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31A-112 (9) N ©K- lo D(,nn,) File#BP-2018-1208 1 �6f� ,how EcfG W�5!Q�L ®„p APPLICANT/CONTACT PERSON PATI CK CALVINa,,�(' 0 N V` V•J ADDRESS/PHONE 95 NORTH MAPLE - HADLEY (413)2j3-65•.5 O � ' PROPERTY LOCATION 56 VERNON Siuz r � MAP 3IA PARCEL 112001 ZONE UR-(100)1 THIS SL,:TION_FOR OFF it AL OSE ONLY: PER!IIT APPLICA,,C�_CHECKLIS'F ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT A Fee Paid Building Permit Filled out _ Fee Paid Typeof Construction: CONSTRUCT TEMP RAMP AAB-NEW CONCRETE ACCESS RAMP New Constmclion Non Structural interior renovations Addition to Exist ng Accessory Structure Building Plans Included Owner/Statement or License 013977 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:§ 5. 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: Cmb Cutfrom DPW Water Availability Sewer Availability _Septic Approval Board of Health Weil 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 Signature of Building Official Dale 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 MGL 40A.Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit May 15,2000 Use only ' Rdal City of Northampton W "I1111 !j Building Department Cu C % 212 Main Street SewedSepUc �1:"ji WN'1111� Room 100 ANeg Avalat, Northampton, MA 01060 chiral Plans phone 413-587-1240 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 I -SITE INFORMATION P- C)(/ ed. Pian s 1A d- 1.1 Property Address This section to be completed by office v&MU\ -Itv� Map 114- Lot Unit /%kW ft,*A X Zone Chraday District C)kqG!k—----- Elm St.District CB District SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: IN Current Mailing Address Sign re Telephone 2.2 Ath.r". �S.n)it t-tkDkF'Y rAA- Signature Telephone SECTION 31ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Permit applicant 1. Building (.2 lot) (a)Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3 +4,5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date (-))rwwV%"v-y @ E-)1'vl;1L,-can - Version L7 Commercial Building Permit May 15,2000 1 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition[] Repairs[] Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing E] Change of Use❑ Other go Brief Description Enter abrief description here. Of Proposed Work' Cm4y�WLMLA ' kmMT ..�OWIQ_.ftR$ SECTION 5-USE GROUP AND CONSTRUCTION TYPE �l�.V� •1SY`' USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A _ 0 E Educational ❑ , '.2B Q F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ ' " 3A [] I Institutional ❑ 1-1 ❑ 1-2 ❑ 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 EXISTIN(i'BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: _.. ..,r.. 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(sf) 2m 2. 3e are -.. . .... 4 4u, m Total Area(sl) Total Proposed New Construction(si) Total Height(it) Total Height R 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Version I.7 Commercial Building Permit May 15,2000 THAMPTON 7.5 N5 G Existing Proposed Required by Zoning This column to be filled m by is iodu,❑'artmmt ze age _........ .._... ._... .. icks Front Side L R. Ll. R Rear Aiding Height .-__. ,Idg. Square Footage % )pen Space Footage % - Loiareamiausbldg&Paved _ _ _.. _.. ...._.. #ofParking Spaces - Fill: A. Has a Special Permit/Variance/Finding ever been issued forton the site? NO © DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES IF YES: enter Book Page.. and/or Document# B. Does the site contain a brook, body of water or wetlands? NONCWI DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained © , Date Issued: C. Do any signs exist on the property? YES 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 © No.,I IF YES, describe size,type and location: r E Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan that'.wlll distu(6over 1 acre? NES O NO IF YES,then a Northampton Storm WaterManag@dtent Permit from the DPW is required. VersionL7 Commercial Bu➢ding Permit May 15,2000 SECTION 9•PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES St CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 36,000 C.F.OF ENCLOSED 9.1 Registered Architect: 00bWNot Applicable Name(Registraral Registration Number Address 413. 757.8 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Resp.mvin ity Address Registration Number _ Signature Telephone Expiration Dam Name Area of Responsibility Address Registration Number Signature Telephone Expradon Date Name Area of Responsibility Atldress Registratwn Number Signature Telephone Exprah"Date 9./3 General Contractor SC 1'n * A+y Not Applicable ❑ Company Name t 014M1 ��wK �ohI � tc(t4 Responsible C in Charge of Construction Address . c<1gQ�k . .ck4V� !' tYIA _oral csc �1�,4�3 dress th3is3�asr, urq eg(, ft� . Si tura Temphone Version 1.7 Commercial Building Permit May 15,2000 UCTURAL PEER REVIEW(780 CMR 110.11) lural Engineering Structural Peer Review Required Yes 4 No MER AUTHORIZATION-TO BE COMPLETED= r OR CONTRACTOR APPLIES FOR BUILDING as Owner of the subject property to alf,in I matters relative to work authodeed by this building permit application flS.fs, � . vne ) Date r41RWYY as OwnerlAuthori2ed by declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge ider the pains and penalties o qury _ (A 2 ie _... _. e of 0wnerlAgent Date )N 12.CONSTRUCTION SERVICES sensed Construction Supervisor: �j Not Applicable ❑ rLiiornia Holder 'T Z.itLL. a��d.�Yt� -LS` 017414--r- License Number : 1J• m�� St. tkrnj�.(� mR _ (ejti 11$ . Expiration Date alb 2.3"S 4S`d,X"" e Telephone )N 13-WORKERS' COMPENSATION INSURANCE AFFIOAVIT(M.G.L.c.152,§25C(6)) s Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will 2suR Dial of the issuance of the building permit Affidavit Attached Yes No City of Northampton 212 Main Street,Northampton, MA 01 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that i a condition of the building permit all debris resulting from the constructio activity governed by this Building Permit shall be disposed of in a properl! licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant Date - Signature of Permit Applicant, . . The Commonwealth ofMassaehusetts Department oflndustrialAccidents I Congress Street, Suite 100 } Boston,MA 02114-2017 %, w.mass.govldia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. :ant fnformatlon Please Print Legibly esslOrganization Name: (7pLt111J t � tY+EkSU AI(Ll/ /State/Zip: VI W MY Mk" Phone#: x(12-�, LS3. 66'$S 'on an employer?Check the appropriate box: Business Type(required): f 1 am a employer with employees(full and 5. Retail or part-rime)* 6. QResimeant/Bar/Eating Establishment Lam a sole proprietor or parmetship and have no y. Q Office and/or Sales(incl,real estate,auto,etc.) employees working for me in any capacity. (No workers'comp.insurance required] 8. ❑Non-profit i] We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees,)No workers'comp.insurance required)' Q W e are a nonprofit organization,staffed by volunteers, 11.0 Health Care with no employees.(No workers'comp.insurance req.] 12.0 Other Nny applicant that checks box ttl must also fill ow the section below shah ing Wevaorkrr�compensaom:polity infmmnoon. 9nflw corporam of9rors have exempudthemsdaee,bat aeeo nolm nhas othe emptoyec,awmkars'eompansatim,policy is raquved aaJ socA an epanivatim shontd ebcek box Kl. -am an employer chic is providing workers'compensmian insurance jar my employees. Bela.is rhe paliry information. monance Company Name: usurer's Addressc nyxr mlb I I :ity/Stattszm: 'olicy#or Self-ins.Lie.# �q,k' z,��' ij� t i "1l� Expiration Date: lttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). allurem secure coverage as required under Section 25A ofMGL c. 152 can lead w the imposition of criminal penalties of me 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 f up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigatons of the DIA for insurance coverage verification, do hereby certif y nnle pf andy(j�'�us o/fgp�erjury chic the information provided ab�vJe is nue and correct `nunam� I Date: 'hone a' t.A. - ' Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License a Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTowu Clerk 4 Licensing Board 5.Selectmen's Met, 6.Other Contact Person: Phone tt: w srmmsgovrdia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their em Pursuant to this smote,an employee is defined as"...every person in the service of another under any contract o express or implied,oral or writtert" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or of the foregoing engaged in a joint enterprise,and including the legal mpreser m cess of a deceased employer,or tl receiver or trustee of an individual,parmershig association or other legal entity,employing employees. However, owner of a dwelling house having not more than duce apartments and who resides therein,or the occupant of the dwelling house of soother who employs persons to do maintenance,construction or repair work on such dwelling Ic or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employ MGL chapter 152,§25Cgo also states that"every stare or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to coustrvet 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 contact for the performance of public work until acceptable evidence of compliance with the insurance requirements of this 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 ofinsuraint. 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. If an 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 confnmadmi of iusmance 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 ptmflt or license is being requested,not the Department of Industrial Accidents. Should you have eery questions regarding the law or if you are required to obtain a workers'compensation policy,please call the Deparo ent at the number listed below. Self-insured companies should anter their self-insurance license number on the appropriate line. City or Town 01211cials 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(ill in the peanit(license number which will be used as a reference number.In addition,an applicant that must submit multiple peram/icense applications in any given year,need only submit one affidavit indicating current policy information fifnecessary). A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each yeah Where a home owner of citizen is obtaining a license or permit not related to any business or commercial venture(i.e,a dog license or permit m bum leaves etc.)said person is NOT required to complete this affidavit The Deparnnem's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industtial Accidents - 1 Congress Street Boston,MA 02114-2017 Tei. #617-727-4900 ext. 7406 or 1477-MA.SSAFE Fax #617-727-7749 wwwtmass.govtdia Four kwised 02-2M5 CBy or Northampton Mail-RE:%Vernon Street CNNf of Louis Hasbrouck<lhasbrouck@northamptonma.gov> i Vernon Street ---------------------- ___._ ssbrouck <Ihasbrouck@northamptonma.gov> Tue, May 29, 2018 at 4:16 PM "DeVriese, Brian"<bdan@jdarchitects.com> ts. Hasbrouck ling Commissioner of Northampton n of Williamsburg 3)587-1240 office 3)587-1272 fax Too, May 29,2018 at 4:13 PM,DeVriese,Brian <brian@jdarchioe ts.com>wrote: -suis, I am coming to the site Thursday morning to assess the situation with the catch basin and make a decision on the ramp configuration.I have two schemes and will choose between the two based on what we find. It would be preferable to submit only the one we will use for the permit. I should be able to submit the Controlled Construction document with the plans at the end of the day. Best, Brian From: Louis Hasbrouck[ihesbrouck@northamptonme.gov] Sent Tuesday, May 29, 2018 4:01 PM To: DeVriese, Brian Cc: David Pomerantz; David Gardner Subject: 56 Vernon Street Brian, We need a construction control document for the ramp project at 56 Vernon Street,and an electronic set of plans. I'd also like some kind of assessment of the brick wall next to the upper section of ramp; some areas will need at least some attention. 1 haven't heard about how the conflict with the catch basin is getting resolved, either. I need to get this info as soon as possible; I don't want the contractor to get too far along before we issue the permit. Thanks Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax '"" 0-nxlk=ec5t19a57efljsver-'xDvk5HntT0.en.&rbkgmail_te_180509A2�4Rview=pf&msg=163adabd2003e57r&dsgt=t&stmt°