32A-169 (2) 36 HAWLEY ST BP-2019-1007
GIS a: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:32A- 169 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ELECTRICAL BUILDING PERMIT
Pmt# BP-2019-1007
Proiect n JS-2019-001640
Est.Cost:$17000.00
Fee:$105.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor. License.
Use Group: LOUIS HALE 091856
Lot Size(sp.R.): 16291.44 Owner. JJ HAWLEY LLC
Zoning:URC(100U Applicant. LOUIS HALE
AT. 36 HAWLEY ST
Applicant Address: Phone. Insurance.,
31 LYMAN ST (413)522-0546 0 SOLE PROPRIETOR
SOUTH HADLEYMA01075 ISSUED OM3129/20190:00:00
TO PERFORM THE FOLLOWING WORK INSTALL 15 REPLACEMENT WINDOWS,
INTERIOR DOOR, EXTERIOR STAIR RAILINGS AND TILE SHOWER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Budding Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Drhre y 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. A4� &v-,,-L
Certificate of OCCUDanCV Signature:
FeeTYpe: Date Paid: Amount:
Building 32920190:00:00 $105.00
212 Main Street,Phone(413)597-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
o V '
,T E N(IWI,,+ww
File 4 BP-2019.1007 PO
IQ.
APPLICANT/CONTACT PERSON LOUIS HALE
ADDPESSIPHONE 31 LYMAN ST SOUTH HADLEY (413)522-0546() )F
PROPERTY LOCATION 36 HAWLEY ST
MAP 32A PARCEL 169 001 ZONE URC000V
THIS SECTION FOR OFFICIAL USE ONLY,
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvceof Construction: INSTALL 15 REPLACEMENT WINDOWS.INTERIOR DOOR EXTERIOR STAIR
RAILINGS AND TILE SHOWER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 091856
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 Pemdt 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
_ 3- N- 2a9
SignAf&re of Building Official Date
Note: Issuance ors 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 Buildin a Permit Mav 15,2000
Department use only
City of Northampton Status of Permit:
Building Department Cum Cut'Driveway Permit
212 Main Street Sewer/Septic 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
APPILICATION'MCONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPM CY O , DIN
OTHER THAN A ONE OR TWO FAMILY DWELLIN
YAR 1 4 2019
SECTION 7 -SITE INFORMATION
1.1 Property Address: This secs to
OEPf OF BUa. 1NaPEC1104
36 Hawley Street Map I
NOB131AMPTON, amen
Zone Overlay District
-- Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
JJ Hawley LLC 240 Reeds Bridge Rd Conway, MA
Name(Pdm) Current Mailing Address: _
j� (413) 522-2493
Signature Telephone
2.2 A.th.,Ved Anent:
Louis Hale 31 Lyman St South Hadley, MA
Name(Print) Current Mailing Address:
/ G10 (413) 522-0546
Signature ��� `— Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
wm leted by permit applicant
1. Building $15,000.00 (a)Building Permit Fee
2. Electrical 00.00 (b)Estimated Total Cost of
Construction from 6
3. Plumbing $00.00 Building Permit Fee
4. Mechanical(HVAC) IO5-0(]
S.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
/� Issued
Signature: /
/ 3. 29
Builtling miselpnwanapedor of Buildings Date
Low® i-lalecons-F����on . �-ot�
i �7+rn i .,. ..�
i �. r-� i�,F' ti
Versiori Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
ti
Interior Alterations ❑ Existing Wall Signs ❑ Demolition 11 Repairs 13 Additions ❑ Accessory Building[3
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑
Brief Description replace 15 windows, select interior door, exterior stair railings and tile shower surrounds 1
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 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3g
M Mercantile ❑ 4 ❑
R Residential I R-1 ❑ R-2 0 R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ SB O
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 a BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(at)
_.� to r
1"
2-
_.. 4e
Total Area(at) Total Proposed New Construction(at)
Total Height(it)
Total Height it
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 1l Private 13 Zone Outside Flood Zone[] Municipal ❑r On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be f lld in by IS
Building Detrainment `
Lot Size _
Frontage
Setbacks Front -- --- -
Rear
Building Height
Bldg.Square Footage -------
Open Space Footage
(Loi area minus bldg&pavid
puking) _.._.._.
tt of Parking Spaces r
Fill:
volume&taction) ---
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW (D YES O
IF YES: enter Book Page and/or Document at
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
........_. ..-.
Needs to be obtained 10 Obtained 10 , 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 construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part 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.
8
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 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE
9.1 Registered Architect:
Not Applicable [Z]
Name(Regislrant)'
Registration Number
Address
Eviration Date
Signature Telephone
9.2 Registered Professional Enginear(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Data
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 Responsibiliq
Address Registration Number
Signature Telephone Expiration Date
9.3 Generel Contractor
Hale Construction LLC Not Applicable ❑
Company Name:
Louis Hale
Responsible In Charge of Construction
31 Lyman ST South Hadley, MA
Address
(413) 522-0546
Signa ure Telephone
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
James Cabral for 1J Hawley LLC
I, ,as Owner of the subject property
hereby authorize Louis Hale to
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Omer Date
Louis Hale ,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 and panalI perjury.
Pnnl Na r
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of license Homer. Louis Hale 091856
License Number
31 Lyman ST South He� 1 ,MA 09/30/2021
T Expiration Date
1111 (413) 522-0546
SignWl rem^ Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152,12SC(S))
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 paring.
Signed Affidavit Attached Yes Q No Q
i City of Northampton
.✓P - Massachusetts
s
( nEPARTHENT OF B➢ZLDING INSPfiCSZ➢NS
.
' 212 xn Sti t .M xciwl Rv 1l �y
xorthw ton, M 01060
Debris 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 Peri[ shall be disposed
of in a property licensed solid waste disposal facility, as defined by MGL c 111. S 150A.
The debris from construction work being performed at:
36 /-If,W If, I
(Please print house number and street name)
Is to be disposed of at:
U" Ire ' G�ec ycirl
(Please print name and location o facility)
O/nr�will be disposed of in a dumpster onsite rented or leased from:
(Company Name andAddress)
Slgnat of Per n t Ap—p%anf or Owner ate
If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 01114-2017
www.massgov/dia _ I
VII.rkers'Compensation Insurance Affidavit:Builders/ContraMoraBleetricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le¢ibly
Name(Business/Organizatiodlndividual): !(41 t.C_ evvi f dtK f/c.fiti
Address: 4 L-�l✓vitin JCS
City/State/Zip: d l w 7 Phone#: 41 S 1 L— 0 S Y G
Ate you an eepoYerY Clerk me appropriate M.: Type of project(required):
LE]I am a earldom with employccr(hdl and/orpm-thoe).' 7. ❑New construction
2.M1 am a sale pmpriemrar pmmmhip and have oo employees winking forme m 8. Remodeling
®y,-M it,[No workm'comp.wurance ree orefil
>.❑I em a maeowmr aoine ail wink ayxlc INo wmkmscomp.imnmoce reaoaod.]' 9. Demolition
4 I am a hoaeowam and will lehhmn nd
mgconhacto couct all work oa mwin peoperi Iw ]0❑Building addition
vsue Wm dl corrmnam eithm love woken'compemetior msumncc m arc sok 11.❑Electrical repairs or additions
M,memts with no empmyees. 12.❑Plumbing repairs or additions
SC]Iam.,.Ico.termit l have hired We sub-cantrenars Imeadio mratmched sheet
These sub-cow r,have utility.avd have workees'ever, insurance.. 13.❑Roof. airs
6.❑We are a cotpomtion and its offices have exeaised their.,k of exemption per MGL c. 14.❑Other
152.I1(4).was we have no employees.Mo worm'eoap.msuance requhed.]
'Any appli®rt that checks box#1 cast also fill ons the secYon below show Wg thew workerscompensation policy thfoanatiw.
t Hoawwners who submit this affidavit indicator Wry are doing all work and can how outside i weaetots must submit a new afida,,it indicator,such.
:Comescror that check this bon amt coached an additional sheet shower,the name fthe sub-contactors sad stere whetter or not thou entities have
employees. Vote sub-covaamon love employees,they mus pavicle Weir workers'mapwlicv 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:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: IG gra. L"'7 City/StatdZip:1)Grl-h .n7�ti
Attach a copy of the worker'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL 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 form 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.
Ido hereby certify under the pains a ena/des of perjury that the information provided above is true and correct
Silmanam /I--�-`-Ci /y`(� Date:
Phone#: Vl ) — SQL-- 0 S-V 6
DlBcial use only. Do not write in this area,to be completed by city or town of riak
City or Town: Permit/License#
Issuing Authority(circle one):
L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: