31D-251 (2) M e t c a l f e Associates architecture & interior design
a 142 Main St. Northampton, MA, 01060 Tristram W. Metcalfe III, Ma. Reg. 5393
Phone number > 413 586 5775
Cell number > 413 695 8200
Email > twm30 rcn.corn
NCARB, NYS, MA, CT
registrations
WMAIA
AIA
14 June 2011
Louis Hasbrouk, [413 587 1239]
Building Inspector City of Northampton
Puchalski Municipal Building,
212 Main Street, Northampton, MA 01060
RE; Minor corrections and refurbishment building permit
Loc; The Round House
244 Main St.
Northampton, Ma
Dear Louis,
I have a client who owns the above location. He wants to get a permit to correct an exit that was
apparently removed by a prior tenant and then he wants to rent his building to a new tenant with the
same use.
The Business B use is unchanged and the attached 4 drawings show the interior layout with some
minor changes to existing office walls. The round wing of the building will remain unoccupied until
a new tenant use is found for it.
This Is Level #1 construction as based in new code 780CMR IEBC SECTION 403
ALTERATION -LEVEL 1
403.1 Scope. Level 1 alterations include the removal and replacement or the covering of existing
materials, elements, equipment, or fixtures using new materials, elements, equipment, or fixtures that
serve the same purpose.
Please let me know if there is any other information you seek.
Thank you.
Sincerely, 4' o I
/ Na 6393 < m ` ■
Tris Mete. e Y Iv
q , r . 8oftlk
#
The Commonwealth of Massachusetts
Department of Industrial Accidents
a t•-- Office of Investigations
600 Washington Street
•
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Buil ' ers /Contractors/Electricians /Plumbers
Applicant Information Please Print Legibly
Name Art►
Nae ( Business /Organization/Individua]): , ■ _
Address: ''N'
v '
C ity /State /Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I
6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
listed on the attached sheet. 7. ❑ Remodeling
2. El I am a sole proprietor or partner-
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 10.0 Electrical repairs or additions
officers have exercised their 11. ❑ Plumbing repairs or additions
3. I=1 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.
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:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
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 #:
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,364ZT ro( _ _ , as Owner of the subject property
hereby authorize .T02)2D_ Ca -e_, -e_, t.l . / . ✓r'_P -- / /v.... ,._ l �,� _. . _ to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner � Date
I, TD .,„ _ ...__.._ ___„ ___ , 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 perjur r m x e _,,.- _....,..... ..._.... _
. . L.- ___ . _
Print Name
S' ture of Owner /Agent Date •
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
C5 o i 7 G ._..
License Number
j
Address Expiration Date
Sig ure 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 0 No � �1
Versionl.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 ❑�
El i
Name (Registrant): _ ,\\
Re Number
14--L h J,p -ter h ....,,s 66111
t I n —
Address
Expiration Date k IS161R
�/ _
473 5 4 .6. ??.5-_ \ or b
Si �� - Telephone F
9.2 - -gistered 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
Not Applicable ❑
Company Name:
- ro C,��.LV.,Z .................... _ ........___._._._.___ _.. _._..___. _ ._.... .., ..__ _'
Responsible In Charge of Construction
/35 SCO - 11- j p7D/4 ice_ ._ Vq TI-G !s1 - re? .1.... Nkcik ... oiQZ,?
Address
Sig ture 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:
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 permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 1 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 Q 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 4
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 0 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 s
L 4
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Access ry Building ❑ Ai
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Ot
Brief Description . Enter a brief description here. in ®ion ; , J A -L- = z. 70 ,0
Of Proposed Work:. _ { �-- t
..1�. .LLStS.. r� ?.._ L�1Al.Ll..2__ ! _r`. ti. &frE_ 2. t.4-.2 ,
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 V ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
. H High Hazard ❑ 3A ❑
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 I ❑
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:
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) L.
1st 8
1st l8h�. i �
G _ nd �..V IQ..
2nd /s O 6 ?f .. 2
3rd
.. „, 3 rd ,.
4th .,
Total Area (sf) T otal Proposed New Construction _
3 (sf) ,
3z7Z� _._
7? ...._
Total Height (ft) ^I- 36 ! ”
Total Height ft . 3 0 .
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public gi Private ❑ Zone Outside Flood Zone El Municipal ro On site disposal system
'RE EIVE D Version1.7 Commercial Building Permit May 15, 2000
D e p artmerttuse on[y,
t
h
N
ity of Northampton Status if Pe tf
r r� , �� 6
— 6 2011 20 1 w ilding Department C� Ot tDrtueway 'Perrntt
JUL ;
212 Main Street SwvertSeptic�,'/ailatsi
DEPT: OF BUILDING � E' � � � �
NOR PT MA CONS Room 100 WaterW i I.Qvaifabitity x
. rthampton, MA 01060 Twt/o Sets ofStructuraTI - - �
phone 413 - 587 -1240 Fax 413 - 587 -1272 P IOt/St #e Flans T
Other Specify :
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
21 1 AkA.j() 5T .E% Map 3 Lot v Unit
NDRTE- (/,�j�(p 7 i Ak4. Zone 111��� Overlay District
... _, _.. .. a. . � : Eim St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address: 3313
_3,05 ..533 ,w.2 9 ... ______ ____ . ". _.__ . .
Signature (.i:u.t —QA. _, Telephone
2.2 Authorized Agent:
TD t� l� CELW delk J 3 ,5C21.iT t &P rQ» 1� A,..V 1 �) ti p
Name (Print) Current Maili9 Address
Signature ........-- 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
b Estimated Total Cost of .
2. Electrical (b) 1 S 17 3 Construction from (6) _..__ _.. _ ____
3. Plumbing / Zy 2 . Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection P „ / 10 0 .
Total= ( + + + + sO A`f 7O �� Check Number f /i 1 : . r
: This f, s "7 2
r� This Section For Official Use Only
, Building Permit Number,. Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0011
APPLICANT /CONTACT PERSON SOVEREIGN BUILDERS INC l) A c613.512P3
ADDRESS/PHONE 135 SOUTHAMPTON RD WESTHAMPTON (413) 527 -8001
PROPERTY LOCATION 244 MAIN ST- ROUNDHOUSE BLDG
31D PARCEL 251 001 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
9
Fee Paid 7
Typeof Construction: RENOVATE INTERIOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 060176
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F ATION 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
114—AJ 7/Zi/
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.
244 MAIN ST- ROUNDHOUSE BLDG BP- 2012 -001 1
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31D - 251 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 -0011
Project # JS- 2012- 000019
Est. Cost: $64706.00
Fee: $388.20 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SOVEREIGN BUILDERS INC060176
Lot Size(sq. ft.): 6969.60 Owner: CURRAN ROBERT G JR
Zoning: CB(100)/ Applicant: SOVEREIGN BUILDERS INC
AT: 244 MAIN ST- ROUNDHOUSE BLDG
Applicant Address: Phone: Insurance:
135 SOUTHAMPTON RD (413) 527 -8001
W ESTHAM PTO N MA01027 ISSUED ON: 7/21/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE INTERIOR
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 7/21/2011 0:00:00 $388.20
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner