22B-040 (18) 221 PINE ST#160 BP-2020-1061
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:22B-040 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADD BATH BUILDING PERMIT
Permit# BP-2020-1061
Project# JS-2020-001796
Est.Cost:
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JAMES MAILLOUX ELECTRIC 081694
Lot Size(sq. ft.): 145926.00 Owner: MOUNT HOLYOKE MANAGEMEN I
Zoning: SI(I 15)/WP(115)/WSP(1)/ Applicant: JAMES MAILLOUX ELECTRIC
AT: 221 PINE ST#160
Applicant Address: Phone: Insurance:
221 PINE ST SUITE 160 (413) 585-1592 Liability
FLORENCEMA01062 ISSUED ON:4/20/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-add bathroom
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 SiHnature:
FeeType: Date Paid: Amount:
Building 4/20/2020 0:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Versionl.7 Commercial Building Permit May 15,2000
Department use only
-- _ City;of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
EPR—,--------8orth�mpton,
1 4 2020 212 Main Street Sewer/Septic Availability
i Room 100 Water/Well Availability
MA 01060 Two Sets of Structural Plans
D6RTHU
N "" 141t-587-1240 Fax 413-587-1272 Plot/Site Plans
NORTHAMPP T7'ON
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
This section to be completed by office
1.1 Property Address:
Z2-1 ?)A c n-*" -, �-, r 1 t o Map v�a Lot C/f/ unit
rL o rcn O J /0.4 0 1 Oi Z Zone Overlay District
Elm St. District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
)ZO -(
j /M 01 U6 V —�
Signature Telephone
2.2 Authorized Agent: y
. �w /l
v�VA t ZZ 'V/n .,
Name(Print) Current Mailing Address:
Signature Telephone '7-1//
SECTION 3-E TIdATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building / O (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
5
Construction from 6
3. Plumbing .rITT9 Building Permit Fee ,L 3 .
4. Mechanical(HVAC)
5. Fire Protection
6. Total =0 +2+3+4+5)
Check Number t 1t�i3 fi
!his Section For Official Use On
Building Permit Number Date
�.• � C&l Issued
� a
Signature:
Building Commissioner/Inspector of Buildings Date
o w�S �eG,Ba
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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description Enter a brief description here.
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 ❑ 1 B ❑
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 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify: F
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: 1— 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)
St E—
` _ Sl
nd y
2
3rd
3rd
4ih i
4« i
Total Area(sf) �— Total Proposed New Construction Vis ,,
Total Height(ft) �
Total Height ft
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 E]
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L:E.' R:= L: R:0 [�
Rear
Building Height
Bldg. Square Footage %
Open Space Footage �—�—� % l
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book i Pagel and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: I
C. Do any signs exist on the property? YES Q NO l
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.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:
_.___I.-,-.IT___.___ _ - 1 11 Not Applicable ❑
Name(Registrant):
_ _..
` Registration Number
Address
� +—�f Expiration Date
Signature ( Telephone
9.2 Registered Professional Engineer(s):
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 Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address v
Signature Telephone
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes ® No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR AP ES FOR BUILDING PERMIT
I,
G !, , as Owner of the subject property
hereby authorize
�7,on�C� /44,,41/J/vI't-A 'to
act on my behalf, in all matters relative to work authorized by this building permit application. _._____
y 1�
Signature of Owner Date
I 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 the pains,and penalties of perjury.___��__
Print Name
Signature of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable [IName of License Holder
SA M CS 11A 1 U-0 uAX
License Number
7— fr 5,„T 16 v 1ToiCn(e MA 01062
Address Exp n ate
S9 r is5�z
Signature P � 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 0 No 0
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: ZZ 1 -7,,e 5� ~`X°
bJ
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
�I
U U
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
R d 1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Letiblv
Name (Business/Organization/Individual):
Address: ZZ t �l J �-L Ito '
City/State/Zip: E-f-erk!"1 J C)I O t Z Phone#:
A7yon employer?Check the appropriate box: Type of project(required):
1. a employer with _employees(full and/or part-time).* 7. ❑New construction
2.F-1 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t
10❑Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs
These sub-contractors have employees and have workers'comp.insurance?
6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors 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. "� , l /
�✓
Insurance Company Name: V TC
Nab lT rAn�Q� —
Policy#or Self-ins.Lic.#: U) Expiration Date: / O
Job Site Address: City/State/Zip:
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 this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cerci u r t i an penalties of perjury that the information provided above istr a and correct
Signature: Date: y
Phone#: 1 597�
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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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141 145
116 136
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104 102 100
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PINE STREET
15_T_ FLOOR STUDIOS
100 BrushWorks 120 Patrick's Art House/Patrick Foley
102 Writer's Ink/S.G.Tyler 130
• 104 America Garcia/Alex Evora 141 Feeding Tube Records
106 Margaret Arraj/Mill River Rugs 143 R-Kale Games/Richard Kalin
107 145 Rising Tide
108 Jo-Anna Ross 150
112 Contact Quarterly 155
115 Kate Jenkins/Jahnava's OrientalRdgso 159 Salmon Studios
116 Herzenberg Designs • a 460 Pioneer Heating and Cooling
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4/14/2020 221waiver.jpg
From:
Louis Hasbrouck
Building Commissioner
City ofNorthampton
212Main Street
Northampton, kXAO10GO
The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for
constructioncon¢rolinoertainsitua¢\ons.inaczordancewithcodesectionIO4.1O,| reque*tthatyou
grant a modification to waive the requirement for construction control of the project at
e work is of a minor nature,will not affect structural elements, ea\th'accessibihty,life or�re
because�
safety,and w ed U|b done ni accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,
»ttpo:8mai|.noog|ozom/meiKua/u/0/?v»vo~1#muox/Qn,uJ*sTjvn|FCKLzxmvhu*wxpwSHx|qaoQ?pvojocto=1&m000aooPamu~U.1 1/2
4/20/2020 221wax=qpg
Fmm� -- �� /� �� � ~tA
�� ^^ . -~ ~ � -'
/ < `
To:
Louis Hasbrouck
Building Commissioner
City of Northampton
212Main Street
Northampton,KAA01OGO
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, 1 request that you
grant a modification to waive the requirement for construction control of the project at
structural elements, ca|th^acc�s�ibiUty,Ufenrf)re
because— �rd with neso|ptivercquir�mentyoftheco6e
sa��y,andw8Ubpdone|nacc�accordance the ,
Thank you for your consideration.
Respectfully,