32C-021 A °r lung CERTIFICATE OF LIABILITY INSURANCE OP
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOR;)NATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIR/AkTIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DoE$ NOT CONSTITUTE A CONTRACT BETWEEN THE ISSNI IG INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlllcete Holder hi in ADDITIONAL 1NSU RED, the polcy(Ies )must be sndossBC{, If SUBROGATION IS WAIVED, subject to
the urns and conditions of die policy, oatsin policies mey require an endorsement. A statement on this i:ertlllcate does not confer rights to the
certificate holder in Ileu of such endorsont (e►.
NORTH ANDOVER 1NSUEANLQ AGANCY, INC. w , E„ (978) 656 -2266 1 ,_ NH: (AM 6e6 -41410
M.J. FOSTER INSVFiANCS SERVICES As k oE' na .g _neEine.oem - - --
,. .. ..
163 I � , I N STREET wra11r - in , B 5 W 3erviaee, Inc_ -_.. ,.. _. .
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POMP MUM A NAUTILUS ILUS I NSIIIiAYI .'(E COMPANY
SHE Services, Ina. NOYea e C.A$VAzint INSUHAIICA
55 Equestrian Drive INWie a GONfINENTAL QTY COMPANY
OMOON1 o GREAT AMERICAN INSURANCE
MAIM a ; _._ ..
North Andover Ia 01845- IWYbIr:
C YIfERAOES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATE°. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONtNTTON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO %%IICH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND COItITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, MP --- — I -- . _
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a mncoomi Lemur/ Y - 07791106 -1 pt. /L1/2ois ps :i el3 • comen1Tp+l#F LINT a 1,000,000
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RE: DosINTOIM ROUNDS, 21 PLSAcaIIT Stmsr, MOP, EJ11e1 Il, ex 01060
CERTIFICATE HOLDER CANCELLATION _ y
- ( ) w SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TIE ERnew ION DATE THEREOF, NOTICE WILL RE OELiIEREO
AoConDANCE Brill THE r'UUCY P110VI5g1/S.
JOSEPH 2LtS€ NTHAL / \
DosigT WN SOMID$ /411/110101110 .pINIMRATeK
21 PI$ASMIT STREET ,'*
NORTHAIIPTON NA 01060 - '- - ,te• r " tiM� '�`�f �
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Version1.7 Commercial Building Permit May 15, 2000
J
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
F,•-6-4 U°NEIVrt-' l.. as Owner of the subject property
hereby authorize __...__. to
act on m ehalfmatters r ativ to work authorized by this building permit application. _mm .....
Signatur wner Date
, 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
Print Name _ ___. _ _
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:. - n_wm _P,
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 0 No
' The Commonwealth of Massachusetts
Department of Industrial Accidents .,
1• , t Office of Investigations , k.
7 _ 600 Washington Street
Boston, MA 02111 •
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /PIumbers
Applicant Information Please Print Legibly
p �
r
Name ( Business /Organization/Individual): S lit S - (/! C ' N C- _
Address: Auer V`t I .//° P L. I • I ' U a - 0 /(F4 ' s —
City /State /Zip: Phone #: 97a-_ 6 (2 // �0 C
Are you an employer? Check the appropriate box: Type of project (required):
1. am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction
Iisted on the attached sheet. 7. ❑ Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees These sub- contractors have 8. emolition
working employees and have workers'
g for me in any capacity. P i tY 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.*
required.] - 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
f
oficers have exercised their 11.
3. ❑ I am a homeowner doing all work h id hi
❑ 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' 13.0 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 narre 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: tioHit 4Nq''OLiee - N 5 1-- [: t° 46, G I T i" C- _
r
Policy # or Self -ins. Lic. #: Expiration Date: / — I ( — /2
Job Site Address: a 1 Pieq,/ f.it S City /State /Zip: t L A i - A'_ 01060
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 co py of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi • . ,� • r the , ains and penalties of perjury that the information provided ab ye is true and correct.
Si • nature: '—` ''r��— Date:
Phone #: ■ — at —
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 #:
ARCHIMETRICS DESIGN STUDIO RN
28 NORTH MAPLE UNIT B �•
FLORENCE, MA 01062
July 20, 2012
Louis Hasbrouck, Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01260
Project: Interior demolition - 25 Pleasant Street
Scope: Removal of sloping floors and projection booth framed over existing floor
system.
The scope of work is limited to non - structural improvements with the existing
space in preparation for new tenant requirements. The tenant will submit its own
building permit application for the proposed use and document the change of use
and applicable code requirements.
Subject to the requirements of the Eighth Edition of the 780 CMR, I, Peter E.
Lapointe, being and architect registered in the Commonwealth of Massachusetts
hereby certify that I will perform the necessary professional services during the
above described demolition activities and be present on the site on a regular and
periodic basis to determine that the work is proceeding in accordance with the
drawings and specifications approved for the building permit.
Respectfully sub,'tted, -.
/ , a -c il .
/V Z ' i I • r r • CO
r
Shouurn. kw, y
Peter E. Lapointe '1. z �'
, , �� yF �' lT N OF ,p,eg fi'
PETER LAPOINTE,ARCHITECT PH 413 582 -9100 FAX 413 582 -9101 www.archimetrics.net
Version1.7 Commercial Building Permit May 15, 2000
4
k
SECTION 9- PROFESSIONAL DESIGN'AND CONSTRUCTIONSERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF EILOSED SPACE)
9.1 Registered Architect:
____ . _____ . _ _.. * __
Not Applicable ❑
Name (Registrant): fY"- ~ G?` 1 - ~--- ._,..._. _�_._,..__ „_,_ ...
__ . �._ro �._ --- _� . ---
Registration Number
Address 7 lt4 __�....m1.2-._...__._._....._. ,_ ..,,�._ _ ____
S, q �� u Expiration 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. n. - Area of Responsibility .....,. _ .
Address Registration Number
Signature Telephone Expiration Date
__ _ _
Name ,...._..__ . __
. ... ._ ____.,.. __ __.__._.__ .._._.___.__..._._ .__ _._ _
_.. Area of Responsibility
Address .:..._.._ __.. __. _..___.. .. _ _. Registration Number ..__ _.__,,._ , _
i
Signature Telephone Expiration Date
9.3 General Contractor
�( _ ?_. (.. --c•.? .___._ ___ __ _.__..; Not Applicable ❑
Company Name:
__.___...__.. __..._.,. _ ___ ,. _ _.
Responsible In Charge of Construction
_Address.
Signature Telephone
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed ` Required by Zoning
This column to '6e filled in by
Building Department
Lot Size _._ w �._._ _....
Frontage .... "._._. ,_... _..._..... 'w
Setbacks Front
Side L _ .. R.
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved — "
parking) .,��..,...�..
r
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 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 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ,Date Issued:
C. Do any signs exist on the property? YES C 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 0
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.
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION. SERVICES FOR, PROJECTS LESS THAN 35,000 t
CUBIC FEET OF ENCLOSED SPACE '°
Interior Alterations ❑ Existing Wall Signs ❑ DemolitionK Repairs ❑ Additions ❑ Accessory BuildingOIS
Exterior Alteration 0 Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
V
Brief Description Enter a brief description here. q, •:: C ' P '�", - V F
(L,1 �/p�. -
Of Proposed Work
b 'Qvrc'� 10 boo s
let
SECTION 5 USE GROUP AND CONSTRUCTION TYPE .- .
USE GROUP (Check as applicable) I CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A4 0 A -5 ❑ I 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B . r ❑
F Factory ❑ F -1 ❑ F -2 ❑ I 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ I 3B ❑
M Mercantile ❑ I 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 0 I 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify: .- ._.____.. .. ......�,__ ___ m...._ __ �..w.,..._ ..,_.�___
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): _ ,____._____,_.._.._._.____.__ __M
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
t
1 _ ._
1
1 .. . ..........-
2nd _ ., _, _._ 2 nd '
4th 4th _ __-_ __ _ __._._. .
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
Version1.7 Commercial Building Permit May 15, 2000
Dep&tmeht use only
. „
City of Northampton
.:;;
1 ---:- Building Department -AtiR*0
212 Main Street
• JUL 2 0 2012
Room 100
wat
orthampton, MA 01060 Twett-Setst. pturat,Plpriv41;,a0v.;‘,;'.;tr,
- ,PEcOo e 4 3-587-1240 Fax 413-587-1272
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
This section to be completed by office
Property Address:
Z' Fc.,e3144:41.4 , eth - r grnsEr
Map 3.z. c. Lot 02.1 Unit Op
Zone Overlay District
Elm StDistrict ' • CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,. frtZ- 7
Name (Print) g C Current Mailing Address
If 0 LP
Signature Telephone
2.2 Authori!d A. ent:
Name (Print) Current MailingAddress:_
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
„.„
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
— This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File # BP- 2013 -0090
APPLICANT /CONTACT PERSON J -BARC INC
ADDRESS /PHONE 21 PLEASANT ST NORTHAMPTON
PROPERTY LOCATION 25 PLEASANT ST
MAP 32C PARCEL 021 001 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 3Vf 0 15-56'
v 1 16'
Fee Paid 7
Typeof Construction: REMOVE SLOPED FLOOR & PROJECTION BOOTH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF91 MATION 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
C7'e V3 2.■
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.
25 PLEASANT ST BP- 2013 -0090
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 021 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
Penult # BP- 2013 -0090
Project # JS- 2013- 000139
Est. Cost:
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 2047.32 Owner: J -BARC INC
Zoning: CB(100)/ Applicant: J -BARC INC
AT: 25 PLEASANT ST
Applicant Address: Phone: Insurance:
21 PLEASANT ST
NORTHAM PTON MA01060 ISSUED ON: 7/30/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REMOVE SLOPED FLOOR & PROJECTION
BOOTH
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 7/30/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner