23A-040 (5) New England Remodeling
General Contractors Inc.
67 Division Street
Easthampton, MA 01027
Phone (413)529 -0801
Fax (413)529 -0006
www.neremodeling.net
12/15/09
TO: Northampton Building Dept.
The detailed description of 52 Maple Street as an existing business is as follows. The business
use was an Acupuncturist, Chiropractor, Hypnotherapy and message therapist. This business had
multiple offices within the building for it's current use. On the second floor there are 2
residential apartment units. There are approximately 20+ off street parking spaces for the
building.
The changes made to the interior of the first floor will consist of the partial removal of non load
bearing walls to open up the floor space for a bike repair and retail shop ( Full Circle Bike
Owned by Jason Graves). There will be no changes made to the exterior of the structure. All 4
existing exterior doors will remain in the same location.
For the fire protection we will use the existing 3 smoke detectors as drawn on the floor plan. In
addition, we will add 4 pull stations, 1 at each exterior door location. On the parking lot side
there are 3 - 36" egress doors to a covered porch witch have 3 stair cases to grade. On the right
side of the building there is 1 — 32" door with stars to grade. In this location there is an existing
fenced in area where an access gate will be installed.
Tom Bacis,
New England Remodeling General Contractors, Inc.
New England Remodeling
General Contractors Inc.
67 Division Street
Easthampton, MA 01027
Phone (413)529 -0801
Fax (413)529 -0006
www.neremodeling.net
12/15/09
TO: Northampton Building Dept.
The detailed description of 52 Maple Street as an existing business is as follows. The business
use was an Acupuncturist, Chiropractor, Hypnotherapy and message therapist. This business had
multiple offices within the building for it's current use. On the second floor there are 2
residential apartment units. There are approximately 20+ off street parking spaces for the
building.
The changes made to the interior of the first floor will consist of the partial removal of non load
bearing walls to open up the floor space for a bike repair and retail shop ( Full Circle Bike
Owned by Jason Graves). There will be no changes made to the exterior of the structure. All 4
existing exterior doors will remain in the same location.
For the fire protection we will use the existing 3 smoke detectors as drawn on the floor plan. In
addition, we will add 4 pull stations, 1 at each exterior door location. On the parking lot side
there are 3 - 36" egress doors to a covered porch witch have 3 stair cases to grade. On the right
side of the building there is 1 — 32" door with stars to grade. In this location there is an existing
fenced in area where an access gate will be installed.
Tom Bacis,
New England Remodeling General Contractors, Inc.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Inzvestigations
600 Washing ton Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly_
Name ( Business /Organization/Individual): ,/"' (4 - ( {i g / i 4r d K +°yh Ode,/ 41_ 6, G,
Address: 6 .- 2 b Iv/ 5
City /State /Zip: I a 1 p^ hone #: ) U V
Are you an employer? Check the appropriate box: Type of project (required):
LT I am a employer with 3 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. [I] New construction
2. CD I am a sole proprietor or partner- listed on the attached sheet. 7. (? Remodeling
ship and have no employees These sub contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
y ap ty 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. ❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the sect :un bek ;w showing then workers' compensation policy information.
T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
`Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Company Name: .4 a 76-1 C jM Plllt r f �� C eio
Policy # or Self -ins. Lic. #: > Q6 (,c f Sal ;pi Expiration Date: Sept 2.6/6
Job Site Address: S 4 p 1 City /State /Zip: /Ur 7'4 cM f 7 14
d ! dGs4
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: ��- -�� l� Date: I ! ' � " G q
Phone #: y enr G
Official use only. Do not write in this area, to be completed by city or town official
City or Town: PermiuLicense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
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 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
, as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
_
Signature of Owner Date
a U , as Own: /Authorized
Agen hereby declare that the statements and information on the foregoing application are true and accurate, to the best of edge
belief.
Signed under the pains and penalties of perjury, �_ .. .._ ..... am.._.
� 0h!l►SC { Gr 5
Print Name .- �
it Signatu: of Owne-!Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder . ..m_� ` . C4
License Number
Address ' Expiration Date
Signature Telephone
SECTION 13 - WORKERS' COMPENSATION 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 9it 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:
Not Applicable
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registratiorl 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
_._.,,_x. ._,..... ......,.._.__..____._ _ ..._._.__.,._.__.._ ._ __. _.. _._.' Not Applicable
Company Name:
Responsible In Charge of Construction
Aririracc
Signature Telephone
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L...__....,.. _ R:. . . _ . . . L:........ R ..... .
Rear
Building Height
Bldg. Square Footage
Open Space Footage °
(Lot area minus bldg & paved
parking)
# of Parking Spaces m - - - •_M
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Findin ever been issued for /on the site?
NO (3 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ` Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO @ DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO 0
IF YES, describe size, type and location:
E. 'MII the construction activity disturb (clearing, grading, avation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES (0 NO
IF YES, then a Northampton Storm Water Managem t Permit from the DPW is required.
'
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
nterior Alteratio s ❑ Existing Wall Signs 41h Demoliti„ n 0 Repairs ❑ Additio, sin Accessory Building ❑
x or Al eration 0 Existing Ground Sign ❑ New igns ❑ Roofing❑ Change of Use 0 Other ❑
Brief Description Enter a brief description here. f for 6Ife
Of Proposed Work: y..., � Ai1 S / �
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B rf ❑
F Factory ❑ F -1 ❑ F -2 ❑ i 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B 0
M Mercantile ❑ 4 0
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 0 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: Proposed Use Group: ,.,__ ,
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 st
2nd 2nd
.
3rd ..:,,.. 3 rd
4m 4m
Total Area (sf) 1 1J., 5 Total Proposed New Construction (§1)__,
Total Height (ft)
. .I ....
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Versionl.7 Commercial Building Permit May 15, 2000
Department use only
City of Northampton Status of Permit
x.
Building Department Curb- CutlDnveway Permit
212 Main Street Sewer /SepticAvailaiility
Room 100 WaterMfell Availability ,
Northampton, MA 01060 Two Sets of Structural Plans
phone 413- 587 -1240 Fax 413- 587 -1272 PIot7Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REP �I NpVATF, qH G . THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
�i!!At✓ A N R FkMILY DWELLING
SECTION 1 - SITE INFORMATION 7nog
1.1 Property Address: This section to be completed by office
frp Lot Unit
S ��d Zone Overlay District
P ore-A.4,-1 o fO 6 c..
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) imp ix ( T c g urrent Mailing Address:
Signature L� Telephone
r 2.2 Authorized Agent: .
Name (Print) Current Mailing Address
54; a Fag
Signature 7 Telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing / Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection ���
,�
f- Total= (1 +2t3 +4 +5)__ _ _ Check Number /0/ T `1:5'
This Section For Official Use Only
Building Permit Number Date
Issued
Signature.
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0599 ( t3 "
l
APPLICANT /CONTACT PERSON THOMAS BACIS
ADDRESS /PHONE 67 DIVISION ST EASTHAMPTON (413) 529 -0801
• • • • _ Y LO. TION 52 MAPLE ST )r1 fl
P' . r 23A PAR 0 001 ZONE ' GA(100)/
THIS SECTION FOR OFFICIAL USE ONI \ t�l
PERMIT APPLICATION CHECKLIST \17') \ 1 L
ENCLOSED 1
ZONING FORM FILLED OUT
Paid
Building Permit Filled out ,2'
Fee Paid �� #.! — �' `
Typeof Construction: REMOVE NON- BEARING WALLS & ADD BENCH'
SHOP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 070061
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved 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
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.