32A-255 (165) BP-2022-1500
36 KING ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-255-001 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-2022-1500 PERMISSION IS HEREBY GRANTED TO:
Project# 2022 WATER DAMAGE Contractor: License:
Est. Cost: 48000 PIONEER CONTRACTORS 017890
Const.Class: Exp.Date: 01/19/2024
Use Group: Owner: MANANTO HOLDINGS LLP
Lot Size (sq.ft.)
Zoning: CB Applicant: PIONEER CONTRACTORS
Applicant Address Phone: Insurance:
PO Box 1145 (413)626-7267 WCC--50059570120018A
NORTHAMPTON, MA 01061
ISSUED ON: 11/21/2022
TO PERFORM THE FOLLOWING WORK:
REPAIR WATER DAMAGED CEILINGS
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 VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: tou
t
Fees Paid: $336.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
-__-!"-__ " 'the Commonwealth of Massachusetts
(V/I E Department of Public Safety
aq, N O V 1 6 2022 I Massachusetts state Building coat f�c:�)
Building Perm t Application for any Building other than a One-or Two-Family elling
__ ! (This Section For Official Use Only)
Bu ildnmg Pem it Nmmmber:.A/�,ilgr�'• Date Applied Building Official
- 1
SECTION 1:LOCATION(Please indicate Block*and Lot I for locations for which a street address is not arailable)
3` V- •` (• Mtn eN ocbC,o Eike\ Voy p\rv— 4 2-5-5-
No.and Street i City/Town Zip Code Name of Building(if appbcaUe) Map an/Parcel
- SECTION 2 PROPOSED WORK '
Edition of MA State C'oe used C► "" If New Co stmrctiton check here ❑ or check all that apply in the two rows below
Existing Building arj Repair Fell Alteration ❑ Addition❑ Demohtion❑(Please fill out and submit Appendix 1)
Change of Use 0 Change of Occupancy 0! Other ❑Specify.
Are building plans and/or construction documents being supplied as part of this permit application? Yes No
Is an Independent Structural Engineering Peer Review required? (l Y s 8 o, 8
Brief Description of Proposed Work: `t - C aoblArele2 1,1 L tex- ys�,
v•,- ce 6( Va.i..4As ri/.�ss
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDTION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION t BUILDING HEIGHT AND AREA j
Existing I Fttoposed
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❑A-2❑Nightclub ❑A-3 ❑ A4 ❑A-5 ❑ B: Business ❑ E: Educational ❑
F: Factory P-1 F2 H: High Hazard H-1 ❑ H-2 U H-3 FM LJ,,,,�S
I: Institutional I-1 is,
❑ M Mercantile 0 1 R: Residential R-1�R-2 ❑R-3 Er
-4
S: Storage S-1 ❑ S2 ❑ U: Utility ❑ Special Use 0 and please desaibe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ ! HA ❑ IIB El1 MA ❑ MB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 11L0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Try PeEri5 Removal:
Public 7C Check if outside Flood Zane /mica A trend'will not be Licensed Disposal Site
required or Private or indentify Zone: X or an site system l smd' or specify:
permit is eclosed VCAAy
MA Historic Commission Review Process (�'�V~C`
Is their review completed?
Yes O No
SECTION S:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: 'l ' Use Group(s): Type of Construction: Occupant Load per Floor: ,
Does the building contain an Sprinkler System?: 'C5 Special Stipulations:
Is your project within 100 feet of any wetland? Yes O No IV
If yes,you must contact the Conservation Commission.
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Pro erty Owner
\. . ' \°A-t-L Gs 4 0.b." i ittk t")/h Cv ZS
Name(Print) o.and Street City/Town ip
Property Owner Contact Information:
M 5e„,t. arikIb ' lfi -SS54-3(OD
Signature Telephone No.(business) Telephone No. (cell) e-mail addr
If applicable,the property owner hereby authorizes
gtm�S4FAI' C o-4s P' 0 ' E.0, 11(-{j to - -G - AAA lob (
Name Street Address City/Town State p
to 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 2)
(If building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check herefland skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. E-mail address Registration Number
Street Address City/Town State Zip Discipline iration Date
10.2 General Contractor
Company Name ,, n
T- 0. ;A C6, x-w— w(i( Yl * GC-0/78co
Name of Person Responsible for Construction Signature License No. and Type if Applicable
?.(>. . t 14.1 ?vd� -- [AA. a(D6r
Street Address 2,�r' City/ wn StarZip /
1113' -S i Ni _4Z4—'12/,7 lrnAeelY.nvti Telephone No.(business) Telephone No.(cell) e-mail address I
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 , ust be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the. 4 ce f the building permit.
Is a signed Affidavit submitted with this application? Yes itNo
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 214 i11C7p Building Permit Fee=Total Construction Cos rt here
2.Electrical $ t 3, --- appropriate municipal factor)=
3.Plumbing $ (i lr?91
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ 211r1j.-- Enclose check payable to
6.Total Cost $ S i (rerp•` (contact municipality)and write check number here sV b)}.
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 contained in this
apph�cuatign is�accura to the/�bes . knowledge and understanding.
G .6 re yl3' 26'77 7 1il'%i
Please print and sign name Title Telephone No. Date
f•D• lette Lit-tJ/ tiA ava&1
Street Address City Town state Zip
4 4 Il
Municipal Inspector to fill out this section upon application approval: ,• i W " - \‘ ;Ii;
101/3,
Name Da e
�
....—.._._ The Commonwealth of Massachusetts
pi =p� '/ Department of Industrial Accidents
1 1= n I Congress Street,Suite 100
I;i'- 4 Boston.MA 02114-2017
MM.mass.govidia
Workers'Compensation lasurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AtiTHOR T .
Applicant Information Please Print LealOily
Name IBusiness'Organtratioiv1ndividual}: l /Eiô
v r . CocAddress: C.° . 1'3 t) (
Ci[YlSlalerZip:..A117.:C.. r _._M z_ Phone#: 4113 'S16r(3-Lt't t
Are you an emptuyer?('Peek tie p t box:
Typed project(required‘:
i. 1 am a crapkr.ver uith .. ..... .cmpIor a(fiat and-or pint-timc)_• 7. Q New construction
_D 1 am a sole pruirsche or partnership and have no crmiskrsces working fur tzar at Rs Retriodeling
any capacity.[Nu workers'comp.insurance required.;
30 I ant u&imo mmu doing all work myself.{No wadwsrs'comp.noun ace moved.)•
9. 0 Demolition
1.0 I am a homeowner and will be hiring aontracltxs to conduct all work on my property. I will to 0 Building addition
enure that all contractor either base weaken'compensation insurance to arc sole I I13 Electrical repairs or additions
ptuprvcwn with no employees.
i2.0PIMA repairs or auditions
5C:1 I am a general contractor and 1 has e hired the sob-contrawn listed on the studied sheet. 13.0ROOf repairs
These subcontractors base employees and hate*inters'comp.insurance.'
6.0 We any corporation and its officer&have exerriscd their right of exempurm per MU c.
14.O Other '
l52§It41.and we hate no employer [No worker'comp.insurance requited.[
':arty applicant that chocks bus=I must also ratan the section below showing their workers'compensation policy information.
4 Ihnneownen who submit this affidavit indicating they are doing all work and then hire outside centractun snort submit a new affitta%it indicating such.
:Contractors out check this box must attached an additional sheet shrew ing the name of the suh-.•untr ctun and state whether or not those entities iustic
employees It the sub-cemtracttrs have employee's.they must pins We their workers'comp.whey number.
i am an employer that is providing worbers'compensation insurance for my employees. Below is the policy and job site
information. 11J�� ' - �//
insurance Company Name: /�.f. .1c1 1��0' In�s ^� 5O •
Policy#or Self-ms.Lie.#: w Cr--- j— ' O 7 Sel 51 - fog( A Expiration Date: 1A30\z —
Job Site Address: 3-, # 'SA• t M Cit)s'State Zip: l-lltrc Qa � M
Attach a copy of the workers co' policy deic�l!<t atioa page(showing the policy number and a ration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to$1 .00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 0.00 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 an r the pa' a ,,, sallies of perjury that the information provided above is true and correct
Sirenature: N4 'I
Date: '/ d/2,-"Y
Phoned: y (3- igZb— 2.47
• Official use only. Do not write in this area.to be completed by city or town official.
' ('its or Town: Permit/License#
Issuing Authority (circle one):
I. Board of Health 2.Building Department 3.('ity,Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6_(kher
Contact Person: Phone#:
City of Northampton
°7 -
e Massachusetts 4'Ss 1• 'c,`
i;
mi 1.
" DEPARTMENT OF BUILDING INSPECTIONS a
' 212 Main Street • Municipal Building �J�� ai
Northampton, MA 01060 _ �:�ac
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:
Location of Facility: IV)UQ l (Jv
The debris will be transported by:
Name of Hauler: U5 PI 29.0ACAVI
Signature of Applicant: fiCk Date: d1/D/zv