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31B-249 (3)
cog 4 weitzer 231 BUTLER ROAD • MONSON, MASSACHUSETTS • 01057 • (413) 267 -5381 • (413 ) 626 -1498 CO . LLC craigQsweitzerconstruction.com Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 413 -587 -1240 June 16, 2011 REQUEST FOR WAVIER OF CONTROL CONSTRUCTION I, Craig Sweitzer, of Craig Sweitzer & Co. LLC. Do hereby request a wavier of the requirement for control construction for a door relocation at the Smith College Campus Center for the following reasons; The scope of work is to relocate an existing door and wall section 7' in length Approximately 8' from its existing location The wall is a non - bearing partition The work will not effect health, accessibility, life or fire safety. It is impractical to abide with the control construction section of the building code Time is of the essence Plans are included in this submission A building permit application accompanies this request. Thank ou for your consideration Craig weitzer CS license CS 15713 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington 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): Calks 4 ,S uJL t t2 !rte CO L L C _ Address: •Z 3 i /3.� i e-�2 f 'f City /State /Zip: test; N f 0 M 4 0(.05 7 Phone #: 13 ' x' 14 ' 11 'S e Are you an employer? Check the appropriate box: Type of project (required): 1. Elam am a employer with 3 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. El I am a sole proprietor or partner- listed on the attached sheet. 7. ['emodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5• ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11.❑ Plumbing repairs or additions 3. El I am a homeowner doing all work 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 section below showing their 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. Insurance Company Name: a a A.S Ci A- ` y Policy # or Self -ins. Lic. #: (tiJ C, 0 3 7 2-7 / 0 Expiration Date: fo 1 5 / Z Job Site Address: $.w► i nt Otte4 CI *0"J C6 - 4•A City /State /Zip: /l/c?,- .7n/`e 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: Date: / Phone #: . - ''2 -- l g ' 'Pa 4l 3 � Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # 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 #: Version1.7 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 i � J r' e Lu GL^ y as Owner of the subject property hereby authorize cs CA-P-1 C. W.. _ S act on my -If, in all matters relaf e to work authorized by this building permit application. Air Signature • •wner Date I, 65 C- A Ca " -A t 2 'e� as Owner /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, , _.. _ , LA . _ ... . cs i 71, cr ?'L .._.n Print Name C rG I/ Signature of Owner /. ;6 Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: _._ S .C(. _ _ ....__. .es_ „q.? ... License mber (z IZ r � ... Address Expiration Date 23 l L Signature Telephone SECTION 13 -W ERS' 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 bu' ing permit. Signed Affidavit Attached Yes 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 43,r` C o % 4 a- , f r._. 3 P / "C() ._ .. eief4 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 ...____ � Si ._ �...__ g p Expiration Date 9.3 General Contractor C • 2,44 ... vas e"�T'2 i— •-.- - Not Applicable ❑ Company Name: C f.- J .3 C .T2dri- Responsible In Charge of Construction urn _.. _. Address 413 -2 (2-1 i 72.7 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. .._.m ._...... R . _.._ 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 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the perm it recorded at the Registry of Deeds? NO 0 DONT KNOW Gr 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 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO 0 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 er IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavati , 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 Management Permit from the DPW is required. r Version1.7 Commercial Building Permit May 15, 2000 ' SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations fJ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration 0 Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter y a brief description here. Of Proposed Work: �c -A-ilr ? r © t W/rL,L_ 4 600 ' Y-eML, w/�2.? ._.,.__ SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1 A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business , 2A ❑ E Educational L� 2B r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use 1:1 specify: . _.,� .. _i_i___ __ _ . _ ___,_ _ COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group. `_m..__ . 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 s t 1 st 2nd 2 nd 3rd 3 rd 4th ,..__....., , ___ __ _ ... _ __, 4 th 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 ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system El Version1.7 Commercial Buildin Permit Ma 15, 2000 Department use onty City of Northampton st �er '' s , '� -1, Building Department `CurrbCutipilN .ay Per t i. 212 Main Street ' Av tilt ,. k ' ` ., Room 100 , l/1/ater/Weil Avattabtfi Northampton, MA 01060 FwaSetsof,Strtctura P . phone 413 587 - 1240 Fax 413- 587 - 1272 Plot/Slte Plans .Othe Spee tty 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 /o EL /4 S-7"; Map 3 Lot Unit J Zone Overlay District W .. P _d .� ._ .�.m. ..,.a. _. Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 7'J4c mi) 5....E s.. 0.17::-_,T.77. gt .__t::. �. L E6e- 1 ? . . ___. ? _ � . __ ...._ s 1.. _ ...... Name (Print) Current Mailing Address: Signature Telephone 2.2 Authorized A s @!fit 4 � w a t ?` cal _... 23 l 1?- v itcr � > . > o Name (Print) Current Mailing Address 171 _ .. _. ..._.._ . Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building �+ vJ Q (a) Building Permit Fee 2. Electrical 1 d d Q (b) Estimated Total Cost of Construction from (6) .,,. . __ _ ._ �. 3. Plumbing i � p .. Building Permit Fee i 4. Mechanical (HVAC) f- 0-c0_ 5. Fire Protection 2, u C) 6. Total = (1 + 2 + 3 + 4 + 5) 11 ()O Check Number 1 W Ol This Section For Official Use Only Building Permit Number Date Issued Signature: / 6/17/1/ Building Commissioner /Inspector of Buildings Date • 100 ELM ST - CAMPUS CENTER 2ND FLR BP- 2011 -1066 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 249 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- 2011 -1066 Project # JS- 2011- 001716 Est. Cost: $11000.00 Fee: $66.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CRAIG SWEITZER & CO LLC 15713 Lot Size(sq. ft.): 15855.84 Owner: SMITH COLLEGE OFFICE OF TREASURER Zoning: URC(100) //EU Applicant: CRAIG SWEITZER & CO LLC AT: 100 ELM ST - CAMPUS CENTER 2ND FLR Applicant Address: Phone: Insurance: 231 BUTLER RD (413) 626 -1498 WC MONSONMA01057 ISSUED ON:6/17/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: RELOCATE WALL & DOOR - 2ND FLR CAMPUS CTR 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 6/17/2011 0:00:00 $66.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner