c=J [::J Side L: O' R: L:c=J R:CJ CJ CJ ---- I CJ CJ Rear Building Height CJ CJ CJ Bldg. Square Footage 1. j 1q,i5j % CJ CJ CJ Open Space Footage II0,8G.\ i fBo:~s, % CJ CJ CJ (Lot area minus bldg & paved oarking) # of Parking Spaces [.9:J C:J CJ Fill: 11 I (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW er YES 0 IF YES, date issued: I j IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONTKNOW 0' YES 0 IFYES: enter Book I I Pagel I and/or Document#! B. Does the site contain a brook, body of water or wetlands? NO (3 DONTKNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: ... I _____ _, C. Do any signs exist on the property? YES 0 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 IF YES, describe size, type and location: NO(?/ E. Will the construction activity disturb (clearing, grading, ~vation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO ~ IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version!. 7 Commercial Building Permit May 15. 2000 SECTION g. PROFESSIONAL OESIGN AND CONSTRUCTION SERVICES • FOR J:SUILDINGS ANO STRUC'tVRES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 {CONTAINING MORE THAN 35,00~ C.F. Of ENCLOSJ:D SPACE) 9.1 Registered Architect: I 51fG-F~lcD /?t,fiTtj I Not Applicable D i I I &G.J'f Name (Registrant): 1,,, PltAJANT 5T $vrrE 3// tAfi°f-UMPTDN MA I Registration Number I o'ff-J 1-«ote; : l Add:1wL--~ ../. 7/,/ f1'.H-S~'f-'i'tJt I Expiration Date Signature //f/ V Telephone 9.2 Registe&d Professional Engineer(s): f l I I I Name Area of Responsibility I I I I Address Registration Number I I I I Signature Telephone Expiration Data ! I I I Name Area of Responsibility I I I i Address R!!9islration Number ) I I [ Signature T eleplt6ne Expiration Date I I I t I Name Area of Responsibility ! I I I ___. Address Registration Number I I I I . Signature Teleptrone Expiration Date i I I I I Name Area of Responsibility l l I j • Address Registration Number I I I l Signature Telephone Expiration Date 9.S General Contractor I .oft+ <'6~i Id~ I I Not Applicable D Company Name; :..._..::::: ~f) h\g)\~ I Responsible In Charge of Construction ~ ~-~!.21.\-f. Ca ~\hu(V\.L ~o-,\\s: t'Y\ 'A I Addre;;------z a , ~ ./.-z..-!lft2 -:;'lS -ja.{8_ l Signature / Telephone ( N ersionl.7 Commercial Building Permit May 15, 2000 SECTION 10· STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required SECTION 11 • OWNER AUTHORIZATION • TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT > Yes 0 No 0 --------------·-- is building permit applicatlo,..n. __ _ -1to -----, I_ '1.0 l1~ J ~ -~ --------------r~-* I,-=' ~ds.t;;.0$.0:::!:::!~('.\L...::.t.uk1..11J;;;L!:ro~O,JQ~~;..;::..;:-====:-===========:......:..J=----· 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. Not Applicable D Ucense Number ~=::::.=.;,.:.;~~~==-=::::;--s:=('('l:::::::=.:)=)=O=\ 3=\..\=(p======::=: I t l/ tg/ I g Expiration Date 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 buildlng permit. Signed Affidavit Attached Yes No Q From: g To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at because the work is of a minor nature, will not affect structural elements, health, accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, --~--------- ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYVY) ~ 01/15/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the tenn£ and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Betsv Wholey-Osell NAME: BLACKMER INSURANCE AGENCY INC !'11~.t .,-,. (413) 625-6527 I FAX IAJC Nol: ~~: betsy@blackmers.com 1147 MOHAWK TRAIL INSURERISI AFFORDING COVERAGE NAIC# SHELBURNE MA 01370 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER 8: HEILMAN JASON P OBA JPH BUILDING INSURERC : INSURERD: 9 WILLIAM ST STUDIO 6 INSURERE: SHELBURNE FALLS MA 01370 INSURERF: COVERAGES CERTIFICATE NUMBER· 356749 REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ,wDL ~!!~ ,=~ POUCYEXP LIMITS LTR ···-~ POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I CLAIMs-MADE D OCCUR UAMAut: I U Kt:N I t:LI PREMISES 'Ea occurrence! $ f--MED EXP (Any one person) $ N/A f--PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ~ DPRO-OLoc $ POLICY JECT PRODUCTS· COMP/OP AGG OTHER: $ AUTOMOBILE LIABILITY ~~~~~~l:_>}llNGLE LIMIT $ - ANY AUTO BODILY INJURY (Per person) $ -ALL OWNED ~ SCHEDULED N/A BOOIL Y INJURY (Per accident) $ -AUTOS -AUTOS HIRED AUTOS NON-OWNED ~~:~~8AMAGE $ --AUTOS $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESSLIAB CLAIMs-MADE N/A AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION Xl~~I I OTH- AND EMPLOYERS' LIABIUTV ER Y/N A ANYPROPRIETOR/PARTNER/EXECUTIVE ~ 7PJUB7H95921818 03/10/2018 E.L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA NIA 03/10/2019 (-ndatory In NH) E.L DISEASE· EA EMPLOYEE $ 1,000,000 If ts· describe under D SCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (ACORD 101, Acldltlonal Remarks Schedule, may be attached If more space la required) Workers' Compensation benefits will be paid lo Massachusetts employees only. Pursuant lo Endorsement WC 20 03 06 B, no authorization is given lo pay claims for benefits to employees In states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued {unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage -Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 2~.L~y, CPCU, Vice President-Residual Market-WCRIBMA I © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/lndividual):----f.::c).J-fL......l..\j..l,__.Q,B~t 2wl~L::=..JD!:::.....!.\....!~--=-=6:...L---------------- Address: 9 lAJ I U,.,\ 8 AA fu . Su I TE: Co . City/State/Zip: B Phone#: 413, "1-t 5 -3 ~05 Are you an employer? Check the appropriate box: 1. ~ I am a employer with Co employees (full and/or part-time).* 2. D I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. D I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. D I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers' comp. insurance.t 5. D We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. D New construction 7. D Remodeling 8. 121 Demolition 9. 0 Building addition 10.0 Electrical repairs or additions 11. D Plumbing repairs or additions 12.D Roofrepairs 13.D Other --------- • Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy infonnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lcontractors 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 sub-contractors have employees, they must provide their 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:._...J,,£>.,L.l,,t<<.!Cf\cuC-,\,~Mx..u...Eot..1?;.,~--'-l ..!.l.".JJ...lS.uV,_,'(2..fl=..!...JW.rv=a:.,,.,,-=---------------~- Policy# or Self-ins. Lie. #:_1--'-'P ...... J-U_,.fJ_,_3: ............. l:\__.9 ..... S..._9 .... 2.=\...,._P,...._l'-"'B~----Expiration Date:~3-=+-'/ 1~0-/-\9~-- Job Site Address: 4:t> btJ k,l S:x · City/State/Zip: t\b~1tl EWWroN 1 /Y) f\ 6\0 b 0 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 ofup 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. enalties of perjury that the information provided above is true and correct. Date: Phone#: 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. Electrical Inspector 5. Plumbing Inspector 6. Other -------------Contact Person: Phone #: ---------------------------------