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31A-076 (18)
264 ELM ST BP-2020-0014 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao:Block:3 I-076 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2020-0014 Project n JS-2019-002097 Est.Cost:$139000.00 Fee:$973.00 PERMISSION IS HEREBY GRANTED TO: const.Class: Contractor: License: Use Group: ALL-TEK BUILDERS INC 76435 Lot Size(sc fl Y Owner: COCHRANE REBECCA Zoning,URB(1001/ Applicant: ALL-TEK BUILDERS INC AT: 264 ELM ST Applicant Address: Phone: Insurance: 88G INDUSTRY AVE (413) 736-0099 O WC SPRINGFIELDMA01104 ISSUED ON.7/5/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.RENO DENTAL OFFICE 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: FeeType: Date Paid: Amount: Building 7/520190:00:00 $973.00 212 Main Street,Phone(413)587-1240, Fax:(413)587.1272 Louis Hasbrouck—Building Commissioner File H BP-2020-0014 APPLICANT/CONTACT PERSON ALL-TEK BUILDERS INC ADDRESS/PHONE SSG INDUSTRY AVE SPRINGFIELD (413)736-0099 Q PROPERTY LOCATION 264 ELM ST MAP 31A PARCEL 076 000 ZONE URB(100U THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATIObLCHECKLIST ENCLO D REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T fConstruclion: RENO DENTAL OFFIC New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 76435 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 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 _7 5-ZO)q Si re ofIlluilding Official Date 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. -A P cal) ) Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permut 212 Main Street Sewer/Septic Availability Room 100 WaterANell Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PIOUSite Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILYppDWELLING SECTION 1 -SITE INFORMATION b 1.1 Property Address: This section to be completed by ogee �� 2— Map Lot Unit Oqcir-A Zone Overlay District - F�/� ------ - -- Elm SL District Ce District SECTION; -PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: caCo.�rane �f �t & Alwih"Kph Name(PnnQ Current Mailing Address: Y/ 3 - —gaol Signature s Telephone 2�.2 AuthorizedA Agent, �si9BEIr -- �i�Qc s—s� y 19-VF �I Name(Print) /..-( 7 W� Atli LQ�i�yd' Current Melling Atltlress: �, /3 zz/ O/VS- Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bernilapplicant 1. Building r77 (a) Building Permit Fee 2. Electrical `,1!/ . ..w-f) (b)Estimated Total Cost of (/ u�Vr�z Construction from 6 3. Plumbing ' Building Permit I" /�' 4. Mechanical(HVAC) - #q7-3 5. Fire Protection V v V 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Cbffirmissioneplaspector of Buikfings Date Versionl.7 Commercial Building Permit May 15,2000 SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Aherations Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions El Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ Naw Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Description Enter a brief description here. Of Proposed Work: .77"j7-�-'-rdo/L- SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ to ❑ A4 ❑ A-5 ❑ IS ❑ B Business tS17Nh 2A ❑ E Educational ❑ 2B F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5q ❑ S Storage ❑ S-1 ❑ S2 ❑ 58 ❑ 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 S BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1" 2na 2n° 3' 3b 0 0 Total Area(sl) Total Proposed New Construction (sq Total Height(ft) Total Height ft 7.Water S ply IN.G.L.e.40,§54) 7.1 Flood Zone Information: 7.3 Sewage sposal System: Public Private 0 Zone Outside Flood Zone[] Municipal On su tlisposal system❑ Versionl9 Commercial Building Permit May 15,2000 ISI 8. NORTHAMPTONZONP]G Existing Proposed Required by Zoning this column m be filled m by Building Dquir l Lot Size _......__ _.._ _. Frontage .... Setbacks Front Side L: _ . . R: .. L' R: Rear Building Height Bldg.Square Footage __i �__ % ----- -- Open Space Footage % --- (LW ameminus bldg&paved #of Puking Spaces --- ---- Fill: A. Has a Special Permit/Variance/Findin ver been issued for/on the site? NO O DON'T KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O 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 DONT 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 © , 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 IF YES,YES, describe size, type and location: E. NAII the construction activity disturb(clearing,grading,exc ion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO 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 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant). Registration Number Address GVV 1/ / f V /� (`•{7-T_ 7 r A/3 Expiration Date Signature elephone 9.2 Registered Professional Engineer(a): 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Data 9.3 General Contractor f � Not Applicable ❑ Ca an Name'. Ressible In CM1arge of Cotystructi �� Q C,,( Address —/�7�^ l/7,,�Tt7nJ / Sign Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(730 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED= OMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I / a[:L1�.G�._�LA7�lA..✓_�� as Owner of the subject property hereby authorize - �!�_-_._.._. to act on If, in all m lative to work authorized by this building permit application. _. 4? !3 Sgnature1o(,,OxLrc�r, /` —1� — Date 1 .-."-'��`TOC:Cicc3h. ----- _..____.._ ,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. Sign dun to ins,and It of perjury. 1i A_'Zi Print Name /� _.. ��..c_CL .r�%tfan (1)211! Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. � Not AOpplicable ❑ sJ-Name of License Holder ca& fJ_T License Number Mdress Exp eatlon Dale 442� �/ a7� / OlVd" Signature Telephone SECTION 13-WORKERSCOMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§2303)) Workers Compensation Insurance af7 evil must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b (ding permit. Signed Affidavit Attached Yes 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 150A. Address of the work:/ The debris will be transported by: The debris will be received by: A Building permit number: Name of Permit Applicant Date Signature of Permit Applicant ®` The Commonwealth ofMassachusens Department of IndustrialAccidents 1 Congress Street,Suite 700 Boston,MA 02714-2077 %nimamass gov/dia Rorkers'Compensation Insurance Affidavit:Builders/CootractorMectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lie—aribly Name(BusinessiOrgaorzaboNludividual): Address: //// City/State/Zip: t Ph� n: C1/3 °736 OD F 9 Are you an employer?Chuck the appropriate bor: Type of project(required): I.�Iwaempbyer with cmploycrs lfull mdlm pori-timet' 7. construction 3❑I am a sole pmpriemror par tp and have w employers working forme os 8. cars log any capacity.(No workers'comp insmance quirtd.l 3.M I am a hosomwmr doing all work myselE[No workers'compuamance m,mroi.]' 9. ❑Demolition 4 1 am a hommwwr and will be having contractors to conduct all work on mypmpery, twill 10❑Building addition ore that all contmcmirs either hove workers,compensation..cm are to 11.❑Electrical repairs or additions veterans.with no m,ploy«s. 12.[]Plumbing repairs or additions 5❑I am a general mnvachit and 1 have ford fie subconmctim fined m the anached sheer. 'flew sob-wrawwos have employers am have workers comp.manmwe.: 13.E]Roof repairs 6.❑We are a corpomoss and its ofTcirs have a iud them right of iccimumn per MGL c. 14.❑0ther 152,51(4),end we Iuvc an employws.[No workers comp.imumno,ayu 4] 'Any appoint flet checks bon e1 must also fill out the swim below showing their workers'compemanm policy infomunon. t Homeowners who submit this affidavit indicating they are doing all work and thm hire outaide eonhnetms must submit a new dTdavit indicating such. :Co..,,that check this Wa must munched an nddinonal shwl showing the nom of no sub-conhncturs and state whether or not those entities have employees. If the sub-mnnacton have employew,they must provide their watkas'comp.policy nations. 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. �, ,. -�-It- Insurance Company Name: �v/ t�'ry(.� Policy N or Self-ins. r�Licc..B: Expiration Date: ��,t �r1 Job Site Address: � cf 7-yL7 ST NQ/�",-bgkPZ�tyismte2ip: i-Lw. 0/®6O Attach a copy of the workers'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 ement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cerci an aides ii/perjury that the information provided above is true and correct Signature Date: / v Phone 4: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License k 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 N: 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 smite 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 of the 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 of the 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 shell 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 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 in your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certificam(s)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. 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 confirmation of insurance coverage. Alto 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,not 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. City 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 fill 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)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that 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 I Congress Street, Suite 100 Boston, MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax#617-727-7749 Revised 02-23-15 w .mess.gov/dia ** �� Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 9ih edition of the Massachusetts State Building Code,780 CMR,Section 107 Project Title:Cochrane Dental-Renovations to Dental Office. Date:May 14,2019 Property Address: 264 Elm Street-Second Floor,Northampton,MA Project: Check(x)one or both as applicable:( )New construction (X)Existing Construction Project description:Demolition of existing plaster partitions,cabinetry,plumbing fixtures and electrical wiring in portion of secogd Boor dental office for future atfice expansion. I Brian De Vnese MA Registration Number:7348AR Expiration date:08-31-19 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': (X)Architectural (X) Structural Mechanical Fre Protection Electrical Other: for the above named project and that to the-best of my knowledge,information,and belief such plans,computations and specifications most the applicable provisions of the Massachusetts State Building Code,(780 CMR),mid accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other subminals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to delcmtine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with peniman comment',in a form acceptable to the building official. Upon completion of the work,1 shall submit to the building official a'Final Contraction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: o E,ED A,. f mS em 1 8 NO. n k nuss 41r1 OF Phone number:(413)747-5285 Email:brian@jdarchitectseo n Building(Malar Use Only Building Official Nnmc Pcnnit Ne: Dam: Yarm 06_11 200