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30D-017 (3)
BP-2023-0374 43 LADD AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30D-017-001 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-2023-0374 PERMISSION IS HEREBY GRANTED TO: Project# 2023 PARTITION Contractor: License: Est. Cost: 4000 LEARY BUILDING COMPANY CSL104806 Const.Class: Exp.Date: 02/17/2024 Use Group: Owner: LLC GLASS LAKE PARTNERS Lot Size (sq.ft.) Zoning: Applicant: LEARY BUILDING COMPANY Applicant Address Phone: Insurance: 13 GLENDALE WOODS DR (413)336-2611 SOUTHAMPTON, MA 01073 ISSUED ON: 03/29/2023 TO PERFORM THE FOLLOWING WORK: BUILD PARTITION WALL IN STORAGE AREA 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: (LttiL l ULiel/ Fees Paid: $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner (-NJ The Commonwealth of Massachusetts .I i r Office of Public Safety and Inspections z. `,{fty� Massachusetts State Building Code(780 CMR) Q'`° Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Numberje2D2- Y Date Applied: Building Official: _ SECTION 1:LOCATION i l LADE M . N oR-nkPMc'11iN 010‘b Pialag-\!A'LL-e.'1 EXi(LcTc No.and Street City/Town Zip Code Name of Building(if applicable) a b-Oil-on i 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 14 Repair 0 Alteration IS 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 Is an Independent Structural Engineering pfer Review required? Yes 0 No Brief Description of Proposed Work: Vputua Qk2-r.oJ) U A t_tr g eu S in pc..& A 4 SECTION 3._COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADIT-I9 ,OR ----'--—____ CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Inve�fi ation an4Evaluation is enclose R 34) ❑ Existing Use Group(s): — Proposed Use Group(s): S fON 4:BUILDING HEIGHT xi . Proposed No.of Floors es(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-1g F2❑ H: High Hazard H-1 0 H-2❑ H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 1-2❑ I-3 0 1-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as ap licable) IA 0 IB 0 IIA 0 IIB ❑ IIIA 0 BIB k IV 0 VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Su ply Flood Zone Information Sewage Disposal: Trench Permit Debris Removal: Public Check if outside Flood Zon j Indicate municipa A trench will not be Licensed Disposal Site Private 0 or indentify Zone: or on site system 0 requiredgor trench or specify: pennit is endosed 0 Railroad right-of-way. Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable' Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No Yes 0 No CISECTION 8:CONTENT OF CER FICATE OF OCCUPANCY Edition of Code: R Use Group(s): Type of Construction: 3 8 Does the building contain an Sprinkler System?: .d A Special Stipulations:,"/A Design Occupant Load per Floor and Assembly space: i SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Mtia A00,iso),-) Zito S T —i,o.0 Pb AMrt�2s; / AAieg 0/001 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: g.U,/t 2 - - tic- V61- 25-73 QERu.)Suot'S Q 6etall, ' Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: �^ T r�it Wt tA4L 13 G/.eNO*tE 1.4-ps 0,z_ cJOvI�tPT M oN It Oro 1.1 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 Pr fessibnalgesponsible for Construction Control(the professional coordinating document submittals) I Name(Registr ,v 11.1 N.T�e e No. dress Registration Number Street Address Ci own State Zip ' ine Expiration Date 10.2 General Contractor Lam\( b)I Lb,Nt, (,oMpANL Company Name t tit L.1c2y CS L. I I)y 60c, Nt(.,# 'globs- Name of Person Responsible for Construction License No. and Type if Applicable I' G LENOAtk M(aotS CRAVE 5o -IAI n1 VA--- 61043 Street Address City/Town State Zip 41S-A2-611 - WA. .cb Telephone No.(business) Telephone No.(cell) e-mail d ess 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 a issuance of the building permit. Is a signed Affidavit submitted with this application? Yes No D SECTION 12:CONSTRUCTION COSTS AND PERMIT Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ y Ooo Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ . . appropriate municipal factor)_$ . 3.Plumbing $ — 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to #/00, 6.Total Cost $ 1000 (contact municipality)and write check number here 2$ZO SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby att nder the pains and penalties of perjury that all of the information contained in this application is true and accurate to the st y e and understanding. fi to-uc A Level ° Patsih T 4413 -Vt,- 2611 3•2.q'z3 Please ri t and sign nanie Title Telephone No. Date 1� GLl=lvALE vrao ta_wk, SOtx 4AM a i o1 Street Address City/Town NIA e Zip Email dress J Municipal Inspector to fill out this section upon application approval: t ✓4 9 /,,3 Name Date From: To: Johnathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 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, I request that you grant a modification to waive the requirement for construction control of the project at because the work is of a minor nature,will not affect structural elements, health,accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, 0 R / 3/Dy D. Timot y A Lear President Leary Building ompany City of Northampton Massachusetts .7 -- e,-, fw z. ti ' , DEPARTMENT OF BUILDING INSPECTIONS St ' .J 212 Main Street • Municipal Buildingc•. \< ,' Northampton, MA 01060 SI 0 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: QAU-eyCA-1/0(4 Location of Facility: CSTVAN'S izu J PM OIU21- The debris will be transported by: 1 Name of Hauler: EU.LbtOcA C0 0 Signature of Applicant: Date: -T,I -I,S The Commonwealth of Alassachusetis , rob=.=_• Deportment of Industrial Accidents 1 Congress Street,Suite 100 Boston. MA 02114-2017 -.. •- cl.r,' ... -. •* www.mass.gorltlio Workers'('ampensation Insurance Affidavit:Builders/C0nsractorsiEleritridanstPlumbers. TO BE FILED S I til 1 ID PERMI El tr44.:411.111()IUTV. Applicant Information least Print tropic Name 4 EitudoessiOrennizationilnelivichialr, uia Address: /3 6/.4,./p4w. 60004s DR_ City/State/Zip: Sarrirktitp-ro.A., M,4 0(0-43 Phone#: ('43.) 334, -249i/ Are no so eitaphryert Clerk ihr appropirtott but: Type of project(required), ' a am a eln*Yer''6111 ---eniP40YeetiMal onNer pain }' 7. CI New construction 20 I ant a sok proprietor or ponnership and have no employees"nickel fur me in S. rg Remodeling any capacity_[No worketh'calm.insurance required" 9- • . 301am a homeowner doing all walk myself.'No workers'comp.imitoome requaredl' * sham i 0 ci Building addition 4.0 ism a homeowners:1,i Iv 3ii Se hiring contractors to conduct tilli work on rll'y prirperty, 1 wtll erasure that all crhttra.-tuni caber hair workers compensation Insurance tit are sole II JO Electrical repairs oradditions prupnetuft uilh nu ernpluve,m, 12.0 Plumbing repairs or'additions $ lain a senend curio actor and I haie hired OK mb-easuseitirs Lad ma the au:ailed ibett I 3.[]Roof repairs [here sub-eourraetoni laic employees and have wurktos'rump.Otilairlirlf:C." 14.0 Othei 6 i'l We uw a c-orporation and as Urflet.T%have ezmetsed thee min of exemption per MCiL e„ 1 2,§li 4 I.and 11,e have no eriaplove .[Nu%writer,'%Amp.41112mi:we required.' "..,-;.ny applicant that cheeks box a I mint aho till oul the section below showing their workers'compenantion'pul icy Infonnation 'Florneureracm who palm'i this 4tYrallaril truireatrnig thine are thinto all work and then hui.outside cmitracton mutt saheruit a new affralMilindialas such Contractor,thst cheek this box must attached an Aldli Iona]i6eei shim in UN:MAIM of the mtb-eusaraetun arid'tate whether re nut[hair emstiet haw on[,1eer. U the tub-condrarehart,have oripluyets.they must prrnhle their wurken,"eArtnp.pulp:).ninnher.. 1 ant gin eMph).$•er that is providing;cankers'compensation insurance far My eMpitry,tes. Below iA the polity and<lob sire infiv million. insurance Company Name: • - Policy#or Self-ins.Lic.#: Eltpire lion Date: Job Site Address City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number mod expiration date. Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine up to 51,500.00 anctior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 Cali LI . . NI A JO . ' pi per,ur-thin'lir i,i r;f,'madam provided above is owe and corret.L Signature; — Date:, Phone It(1/2) S "2(0 I . Official use only. Do nor arise in this area.to he completed by 4:ity or town officiaL City or Town: Permitilicenve A Issuing.1uI hority(circle one): I. Board or Health 2.Buildittg Department 3.City/Town Clerk 4.Electrical inspector 5. Plumbing Inspector 6. Oilier i ( rioted Person: Phone.4'. _.. 'FORM 153 The Commonwealth of Massachusetts DIA Use Qmy , Department of Industrial Accidents 'RjVLD Office of Investigations-Dept. 153 1 Congress Street,Suite 100,Boston,Massachusetts 02114-201 • http:!/www.mass.gov/dis Inv t./SWO ID#: AFFIDAVIT OF EXEMPTION FOR CERTAIN CO ORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, §1(4) by adding the following paragraph: "This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation.Notwithstanding section 46,these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C." Pursuant to 1vi.G.1,. c._152.,.§1(4) as amended, 1tWe the undersiglird officers of: Leary Building, Inc. 1039 East Mountain Road, Westfield, MA 01085 (Name of Corporation and Address) each holding at least 25% of the issued and outstanding stock in said corporation,do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further,I/we the undersigned do understand that, should the above-named corporation hire or have in its employ any employee(s)in addition to the undersigned corporate officer(s)or director(s), "id corporation is required to obtain workers' compensation coverage for the employee(s)as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated abve and 1/we have checked the appropriate box below my/our name(s)indicating my/our desire to be eaRnpt.or not to be exempt from the provisions of M.G.L. c. 152. r— Signed er th pal enalties of perjury: ° { Timothy A. Leary, President 0711.5/2014 .,., L Sign re Print Name&Title Date(mm/dd/yyyy) ❑✓ I w h to exe e my righ o exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) ❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd!yyyy) ❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Instructions on back. Form 153—7/2010 MASSACHUSETTS DRIVER'S LICENSE ' NOT FOR FEDERAL ID . _ ' ,••' 10103/2021 S40956942 ' _ 0211712026 02/17l1984 '-,U1SS RES1 I-tJD t ► D B NONE F LAf7Y r —,. , TIMOTHY A xI4w ,13 GLENDALE WOODS DR SOUTHAMPTON,MA 01073 9476 "Iw.� EYES HAZ *� I 4Ex M xc1 8'•01" no loom ri#h.na,zarn,a 02/17/84 1 Commonwealth of Massachusetts 1 �} Division of Occupational Licensure Board of Building Regulations and Standards Constort Svisor CS-104806 ..• "" _ s pires:02117/2024 TIMOTHY A VAR . 9 1.m. l 13 GLENDALE SOUTHAMPr9N '♦ �' ar .rOtte.4.03 il Commissioner 3-n, ,;. Ueiii At. Ti•IE COMMONWEALTH OF MASSACHUSETTS Offit,e of Consumer Afiaits&Business Regulation HOME IMPROV IJT CONTRACTOR TYP,g oprdoration kvimtritiort t E=_xpiwjgn 181* r i., '.ti0/14/29,24 LEARY BIIILDINta,INC.=:, 4 ", ` i- TIMOTHY LEARY '' • 13 S�LENC'ALE WOODS OR ", • y,4,,,,,if a '4. 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