31A-044 (2) BP r 022-1359
267 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31 A-044-001 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
Permit # BP-2022-1359 PERMISSION IS HEREBY GRANT S D TO:
2022 EMERGENCY LIGHTS &
Project# SMOKE ALARMS Contractor: License:
Est. Cost: 4000 JAMES MAILLOUX CS-081694
Const.Class: Exp. Date: 10/16/2023
Use Group: Owner: LLC 267 CRESCENT STREET
Lot Size (sq.ft.)
Zoning: URB Applicant: JAMES MAILLOUX
Applicant Address Phone: Insurance:
221 PINE ST SUITE 160 (413)585-1592 WCT0721Q
FLORENCE, MA 01062
ISSUED ON: 10/20/2022
TO PERFORM THE FOLLOWING WORK:
INSTALL EMERGENCY & EXIT LIGHTING IN COMMON AREAS & SMOKE/CO DETECTORS IN EACH A"ARTMENT (6)
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 VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 1 3-)
` I
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
2 0 022 Office of Public Safety and Inspections
I( r Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
[ rut DING,INSPECTIONS
u- THAMPTONNA 01060 (This Section For Official Use Only)
Building"Permit Numb o�� •/35gDate Applied: Building Official:
SECTION 1:LOCATION
No.and Street City Town U Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition❑ Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other iSpecify: L/G a t"!r-
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑
Is an Independent Structural Engineering Peer Review required? Yes 0 No Cl
Brief Description of Proposed Work:
,...271,51;l/a 1 v F roc aiK
( ,41nt 4 /Ta>/1 5,1(eiAV
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 0 - E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1❑ H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 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 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 VB 0
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 0 Check if outside Flood Zone 0 Indicate municipal 0
A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system 0 required 0 or trench or speciry:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE 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
:7-d, Massachusetts ,-
DEPARTMENT OF BUILDING INSPECTIONS
#ir ;;;,` 212 Main Street • Municipal Building
tr+- Northampton, MA 01060 y
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
1 SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
I
'+vim lerip'7(c-r1
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
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 building permit 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 0.
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
fMC I r4,n i GL.-.,,_^4.
Company Name
;�/s-tes" /ii.,//„./.`L--- C o i '
Name of Person Responsible for Construction License No. and Type if Applicable
.Y-�1 7'no ,s /(v n'01-t eticE A,14 p/UG Z
Street Address City/Town State Zip
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 completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor r f ^ "
Item and Materials) Total Construction Cost(from Item 6)=$ 7 " O`er
1.Building $ Building Permit Fee=Total Construction Cost x Insert here
2.Electrical $ `'
' O(7 J — appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$$//00 (contact municipality)
5.Mechanical (Other) $ , Enclose check payable�to /
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By enterin name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
applica ' is e a ate to the best of my knowledge and understanding.
d w-1. ,. - e/IY CIS /r2-
Please print and sign qaJne _4..... (-�— Title Telephone No. Date
-5t 1 A h• sr,- 7�4 L o /6J r'1 /c h L e /►4-✓O 9I 01 Z htQ,//. eke 6'4 6A-4",
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: /14 -- g-za"2eZZ,
Name Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
.ram:
City of Northampton
, .
" L Massachusetts � .
41
• DEPARTMENT OF BUILDING INSPECTIONS 5 c,
+� 212 Main Street • Municipal Building „-;t,
,, Northampton, MA 01060 -1,")g1,
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 150A.
The debris will be disposed of in:
ZZ') Ciee a IA L---)
Location of Facility:
The debris will be transported by:
�/ r- c( 2L
,/ )Name of Hauler: C)il �I / S/,
Signature of Applicant: l Date: /✓ z 'z
•
id!i\
The Commonwealth of Massachusetts
,It Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA02114-2017
www.mass.gothila
1‘inters'Compensation Insurance Affidavit:BuildersVontracturstElectriciansiPlumbers.
10 BE FILED WITh 11W PERMITTING AUTHORITY.
Annlicant Information Please Print Lreiblv
Name aittsinct"OrgantzationInclividual /::11/11Le5 (1.a. illdL.,
Address: 2 2- Fi 12 4 l‘
City/State/Zip: ,I-1; e h_t_c il4A 0) 1-)— Phone q )-5 `,2._
Arc yam sa employer?elleA the appraprtait hoc Type of project(required):
ant a employ a with 0- eiriployers(full miter part-timer' 7. New construction
1 arn prom-Deux ur path:unship wad tout no employee,working tot me to K. c3 Remodeling
any capacity.[No worierx*comp.mum= requiring
. El Demolition
3C]I an]1hananoner doing all work myself.1No w-orkers."comp.insinimoc requand j
10 0 Building addition
4.0 I am a homeowner and will bin hiring curaraetors to ivadati ail work on nry property. I
101-.3L131:that aif Curktrailtn%either haw workers'compensation nourance of SVC aide 11EKlectrica I repairs or add al..
proprietor,cards no ernployt.vic
12.0 Plumbing repairs or addition:.
:41:1I am a peneral contractor and 1 hour hued the sub-cantraetor,bitted on the auadlud litct
1 3.0 Roof repairs
The*:,ub-eontracku,have citirklyte5,and Ixas.e worker/4 comp.inkituricc.:
14.[7.0 Other
hip V.e are a oorporanur,and 3b officer,have cktaviied then right of exiainphon per MCA.c.
I .§1(4).and sk c It. no anployeex.[No worker;comp..imam:ince required.1
*Any applicant that...-heels b.i al must also all out the section below%bowlike thin VaIrkt:T!'COmperualiOri rot
*ihnneownerx s.bo submit this atTita',ii indicating they are doing all work and then hire outside comm.-tors most subirrin a no;affiiiax it indiealling mach.
k.'untnickirs that cheek this boa maxi attached an&Malaria.'%him showing the name of the iali-corttractora and stare hethcr or not theme etatitie have
employee% If the to,b-contractuts lure employ ue,.they mutt provide-their uorker,' poltey number
I am an employer that is providing worAers compensation insurance,for my employer,. Below ii the futile'y and jab site
information.
Insurance Company Name: NA 11 ail L Oro n ot
Policy#or Self-ins.Lie.#: 1N C or70Z1 Expiration Date: ki/siz-
Job Site Address: 0T6 C $r; CityState'Zipk-tt•ii 0
Attach a copy of the workers'compensation polic declaration page(showing the policy number and expiration date).
Failure to serum coverage as required under MGL c. 152.*2:.SA 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 iolator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage entication.
Ida hereby certif.' n r the, zIpinuliirpenalties of perjury that the information provided above is Mei r#iilt roreLt.
SiVnliEUTC: Date: /a/7/2"2-
Phone#:
Official use only. Do not write in this urea.to be completed by city or town offic lot
City or Tovin: Perniitil.icense a
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5. Plumbing I nspecti ii
6.Other
ContAct Person: Phone#:
'
x Initial Construction Control Document
0 j �
To be submitted with the building permit application by a
t ' Registered Design Professional
i
'+ for work per the ninth edition of the
Massachusetts State Building Code, 780 CUR, Section 107
Project Title: Date:
Property Address:
Project: Check(x one or both as applicable: New construction Existing Construction
Project description:
ILA Registration Number: Expiration date: ,am a registered design professi nat.and I have
prepared or directly supervised the preparation of all design plans,computations and specificati s concerningr:
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and be -el such plans,
computations and specifications meet the applicable provisions of the Massachusetts State g Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and a that I (or my
designee) shall perform the necessary professional services and be present on the construction ite on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, s ples and other
submittals by the contractor in accordance with the requirements of the construction d ents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as app ble.
3. Be present at intervals appropriate to the stage of construction to become generally f:. • - with the
progress and quality of the work and to determine if the work is being performed in a • er consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions •f 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)togeth: with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a 'Final Construction Co. 1 of Document'.
Enter in the space to the right a"wet" or
electronic signature and seal:
Phone number: Email:
Building Official Use Only
[ uildin Official Name: Permit No Date:
Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised If'other'is
chosen,provide a description.
Version Ol Ol 2018
4
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.)
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.