32A-102 (2) BP r 022-1295
14 MARKET ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-102-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Penn it# BP-2022-1295 PERMISSION IS HEREBYGRANTEI TO:
Project# REPAIRS Contractor: License:
Est. Cost: 35000 FORREST DEVINE 095779U
Const.Class: Exp.Date:07/07/2024
Use Group: Owner: LLC DDM PROPERTIES
Lot Size (sq.ft.)
Zoning: CB Applicant: DEVINE CONSTRUCTION INC
Applicant Address Phone: Insurance:
129 LOVERS LANE (413)478-9691 2001W89165
GRANVILLE, MA 01034
ISSUED ON:10/12/2022
TO PERFORM THE FOLLOWING WORK:
REPAIRS DUE TO WATER DAMAGE
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL• TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
II
Fees Paid: $245.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
AECFIVE
The Commonwealth of Ma ac uss 1
Office of Public Safety and Ins ectio 2022
�`I f Massachusetts State Building Code( 80 R)
Building Permit Application for any Building other tha a O ' ]welling
PT OF RIMMING INSPc�. IUrvS
(This Section For Official Use Only) .—_NORTHAMPTON.MA 01060
Building Permit Number:ski —17.4 S Date Applied: Building Official:
-^�—
SECTION 1:LOCATION
/G KM'444- $f N c rAIRAt.?flt a 0 l ac o
No.and Street City/Town Zip Code Name of Building(if applicable)
34 -)o�
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used ?.ol6'MC, If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair J Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No I'
Is an Independent Structural Engineerin Peer Review required? Yes 0 No I�
Brief Description of Proposed Wprk: Ke I/1.C./_ kitdw s cry/ �Ij--Rso< 't.v IoaeA.Aato 4—
Aki& Z e/tt-ou 1't/t.v 4(( D� 3 A` c, (A/Artk. ?-0 1200 u(4-(-t dive
do wkJr CIO a MF
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business I E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4❑ H-5 0
I: Institutional I-1❑ I-2❑ 1-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4❑
S: Storage S-1 0 S-2 0 U: Utility❑ Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB CI IIACI IIB ❑ IIIAO IIIB 0 IV VA 0 VBO
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public I$' Check if outside Flood Zone i Indicate municipal 9, A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system❑ required pil'or trench or speci y:
permit is enclosed 0 rd
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission RevierZ Process:
Not Applicable% Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 9, Yes 0 No p0
SECTION 8:CONTENT OF CEIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
City of Northampton
`�yf.�l�IfrJi
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
, 212 Main Street • Municipal Building
�*—= Northampton, MA 01060 •
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any•Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11.Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Po'9411-,e 5 l 6 f-lAt fi-e Sfi L) 0(414a ikt?4-o 0/06 d
Name(Print) No.and Street 70 Ind
City/Town Zip
l�o}o
Property Owner Contact Information:
- zst1SF 0_40\.cam,,,
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
} 4-��th.,4,1_ te eig lowt- (rq,tviitt #&Rt 01034/
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this buildingpermit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
-c,vt. 94at..c-(t, N
Company Name
torte-�- ckA4 0?577 9'
Name of Person Responsible for Construction License No. and Type if Applicable
t,Z9 `ovu5- /c A (9�2/lv'`� - ()to
Street Address y Pi'( City/Town C 1 -r State Zip
/ / 1
Telephone No. (business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be compl:ted and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buil• g permit.
Is a signed Affidavit submitted with this application? Yes No CI
SECTION 12 CONSTRUCTION COSTS AND PERMIT E
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6) =$
1.Building $ 'Ss-coo r
Building Permit Fee=Total Construction Cost x Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $ ccy�hr�--C
4.Mechanical (HVAC) $ Note:Minimum fee=$O'' (contact munici.ality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ '3 5-d U ' ; (contact municipality)and write check number here i
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information con . ed in this
application is true and accurate to the best of my knowledge and understanding.
"4_ itc3Y7 s?G7, I
Please print Ind sign name 6 U Title /� Telephone No. Date
\2 'mil Lite kiv_ fitilkt ,t4./) tY'U)T - fr6 AIr 7 '. 4t1ic0al
Street Address City/Town State Zip Email Addres-
Municipal Inspector to fill out this section upon application approval:
Name ' Da e
i -
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Massachusetts f' ''
fir..
DEPARTMENT OF BUILDING INSPECTIONS
v. 144 212 Main Street • Municipal Building
r ,r Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 1S0A.
The debris will be disposed of in:
Location of Facility: V ACtey jZe. yCI1/Le rrksuct kiQ
The debris will be transported by:
Name of Hauler: vt < Cdn5 FF'vtho
Signature of Applicant: Date: to- -
.r- .,
• The Commonwealth of Massachusetts
:.,
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
wirstmass.govidia
Vs oikers't'ompensation Insurance Afridas it: BuildersiContractors/ElectriciansiPlumberN.
II)HE HEED WITH l'Iiil l'ERNII 111.7.+01;AUTHORIT1'.
Applicant Information Please Print Legibtv
Name 4 B us uirs_VOTamitttidn.1 ndnidual ...,_...,-De...v 4,,..c....,,, C--c:77-2,-A r„„c.4_s_%,,iv (iv
/ \
Address: l2-.7 4er cAerz5 i -t,. .. _. a —
.,. .. ,
City/State/Zip: 6 cc(it.V c,t(4-- RP,- C) _03171 Phone#: lit 3 'I 7 f?' ?e7
Aft yini an rambled?Check t iippreprinie add: r
Type of project(required):
l. -1111:1 CrIErkl,yer With , 3 _...„.....),.0.6 g.,,,d,.,Ttdr....6„„0 I. 7. Ei New construction
sok proprietor or partnership and have no en-mkt:sem worhum for rue in K. 0 . emodeling
,i.
any capacity.[No workers"comp.assurance ram:roil
9.. 0 De-rmilition
.SE:i I ant a homeowner doing all short.myself[No workem'comp.insurance remitted.)'
10 EI Building addition
4.E)i sia a homeowner and will be hirinE contraemrs to conduct all Audi on my property. I will
ensure that all Coniniclue either have wtsricrs'commeniamm insurance in an sole II El Eloctrical repairs or additions
proprietors with no cmployinN,
110 Plumbing repairs or additions
A I am a i...crieral contractor and I have hired the sub-contractors listed un the auadied sheet
1 3.0 Roof repairs
These sub-eolarbeior,have employee&and base workers camp.insurance).
14.0 Other
6.E3 We are a emporamon and;4 otlisms have cXerti.svd their nen of exemption per Wit.e..
I'.'•2..:.sit 4 i.and.N.,:ha‘cnr.east,los ecs.[No'O.ea kers'comp.insurance required.]
krzy appltcant 1113:Litt,..1 11/4!:,.011:11.z..t tb..IA out the Wistion bell.*sbCnving thus wuriaN'compensation policy information,
t Homems nen 14 In,sutural this affidavit indicatirry dn."21t.doing all work and then true outiade comnictraes„mtai submit a nevi affda it Itattitwitty such.
Contractors that cheek din Ism.rturia artar..-hed an uldniornd sheet&bowing the name of the sub-contractors and mate whether or not those tiliitie8 have
ciiirloyee. 11 the 5 ub-contrictim4,base employ Lscs.they mug r...,,,d their voirker,''Wrap.policy number.
I am on employer that is providing wtirAers'compensation insurance for my emplayees. Below is the policy and job site
information.
Insurance Company Name: IA-- ct,..e. .-t... IX —
Policy#or Self-ins.Li .#: ZOO ( 'u (.435- Expiration Date: 7 1 1113
Job Site Address: /6 frt-A-c-Ve,4- S 4--re.e-4- citv,statezip:.i.Jort(67..p.14 Pico:a i'1-tr4
Attach a copy of the viorlters'compensation policy declaration page(shoving 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.(10
anitor one-year imprisormient.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.{.10 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 cerr tide-rihc pi ' wit!rwilaltie. of perjury that the information prodded above is true and correct.
Sit:mature: Date. 0-LU_I_Z__: ,____
Phone : 4// 3 i/2 ?6 q/
.. _
Official use unit. Do not write in this area,to he completed by city or town(Aft-trial.City or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
(.Other
t °nue( Person: Phone#: