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31D-018 (2)
164 GREEN ST ` BP-2020-1113 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31D-018 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:REPAIR BUILDING PERMIT Permit# BP-2020-1113 Prosect# JS-2020-001846 Est.Cost: $63238.00 Fee:$441.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCAPES BUILDERS & EXCAVATION LLC 129632 Lot Size(sq.ft.): 59677.20 Owner. SMITH COLLEGE OFFICE OF TREASURER Zoning: EU(100)/URC(100)/ Applicant. SCAPES BUILDERS & EXCAVATION LLC AT. 164 GREEN ST Applicant Address: Phone: Insurance: 110 NORTH HILLSIDE DRI (413) 665-0185 O WC DEERFIELDMA01373 ISSUED ON.51812020 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR SUB FLOOR AND JOISTS IN DISH ROOM 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 5/8/2020 0:00:00 $441.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15, 2000 f` Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability ROOM 100 Water/Well Availability__ Gin Northampton, MA 01060 Two Sets of Structural Plans one3-5$7-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO C T, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING c OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 164 Green St, Northampton, MA 01060 Map jD Lot C � � Unit Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: The_Trustees of Smith CollMe c/o Gary Hartwell 126 West St, Northampton, MA 01060 ^— Name(Print)Gary Hartwell Current Mailing Address: 585 413-320-9763 (cell) Signature Telephone 2.2 Authorized Agent: Douglas A Blowers,_ManainMember LLC 110 North Hillside_Rd,S Deerfield,MA 01373 Name(Print) Current Mailing Address: ,(413) 665-0185 i Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $43,826.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of $6,997.00 Construction from 6 3. Plumbing Building Permit Fee $12,460.00 g 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 +2 + 3+4 + 5) $63,238 Check Number This Section For Official Use Only Building Permit Number Date /) Issued �i `� - Signature: / Building Commissionerllnspector of Buildings Date J� Version].?Commercial Building Permit May 15, 2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations El 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: n �`� & dry' S(,{,� (O()t- L 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 ❑ 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 ❑ 513 ❑ U Utility ❑ Specify: Dormitory 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 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 s1 ��-------�-� 1st i --------_ _— 2nd - 2nd 3 d 3'd 4tn 4t" Total Area (sf) `` Total Proposed New Construction (sf) 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 Q Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑ _ 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: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (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 Q DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q 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 O NO 0 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 ® NO e 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: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date T 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 i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number L_ Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Scapes Build"Oqj4jCE��Ca*E*ers &Excavation, LLC Not Applicable ❑ Company Name: Douglas A Blowers, Managing Memeber, LLC w, Responsible In Charge of Construction 110 North Hillside Rd,South Deerfield,,MA 01373 Address (41 65-0185 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 O No O SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Gary Hartwell,Facilities Management, Smith College as Owner of the subject property hereby authorize Douglas A Blowers,Managing Member, LLC to act on my beh mat lative to work authorized by this building permit application. 4/28/20 Signature weer Date Douglas A Blowers, Managing Member, LLC ___.. 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. i Douglas A Blowers Print Name Signature of Owner/Agent Date SECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Dou las A Blowers CSL 129632 _ Name of License Holder. � - License Number 110 North Hillside Rd, South Deerfield, MA 01373 04/05/2022 Address Expiration Date (4l 3) 665-0185 Signature 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 O No 0 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance oithe 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: 151-199 Green St, Northampton, MA 01060 The debris will be transported by: Dave Wickles Trucking The debris will be received by: Dave Wickles Trucking Building permit number: Name of Permit Applicant Scapes Builders & Excavation, LLC (Z�' ,- 'q' C--, Date Signature of Permit Applicant S " The Commonwealth of Massachusetts viDepartment of Industrial Accidents co I 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 Leeribly Name(Business/Organization/Individual):Scapes Builders & Excavation, LLC Address: 110 North Hillside Rd City/State/Zip:South Deerfield, MA 01373 Phone#:413-665-0185 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 14 employees(full and/or part-time).' 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Q✓ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.Q 1 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.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. l 3.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.-* 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 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. 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: Liberty Mutual Insurance Co Policy#or Self-ins.Lic.#:XW059660868 Expiration Date:6/25/2020 Job Site Address:51-199 Green St City/State/Zip: Northampton, MA 01060 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 certify under the pains and penallli^eys of perjury that the information provided above is true and correct Signature: Date: --2r/—ZO Phone#:413-665-0185 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#: