32C-013 (2) /1,1
(5/NV
15251
IBankof America.
PIONEER CONTRACTORS ✓i,
DIV PI CON INC.
PH. 413566 -6491 5 -13 -110 1/25/2012 /25/2012
P.O. BOX 1145 i
NORTHAMPTON, MA 01061 1
PAY TO THE City of Northampton - Building Dept. $ * *55:
ORDER OF i
Fifty - Five and 00/ 100***.******,.**********************************«******************* * * * * * * * *;4 * * * * * * * * * * * * * * * * * * * *$
DOLLARS #
City of Northampton- Building Dept. c
212 Main Street 6
Northampton, MA 01060
MEMO 108 Main St.-2nd Floor AUTHORIZED S�GNATURE
L 5 2 5 Luu' 1:0 L L 000 L 381: 000050 26960 2"1'
PIONEER CONTRACTORS • DIV PI CON, INC. 15251
City of Northampton- Building Dept. 1/25/2012
108 Main St., 2nd Floor- Demolition Permit Fee 55.00
PI CON, Inc. 108 Main St. - -2nd Floor 55.00
PIONEER CONTRACTORS • DIV PI CON, INC. 15251
City of Northampton- Building Dept. 1/25/2012
108 Main St., 2nd Floor- Demolition Permit Fee 55.00
PI CON, Inc. 108 Main St. - -2nd Floor 55.00
PRODUCT DLT104 USE WITH 91683 ENVELOPE
O,,
6 � U � � i Alasaachasctta = `c�i' 7.
3
DEPARTMENT OF BUILDING INSPECTIONS 4 = _t—
• 212 Main Street • Municipal Building
•
Northampton, Mass. 01060 r'
WORKER'S COMPENSATION INSURANCE AN'1tUDAVTT
I, Pioneer Contractors
(licenseeJpermitiee)
with a principal place of business/residence at
•
P. BOX 1 1 45 NnrtharnntOn MA 01061 _ (phone#) 586 5491
(atr=t/ci tylsta telap)
do hereby certify, under the pains and penalties of perjury, that:
(0
I am an ernployer providing the following workers coin pensauon coverage for my
employees working on This job:
Wcc 50059570120Cq �, 2.-
Assnc' i a ted Employers Ins --- - 1
(Insurance. Cnnpany) (Policy Number) (F piranon Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hued
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Nutabcr) (Expiration Date)
. .
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Conn (Insurance Company/Policy Number) (E. \pirabon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(amen additional sheet ifnoccasry to include infuriation pertaining to all wonders)
( ) 1 am a sole proprietor and have no one working for me.
( ) 1 am a home owner performing all the work myself.
NOTE: please be aware that while bomcowncra who craploy parsons to do o i t ac coosavctioo err repair work on a dwelling of
not mere than throe units in ‘chich the borneowocr raid= oc oa the grounds appurtenant Thereto arc not gcacrnity coarickssd to be
catploya under the worker's compass's—lion Act (GL152,ss 1(5)), application by a horneowncr far a license cc permit may a'idc3+c the
legal statue of an employee under the Worio:es CoaapooaaLion Act
I understand that a copy of this miemcni may bo fo.wsudod to the Depoltmoai of Industrial Ac dcate OfEoo of Itsstuwc° for tits
coverage vuificstioa and that failure to acatre eovcrago under section 25A of MOL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S 1, 500.00 andloc imprisomn at of up to one year and civil peal/tics in the form of a Stop Wort; Otdc and a
5no of 3100.00 a day against me-
For dcrputr sl tine only
A, AII //s Permit Number
i dig r W Lot #
Si p. tore of Licen_see/Permi . -�
•
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,. .. .. as Owner of the subject property
hereby author
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Pioneer Contractors
, as- Qbacog' /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury. _ __
David Claxton
Print Name A z .
Signature Owner Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
David Claxton 17890
License Number
'P.O. Box 1145 Northampton, MA. 01061 01/19/2014
Address Expiration Date
Signature
(413) 586 -5491
/ 1 Te lephone
� ,
SECTIO ei RKE RS' COMPE SATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit 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.
Signed Affidavit Attached Yes 0 No 0 •
•
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Thomas Douglas Architects Not Applicable
Name (Registrant):
Thomas Douglas Architects Registration Number
Address
(413) 585 -0641 Ex Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
•
pioneer Contractors Not Applicable ❑
Company Name:
David Claxton
Responsible In Charge of Construction
P.O. Box 1145 Northampton, MA. 01061
Address Ae
if (413) 586-5491
Signature Telephone
Versionl.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
ti
Lot Size
Frontage.
Setbacks Front
Side L . _- , R : L: _ e_
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO ►)
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
•
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition$ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here. Removal of existing non -load bearing partitions per plan
Of Proposed Work: 'submitted.
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE I
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 I:3 A-2 ❑ A -3 ❑ 1A I ❑
A-4 ❑ A -5 ❑ 1B ❑
B Business 0 2A ❑
E Educational ❑ 2B 1 ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A 17
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: 'Business w Proposed Use Group: ,Business
Existing Hazard Index 780 CMR 34): , ._ __, . _ ? Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 st
1 s�
. __ . .. 2 nd
2nd _..
rd 3rd
. „.
4 a,
4
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft) :
Total Height ft
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ig Private ❑ Zone Outside Flood Zone p Municipal n On site disposal system ❑
Version!.7 Commercial Building Permit Ma 15, 2000
EGE,VE� Cit of Northampton S err 1$
R �a,,, wu
B u il ding Department
2ZA2 212 Main Street
Room 100 i ii �tla• ���
PECn�'s orthampton, MA 01060 � Y'1" '4, 41 tr �„ Va si���� v � ��
oF' � ►� � � 3- 587 -1240 Fax 413- 587 -1272 P� � � �� �ii �����i ti W
pert APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
'108 Main Street - -2nd Floor Map �, Lot Unit
IOU C Zone Overlay District
' Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Bally Bunion Realty LLC P.O. Box 342 Feeding Hills, MA 01030
Name (Print) Current Mailing Address:
(413) 562-6611
Signature L Telephone
2.2 Authorized A. a 1:
Pioneer Contractors ;P.O. Box 1145 Northampton, MA. 01061
Name (Print) Current Mailing Address:
� (41 -5491
Signature A \ Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building $3,000.001
(a) Building Permit Fee��� �
..ee
2. Electrical (b) Estimated Total Cost of
Construction from (6)..
3. Plumbing ' Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number 15-0/5/ /1r55
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0677
APPLICANT /CONTACT PERSON PIONEER CONTRACTORS
ADDRESS /PHONE PO Box 1145 NORTHAMPTON (413) 586 -5491
PROPERTY LOCATION 108 MAIN ST
MAP 32C PARCEL 013 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 50? 55" Fee Paid
Typeof Construction: REMOVE NON -LOAD BEARING PARTITIONS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 017890
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved _ _ Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
Val/
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
7/T
108 MAIN ST BP- 2012 -0677
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 013 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2012 -0677
Project # JS- 2012- 001168
Est. Cost: $3000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIONEER CONTRACTORS 017890
Lot Size(sq. ft.): 1742.40 Owner: BALLY BUNION REALTY LLC
Zoning: CB(100)/ Applicant: PIONEER CONTRACTORS
AT: 108 MAIN ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586 -5491 Workers Compensation
NORTHAMPTONMA01061 ISSUED ON:1/26/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE NON - LOAD BEARING PARTITIONS
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 1/26/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner