22B-040 (23) BP-2023-1803
221 PINE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
22B-040-001 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-2023-1803 PERMISSION IS HEREBY GRANTED TO:
Project# RENO #140 Contractor: License:
Est. Cost: 9000 JAMES MAILLOUX CS-081694
Const.Class: Exp.Date: 10/16/2025
Use Group: Owner: LLC THE BRUSH WORKS
Lot Size(sq.ft.)
Zoning: OI/WP Applicant: JAMES MAILLOUX
Applicant Address Phone: Insurance:
221 PINE ST SUITE 160 (413)585-1592 WCT0721Q
FLORENCE, MA 01062
ISSUED ON: 01/02/2024
TO PERFORM THE FOLLOWING WORK:
RENOVATE SUITE 140
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:
Fees Paid: $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
--1
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- Th• Co monwealth of Massachusetts
Kto Of .ce of Public Safetyand Inspections
F ttittp�N. NsP OGO�N ••assachusetts State Building Code(780 CMR)
: }a
DEB , ytitu•: • pplication for any Building other than a One-or Two-Family Dwelling
--�` (This Section For Official Use Only)
Building Permit Number:.y3' /803 Date Applied: Building Official:
SECTION 1:LOCATION
419.1 7wCcr. Via rtcrlivcE "AA Dlo4A --61,1ashk+►,°(K5/I tT'} iv9,
No.and Street City/Town Zip Code Name of Build' g(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building$f Repair 0 Alteration Sir 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 1( No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No Iff
Brief Description of Proposed Work: Cons ti Zr W A LL t Fc
wA• ,"1 rzy—i 3 trM.atd t 0 _.0 6.1rb..n Sk%+-c 14o Gc $W -
sPnlh)ct€>v r° !3E ►N Con. ) i ••nct
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) ❑
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 ❑ A-3 0 A-4❑ A-5❑ B: Business 0 E: Educational ❑
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 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 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA CI IBD IIA ❑ IIB ❑ MA CI IIIB ❑ IV El VA CI 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 CIIndicate 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:
City of Northampton
1 Massachusetts _ _ _ -
DEPARTMENT OF BUILDING INSPECTIONS ;
yiY_. gyp.' 212 Main Street • Municipal Building.,
,y Northampton, MA 01060 4,6 ,_
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
I3auswworty LLC I phi,. ?C • rU✓t EMCE 61 d c-L
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information: II
- -
yn _37� L�z9 a/`1 r")1 on 6.) Aorn,.i).Cr/y
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
/4rn l3crc��.
Name Street Address City/Town State Zip
to apply for and act on the property ownet'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
( ebb
)1
Company Name �
$-AM byC CS� 16gq
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
is"). -C63.. /6 55/ N,o„ )) •.- t l e t t:t4 16inse .C4,01
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No D
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ cP00 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ 1900 appropriate municipal actor)=$
3.Plumbing $ m
4.Mechanical (HVAC) $ Note:Minimum fee= Ov ontact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ c7 .,i (contact municipality)and write check number here C•Caek
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
application is true and accurate to the b•: : my • • ledge and understanding.
kr70Mft% /yo)1h ()vino " 3 ��f 1SfL �r-1Z�fi3
Please print and sign name Title Telephone No. Date
22 tr Icv f?o/o►►tr M,o d/vh").. Jt_.4,.v4-1 el %.:." .. 1cr •►/
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval:
4 � , , Va
Name I ate
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD - SIDE YARD
FRONT SETBACK
FRONTAGE
221 Pine St. Suite 140 Renovations
\ \
N Break Room /
_ \ \
Zo
1 O N \
Oo
14'-5 1/4" Office
— n in
ti ti
2'-8" Storage
i
6'-11 1/4" 8'-8"
/ // - -/
3'-6"
Office
N 1 \ Co
°Q Studio 3 .q
N oo lb
Zo \ Bo
N
10'-7 1/4"
14'-5 1/4" \ ''
\
4'-1 1/2"
\ k Studio 2
co
N -'
\ Co
/ 10'-7 1/4"
1/ n
J3'-0" \
il,
Studio 1
\ -
00
Lobby/Waiting Area q `r'
Bo c9
\ co
10'-7 1/4"
\ \
31'-0"
City of Northampton
(7.im
14 Massachusetts _ ef`.
DEPARTMENT OF BUILDING INSPECTIONS its ,,
4*` 212 Main Street • Municipal Building �;
- ! Northampton, MA 01060 °pp ��`'�
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: Vial id (Z�t*C l''l
The debris will be transported by:
Name of Hauler: �jiirk S (titQ->)l``
Signature of Applicant: Date: 12_2-1
•
•
The Commonweahh of Massachusetts
Department of Industrial Accidents
,p1=.
I Congress Street,Suite IN
Boston, MA 02114-2017
wwistmass.gov/dia
II kers' nopenuttion Insurance Affidas it:BuilderContractorsJElectricians/Plumbers.
TO BE FILED Willi'I'HEPbKH iUM;AUTIIORIIA
Applicant Information Please Print Leo bh
Name{Busincss'Organization I ndividual}: \TWO" Ma,,
Address: 7_2 I 71 (
City/StateiZip: VT;re AL( MA Q I 0 7-- Phone P: /17
Ana you ad etsiptity,re?(Ara the appropriate&ix: Type of project(required):
LEDA a employee with raisplo}ves tfu3l and or parhtimelt. D w -• 7. N onstruaion
20 I am a sole proprietor or portnership and have no cinpltileri working for nu:in Retitudeiing
any capacity.[No*sake&comp insuranceLJ required"
9, fl Demolition
t am a homeowner doing all work myself INsi worksait"comp instil-awe verpined_r
IOfl Building addition
4.0I am a tioincoo.nci and will he hiring exiadmotima to conduct all ova on my propen:.. I
emure that all 4:immix-tun Coropt-n14iboal insurance tie am mile 11.C] Electrical repairs or additions
Firtypriotor,with no einpkiyet. ..
i ID Plumbing repairs or additions
t'.10 I am a general contractor and 1 base himd the mib•cuttLtactort.listed on the anaslind sheet
tin Roof repairs
Them:sob-cuntratetors baste employes-sand base workers;comp.insurarice,;
i Othei
et.1:3'di et are COrporation and it.Officer%have thk•itnyht or exemption pier!VIOL r.
11,2.§114t., Iti•oc no slur lossics.[Nto tkorkern.comp,inaininiteLpillea f
'An}applicant that checks boa.1 mind ako rill out itis:wctivit beluss showing their workers'compensation paw).information
lioniramshers who suhrem tha affidas it indicating ilk,are doing all work and then hire outside contradors mail-submit a new alliihas it indica/me such,
;Contractor%that check dui Kis MUM altac.Foal an additional shoot think mg the name of the iruli-iiiiiittractUrs and trtAte Y.hater or not those entities hate
e niplsrsesta, sub-cm1r3ctorN ELJ,V CITT111!,CC5.dn:y insist pruvidcihcir Workrr;comp,policy number,
lam an employer that is proridinz worAers'compensation iltillrunce fur my employees. Below is the policy and job sire
information.
Insurance Company Name: /*IN r
Policy#or Self-ins.Lk. E r 0 7 Expiration Date: 1 0/2 4
Job site Addres.-.4: 7.2-1 iho Cr: F ie n Li)piA City/State/Zip: I-z......
Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MILL c. 152,§25A is a criminal violation punishable by a tine up to S1,500.00
and-or one-year imprisonment,as well as civil penalties in the form-of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be fonssarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ida hereby cciiiy mink t pain..and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone e: 4 5 SW /C/
Official use only. Du not write in ilti\tile'll.to be completed by city or town official
City or Town: PermittLicense Ii
Issuing Authority (circle one):
Board of Health 2.Building Department 3.(:it:s'iToram Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: