32A-081 BP-2023-1733
34 GRAVES AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-081-001 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-2023-1733 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2023 Contractor: License:
Est. Cost: 31787 ANDREW GANSSLE 109678
Const.Class: Exp.Date: 09/12/2025
Use Group: Owner: LLC 34-36 GRAVES AVENUE
Lot Size (sq.ft.)
Zoning: URC Applicant: ANDREW GANSSLE
Applicant Address Phone: Insurance:
3 FRUIT ST 4138850315
NORTHAMPTON, MA 01060
ISSUED ON: 12/13/2023
TO PERFORM THE FOLLOWING WORK:
INTERIOR REPAIRS
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:
s ?.T,
Fees Paid: $483.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
BECi
``' T23
he C I m onwealth of Massachusetts
:� ice f Public Safety and Inspections
�'\��t( a� assach i setts State Building Code(780 CMR)
p T,pF bUILDTNA INSA E1GT
Bu gP ion for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number.?' / /3 Date Applied: Building Official:
SECTION 1:LOCATION
3u cj.4ocs gokTF*m PToN 6(6c0
No.and Street City/Town 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 ❑or check all that apply in the two rows below
Existing Building Repair 0 Alteration IV'
Addition❑ 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 0
Is an Independent Structural Engineerin Peer Review required? Yesn 0 N ❑
Brief Description of Proposed Work: PAD E T .IOQ WALL so AS TO F- R 3
STALE CALk pI ATF Li EKE riV ac.-mac PE,v try
CALK £ Zs74-01/ V-1 �f t1�N li pt.-44/es so 045 -ro sior 4 FTS
(TANG $t er Pvtk I}ND APPLY T RL r i 0 r eqer
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 ❑ 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 0 H-2 0 H-3 0 H-4 0 H-5❑
I: Institutional I-1 0 I-2❑ I-3 0 I-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 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA El IB ❑ IIA 0 IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 VB
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 specify:
permit is endosed 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:
4 7 Imo'`'
IIIIP
City of Northampton
7` �„' Massachusetts
N .t
f
DEPARTMENT OF BUILDING INSPECTIONS I
-�. -;. 212 Main Street • Municipal Building
ea.
—"` ^ 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
4b
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Own
Nil Cc,�-ne,5 a10 bel i ont Faced. L kKta-Q,Ik 11rofwai MD a(693
Name(Print) No.and StreetCo.Acf*(03 City/Town Zip
Property Owner Contact Information:
- - 110 -3c5- eta? - KA F$ 0 ((CEA. Coo/
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes: ^1
AAarew G 1 (C, 3 i r-!h 5/L A.)oc mp 6!V co
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 D.
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
Ana yc Ck t4
Company Name
Pnek svle Cs - 1016 ?
Name of Person Responsible for Construction ( License No. and Type if Applicablen
3 r 5ke .4 Nar�...• 1 vn ,/(/!s- O/Old
Street Address City/Town State Zip
- - 4/3 _615C44V55te ea 6144a _cam
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 issuangyphe building permit.
Is a signed Affidavit submitted with this application? Yes D No
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials)) Total Construction Cost(from Item 6)=$ 3,t l )7
1.Building $ 9 0d, 06 7100 Building Permit Fee=Total Construction st x o sert here
2.Electrical $ iel 10.16 , L5 appropriate municipal facto =$ 4 g43 .
3.Plumbing $ q 6 a
4.Mechanical (HVAC) $ Note:Minimum fee=$ (co ity)
5.Mechanical (Other) $
Enclose check payable to
6.Total Cost $ 31 1 D f, (contact municipality)and write check number here _L D z
SE RE 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
application is true and accurate to the best of my knowledge and understanding.
An()ow 6.4(4 ,-- -.._, GC 03 _ 91l5- 0715 I V . 3
Please print and sign name i Title Telephone No. Date
3 1r s:4- St— Warkhi,.y(.n _AdA._ 6(o,o a Ga..AN5 56,_E_nq .._civic co•-t
Street Address City/Town State Zip Email Address
g lit I t
Municipal Inspector to fill out this section upon application approval: ' �� ' ' ‘ f/ a3
Name Date
1
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK _
FRONTAGE
I
City of Northampton
Massachusetts 47 s''t
1,1 A
I ` DEPARTMENT OF BUILDING INSPECTIONS ;t
IA
. 212 Main Street • Municipal Building
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 150A.
The debris will be disposed of in:
Location of Facility: UG l ie1
The debris will be transported by:
Name of Hauler: lilt if-tQOct2.,> 6,0 e Ce.
Signature of Applicant: Date: ((/)0/a3
The Commonwealth of Massachusetts
Department of Industrial 4 ecidents
• _
1 Congress Street,Suite 100
•••• Boswn,MA 02114-2017
www.nia.ss.gotldia
-
1.%pikers'('onipensation Insurance Affidavit:illiiklers/ContractorsfElectriciansiPlumben.
10 HE FILED WITH 111E KAM,'TING AtrillORITY.
Applicant Information Please Print Leitibl%
Name ju reanuatton,Individual): 4iir6,arfte
Address:
City/State/Zip: Phoneqi; 2rg,,5 03/5
Are you an Check tat appropriate hos: Type of project(required):
la i Ant lo!,er _cmployetx(fall and,e1 7. c3 New COnStrUCtiOn
2 in a sole penman'or partnership anti have tio crrytilars winking for me in K. Gkittr."--Triodeling
unyiapatit Nu*rakers'cutup iftSlOratilt required.)
9. CI Demolition
3.0 I am a hurneounet doing all work myself.I N0 workers'curry insurunix reqthrod.r
10 fJ Building addition
41:3 am a hurnoun.nes and well he hiring etantraelors to enriduct ml *tad:on my property.. I will
ensure that all contra:tura rithtx love rturkers*ournpensalzon insurance in are sole 11.0 Electrical repairs or additions.
proprietors with no ernpluyeth.
I 2.0 Plumbing refrain;or additions
5C:I 1 am a general cuntractur and I base hired the sub-contractors listed on the anachitd
1 3.FiRoof repairs
Thchc sub-contracturs hate eincduyecs and ha...c worker.'cum.inaitranec;L
14.00thei
t...0 Vie are a Col',oration and its oft hat e exercised then right of exemption per MCI
1(41.1.,and n ha.re no employees.f No*Aim'ctrrap.insurance teniined.
'Any applicant that chteks box i mini OltSt)fill out the sectrtni below Yhowing their workers'cornpetharion policy itiformawn
t limancuwners who submit this afrbdas,it intbeaiing they arc doing all work and that hire outside einu=bur mini submit a new athilnt it indientrig such
Contractors that creep this bus Mug attached an additional sheet aborting.the name oldie fub-eranfrackas and state*hater Or nut those entities ha'e
in siX, It the stab-cesnracturs 60,0c cmplu)eel.they=of prix.ide thcir workers comp policy number
urn an Employer that is providing reorAers•compensation insurance for my employees. Be Itt IV is the policy and job Silt'
information.
InsuranceCompany Name:
• Policy#or Self-ins.Lie.ts-: Expiration Date:
Job Site Address: CityiStateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number sad expiration date).
Failure to secure coverage as required under NIGL c, 152.*25A is a criminal s,iolation punishable by a fine up to S1,500.00
and/or one-year imprisorunent.as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S250M0 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the[MA for insurance
radiatecCrrtc verification.
I do hereby certify under the painr and penalties of perjury that the information provided above is true and correct
SI4Tlat Wv. Date:
Phone#: Y/3 °5(5
Official use Only. De''WI write in this area.to be completed by city or town official
City or Town: PermitiLicen se#
Issuinf„0 Authority(circle one):
I. Board of Health 2.Building Department 3.City-if own Clerk 4.Electrical Inspector 5.Plumbing Insiii.ct or
6.Other
(`on tact Person: Phone*:
0
, *),‘, Initial Construction Control Document
I * a
To be submitted with the building permit application by a
f ! 1 I\ 'a
.0
/ • Registered Design Professional
\
for work per the ninth edition of the
.. v- Massachusetts State Building Code, 780 CMR, Section 107
__.
Project Title:3416441 Date: ti/A0/100
Property Address: 3 ci 6,,,„4, 4,,, Ai
eic-414A-Kete 0 44, 4/066
Project: Check(x)one or both as applicable: i---S;;Tconstruction Existing Construction
Project description:
I MA Registration Number: Expiration date: ,am a registered design professional,and I have
prepared or directly supervised the preparation of all design plans.computations and specifications concerning::
Architectural Structural Mechanical
Fire Protection Electrical Other: -r-456,t4/_;on 4- 5.4..2d-rac K..
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee)shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CNIR.Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official.I shall submit field/progress reports(see item 3.)together 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 Control Document'.
Enter in the space to the right a"wet" or
electronic signature and seal:
Phone number: it If-Ye5-ccifs- Email: i4.1/55L,E-Q 6/04r-t-- .C6d-k
, —
Building Official Lisa Only
Building Official Name Permit No.t Date:
Note 1.Indicate with an'x'project desivi plans,computations and spedficabons that you prepared or directly supervised If'other is
chosen,provide a desa-iption.
Vusion 01_01_2018
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.