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17C-135 (4) , . �N ---` Initial Construction Control Document Tb be submitted with the building pemnt application by 4 Registered Design Professional for work per the 8 edition of the Massachusetts State Building Code, 780CMR, Section 107.h.2 Addition at Forence Casket Go. 7 Dec 2V12 Prc�,,ci Tide: __ _ __ Date: BardweUSbeeg Florence MA |`n u ,p�./�ddrmms: � ���� Pi .yccL Cheek ouc or hoth as applicabie: New construction X Existing Construction � � NewS0O+� sqMooe'oVo�add�nn prwi�c/dcs�np|/oo� _ . . — __- __-_ ._ _ �� ^ . ___ _-__ | William A. Shaheen Ph.D`P.E. MA Registration Number: 36292 Expiration date: 6-30-2013 , am a iunvii prgfessional, and hereby certif' that 1 have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: / 3 Entire Project [ 3 Architectural [x] Structural [ 3 Mechanical | l Fire Protection [ 3 Electrical [ l Other__ fo«|6cubovenamed project uoddbutsuckokuua computations and specifications meet the applicable provisions of the Nlxasaubuuedu State Building Code, 780 CMR), and accepted engineering practices for the proposed project. 1 unc1crsand and agree that 1 (or my designee) shall perform the necessary professional services and be present an the constrution site on a regular and periodic basis to: 1. F&eview, for coriformance to this code and the design concept, shop drawings, samples and ather submittals by the contractor in accordance with the requirernents of the construction documents. 2. Pcrform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3, Be present at intervals appropriate to the stage ofconstruction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved constrUction documents and this code. ‘ hen required by the building official, 1 shall submit field/progress reports (see item 3.) together with pertinent oonnco/a in a form acceptable to the building official. Upon completion of the work. [ shall submit bu Document'. Enter iu the space k/ the riobtu - ��\ c|uo"ooicsign:tureundseu|: �D��� 4134873141 n`oq@cnmcamo.nmu Phone number: �-�-- Email: Building Official Use Onty [ 8uUd Name: _ Permit No.: _____D���_________ 1ii,1 Yos\o^10_09_2012 c ;/3 >9 —Co a— CITY OF NORTHAMPTON, MASSACHUSETTS i u -k DEPARTMENT OF PUBLIC WORKS 6 .4& '4.,t 125 Locust Street �'� '' � ► " �►sc Northampton, MA 01060 -2066 sof 'lime . p RECE1 "v . , 413 - 587 - 1570 Fax 413 - 587 -1576 Edward S. Huntley, P.E riFG - 7 2012 Director i tt NORTHAMFTON, MA O ;;0i December 6, 2012 Louis Hasbrouck, Building Commissioner Municipal Office Annex 212 Main Street Northampton, MA 01060 Re: Sewer Cutoff Notice #63 '/2 Maple Street, Florence Dear Mr. Hasbrouck: The sanitary sewer services for the above referenced buildings have been cut and capped as of December 4, 2012, 1:30 p.m. Please contact me if you have any questions at (413) -587 -1570 ext. 4316. Sincerely, aoldA Aw John Hall Sewer Department Foreman Cc: Ned Huntley, P.E., Director of Public Works Tim I,aurila. P.E., City Engineer City of Northampton Massac , .<7,- - -'� ¢ ' '' ' DEPARfi3rZNT - QS BUILDING INSPECTIONS # � 212 Main Street s- Municipal ilding '«' , Ptorthampton, MA 01450 Bu 3tr �� INSPECTOR Louis Hasbrouck Fax: 413- 587 -1272 Chuck Miller Building Commissioner Phone: 413- 587 - 1240 Assistant Commissioner SECONDARY CONSTRUCTION CONTROL DOCUMENT (For pro€ essional - Engineers /Architects responsible for a- portion of a controlled project) Project Title: Florence Casket Co Date: 11 Oct 2012 16 Bardwell Street, Floren Project Location: Map: Parcel Zone: Scope of Project: 540 +1- sqft Building Addition In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR' Section . 107.6: L William A. Shaheen P.E. Mass. Registration # 36292 being a registered professiona r gine- /Architect hereby CERTIFY that I. have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: 3 Fire Protection [ ] Architectural V] Structural [ ] Mechanical [ ] Electrical [ ] Other (specify) for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit. Upon completion of the , • shall submit to the building official a final report as to the satisfactory Completion of the -, ,.,= tit... • 'work. Signature and `,,- ;; •fg ed •s -ssional N 4C. iii --- "4 , T1i0 T * VP ir -Day of .1. . di =41 20t r (seal) Required Inspections and Site Review Document * = l dri As a condition of the building permit the following Inspections and ! !� t Site Reviews identified by the building official are required for work per the ' 8 Edition of the `' Massachusetts State Building Code, 780 CMR, Section 110 and Chapter 17 - TiOteRc-e, Project Title: (--CS ke t Date: I — 5 — 9crrduAli t. Property Address: Rc >/ i , Buildin Permit No.: 1. The inspections indicated (x) are required by the building official. It is the responsibility of the permit applicant to request these inspections. 2. Include NFPA 72 test and acceptance documentation 3. Include applicable NFPA 13, 13R, 13D, 14, 15, 17, 20, 241, etc. - test and acceptance documentation 4. Include NFPA 720 Record of Completion and Inspection and Test Form Required Inspections to be performed by the Building Official 1,6 Inspection R Inspection R Preliminary (prior to start) x Roofing System /Attachment x Soil/Footing/Foundation Smoke /Heat/Fire Alarm System' x Concrete Slab/Under Floor Carbon Monoxide System Flood Elevation/Certificate Sprinkler /Standpipe/Fire Pump x Framing — Floor /Wall/Roof x Fire /Smoke Dampers x Lath and Gypsum Board x Witness Special Inspections Fire /Smoke Resistant Assemblies x Accessibility (521 CMR) x Energy Code Inspections x Manufactured Building Set Sheet Metal Inspections x Other: Emergency Lighting/Exit Signage x Final inspection x All Means of Egress Componenets x All items listed in this table Required Site Review and Documentation for Phased Construction 1 (to be performed by the appropriate registered design professional or his/her designee or M.G.L.c 112 §81R contractor) Site Review and Documentation R Site Review and Documentation R Soil condition/analysis /report Energy efficiency x Footing and Foundation Fire Alarm Installation' x (including reinforcement and foundation attachment) Concrete Floor and Under Floor Fire Suppression Installation x Lowest Floor Flood Elevation Field Reports' x Structural Frame — wall/floor /roof x Carbon Monoxide Detection System Lath and Plaster /Gypsum x Seismic reinforcement Fire Resistant Wall /Partitions framing x Smoke Control Systems x Fire Resistant Wall /Partitions finish attachments x Smoke and Heat Vents x Above Ceiling inspection x Accessibility (521 CMR) x Fire Blocking/Stopping System x Emergency Lighting/Exit Signage x Other: Means of Egress Componenets x Special Inspections (Section 1704): Roofing, coping/System x Venting Systems (kitchen, chemical, fume ) Mechanical Systems x All items listed in this table 5. Include field reports and related documentation 6. Work shall not proceed, or be concealed, until the required inspection has been approved by the building official, and nothing within construction control shall have the effect of waiving or limiting the building official's authority to enforce this code with respect to examination of the contract documents, including plans, computations and specifications, and field inspections. 7. Rough and/or finish inspections of electrical, plumbing, or sheet metal shall be inspected prior to rough and finish inspections by the building official. I (type or print name) am the building permit applicant and by entering my name below I attest under the pains and penalties of perjury that I have received this checklist of required inspections and approvals. �t Si Phone No.: Email: I GLtc i,kO s A �6,C� r ✓ 0 A( ��, 4 D Z 0'4 C E Signature or type name if electronic signature / ( Q Lt o i �C & [ . e �U aaC t y � .- j 111 u '" Building Official Use Only Building Official Name: Date: Trial Version 10 09 2012 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Superiisor Li*ense: CS-062358 RICHARD D A 30 FORBES EVEa ; NORTHAMIITONi OI Expiration Commissioner 02/10/2014 Unrestricted - Buildings of any use group which contain less than 35,000 cubic feet (991m of enclosed space. Failure to possess a current edition of the Massachusetts I State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov /DPS ACO 41 CERTIFICATE OF LIABILITY INSURANCE DATE 0/ 1 1 D,YYYY) �/ 10/ PRODUCER (413) 586 -7373 FAX: (413) 584 -0859 - - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Aquadro &Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 355 Bridge St., P. 0. Box 357 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Northampton MA 01061 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Insurance Company 0015 Aquadro & Cerruti, Inc. INSURER B: Commerce & Industry Ina Co. 0005 Texas Road • INSURER c: P.0 BOx 656 INSURER D: 1 Northampton MA 01061 INSURER E: i . COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. wsix ADO1; 1 POUCY EFFECTNE 1 POUCY EXPIRATION1 •: • �� POUCY NUMBER • : „ � l +. •: ►• 1 • : �, I. • • ■ UMRS I . GENERAL UABIUTY EACH OCCURRENCE $ 1, 000,000 •. v. a - , 7• X COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) $ 300,000 A 1 CLAIMS MADE X OCCUR T- CO- 8336L914- COP -12 01/01/2012 01/01/2013 MED EXP (Any one person) 15 5,000 PERSONAL 8ADV INJURY 1 8 1,000,000 ,......_i GENERAL AGGREGATE I $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCTS - COMP/OP AGG $ 2,000,000 7 POLICY 7 PRO- f-� • rig-S I I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ___ $ AUTO (Ea accident) $ 1,000,000 A X ALL OWNEOAUTOS IDTA0- 810 - 978X7592- COP -12 01/01/2012 01/01/2013 BODILY INJURY X SCHEDULED AUTOS (Per person) 5 HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS I (Per accident) PROPERTY DAMAGE S 1,000,000 (Per accident) GARAGE UABIUTY AUTO ONLY - EA ACCIDENT 1 $ ANY AUTO OTHER THAN EA ACC I $ AUTO ONLY: AGG i $ EXCESS 1 UMBRELLA UABIUTY EACH OCCURRENCE ' 5 10,000 000 X OCCUR I CLAIMS MADE AGGREGATE $ � v I$ A ? f I DEDUCTIBLE DTSN - 00 - 8336L914 TIL - 12 01/01/2012 i 01/01/2013 I $ X 1 RETENTION $ 10,000 I $ WORKERS COMPENSATION 1 WC STATU- OTH-; B AND EMPLOYERS' LIABILITY , TORY I NITS X FR ,' 1 �� -- ANY PROPRIETOR/PARTNER/EXECUTIVE El E.L EACH ACCIDENT i$ 500,000 OFFICER/MEMBER EXCLUDED' L J lI 1 (Mandatory In NH) WC006944471 12/31/2011 " 12/31/2012 E.L. DISEASE - EA ETIPLOYE6 $ 500,000 K desc x d SPECIAL PROVISIONS beiow E.L DISEASE • POUCY LIMIT I $ 500,000 OTHER Rented /Leased 660 84151118 01/01/2012 01/01/2013 $50,000 A Equipment or Der unscheduled it Equipment Floater DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION FLORENCE CASKET CO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 16 BARDWELL ST NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL FLORENCE, MA 01062 IMPOSE NO OBUGATION OR UABILJTY OF ANY KIND UPON THE INSURER, as AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE • C Aquadro /CTA 7 7 9 rya.' ACORD 25 (2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. 'N5025(293901) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office o Investigations 600 Washington Street Boston, MA 02111 . WWW.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /EIectricians /Plumbers AD plicant Information Please Print LeaibIv Name ( Business / Organization /IndividuaI): 40tAfi r E R Address: 0 c'k 5 6, P c k a S Gr - City /State /Zip: Al / 7 4 , 14 -' j - di22 / Phone #: 'Y Are you an employer? Check the appropriate ox: I Type of project (required): 1. ❑ I am a with employer 4. I am a general contractor and i Y 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2_1. I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling — _ These sub- contractors have ship and have no employees 8. Demolition employees and have workers' 9. Building working for me in any capacity. addition [No` workers' comp. insurance comp. insurance.$..: 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.❑ 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 q 13 ❑ Other employees. [No workers' 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: (CI14/l� erg ">v vm Gyc✓s p (3e( e to f wPc Policy # or Self -ins. Lic. #: //0( &r"/"Y y / // Expiration Date: 0/3/7A2 ( Job Site Address: / (e(Chc' ���� e ( -1 City/State /Zip: rlC�4� � lll �� )7/)(i),? 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 the imposition of criminal penalties of a fine up to 51, 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sienature: _ C /y� �'2! Date: / Phone #: `l Official use only. Do not write in this area, to be completed by city or town offcciaL — City or Town: __ _ Permit/License # - Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6. Other II Contact Person: Phone #: Versionl..7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR:110.11) ' SECTION 11 Structural REAUTHORIZATION Structural TO BE COMPLETED WHEN No WH Yes OWNERS AG • ' 0 CONTRACTOR APPLIES' FOR BUILDING PERMIT I, X. �f_ . __..__..__.._.:,..__ .._. _..__ ._.._._ ............._ .. a wnz f the subject property hereby authoriz; / c [,4-D R C. '6 C- Q k ft o �._/ -/CiC act on my b- If, in all n.-tters relative Jo-work authorized by this building permit application. _ M �� Airiti /- Sign .f •. -- Date T .G�� (�'/`. . . S t/ 1 C C d a /f C ` :a G , as uthor ge ereby 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 Lenalties of _ ._,_ \ C�,1iR v` C / _ i t l- c ' Print Name Signature of O edAgent Date - SECTION 12 - CONSTR SERVICES . 10.1 Licensed Construction Supervisor: Not Applicable El Name of License Holder. ` ..1 • �._.:__ _.._a,._._e.,......__. ;,....�._. ...... �. .......,,-. _....y._._.__._...._..,....__: .,.....____ _ __.._.. _._...__, _S . License Number 20 �(he5 /11.<e_ �/ /t i� o/ i96(7 .. _ Address Expiration ate 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 th b ilding permit. Signed Affidavit Attached Yes - No 0 • • • • Version1.7 Commercial Building Permit May 15, 2000 ; * .... SECTION 9- PROFESSIONAL bESIGN AND CONSTRUCTION!S ER:VICES - FOR 'BUILDINGS 'AND STRUCTURES' b•UBjECT TO C ONSTR UCTION. CONTRO L.: PUIRS UANT TO. 780 OMR .:1164CONTAIN !NG . Mb AE.tHAU35,000! C.F. . OF E.NkcLOSED:SPACE) 9.1 Registered Architect: Not Applicable CI - Name (Registrant): . • ________________________ .,,, Registration Number . ., ......,_ _ Address • , 7 ----- ----, Expiration Date • Signature . Telephone 9.2 Registered Professional Engineer(s): ., . ..4._:_.._:. I a f t , ,..a ______ ....__ Name Area of Responsibility . , — — --- • - - . AdOress Registration Number / ---, .---- ------- • Signa u Telephone Expiration Date --------- ----- _ _____, . . Name Area of Responsibility • _______ _____ ----- Address . .. Registration Number . l . . Signature Telephone Expiration Date Name Area of Responsibility Address . Registration Number • . . L.__ _ _.......: Signature Telephone Expiration Date Name Area of Responsibility I . : _ Address Registration Number ___ Signature Telephone Expiration Date 9.3 General Contractor ' A Not Applicable CI Company Name: ----- --. tRYTCCI iTcTieicri" ____—_________ Responsible In Charge of Construction P 0- aC /c 7 "4- 0(0 _ Address .1. Sgnature + .Jr i i Telephone • • Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTIONiSERVICES - 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 4/3 " Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number ._... Signature Telephone Expiration Date Name Area of Responsibility�� Name Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor 4 A. D U ` t ( /CC .__ Not Applicable ❑ Company Name: Responsible In Charge of Construction Address 378`/ Signature / Telephone Versionl.7 Commercial Building Permit May 15, 2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to6e filled in by Building Department Lot Size ____ _ _�(�G Frontage ....__...__ ', ._ . `._._,_.,..... ._.....,._.: Setbacks Front Side L. __ - R.`,._. Rear jee x « 1 f/ - Building Height E 77E2 n Bldg. Square Footage % Open Space Footage ° (Lot area minus bldg & paved parking) # of Parking Spaces -- Fill: (volume & Location) A. Has a Special Permit /Variance /Fin 'rig 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 Re•istry of Deeds? — NO DONT- KNO- W- IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO (X DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , 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 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, e vation, 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 , CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Addi m1 Accessory Building Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. / R k S u(, ."' 7 Of Proposed Work: 6f (c.L�'e t� r �.t . IL ''` ';�fe f 4j6-'�'t A^-t , , 5,0' 4. ') < 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 - I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 0 1 -2 ❑ 1 -3. ❑ ,P5- M Mercantile ❑ 4 0 R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 58 I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: ` P S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: _- ___ _____ , __._,.. ___- .,. '_ P_roposed_Use_Grou '� u - /: � _. .__. .-._------- - Existing Hazard Index 780 CMR 34): _______ w Proposed Hazard Index 780 CMR 34): ____ __ ,____.____ ____.,_ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSEDN CONSTRUCT OFFICE USE ONLY Floor Area per Floor (sf) / ( (( '\ 1 5t 3- 2 1 5- nd 2nd _,..._ 2 3 4 h _ _ ._._ _ 4 m ...�.. _. W.___- ---- _ __ _ Total Area (sf) Total Proposed New Construction (sf)_, ....._... 1 . ..... ... _. Total Height (ft) Total Height ft / /, 7. Water,Supply (M.G.L. c. 40, § 54) 7.1 Flood.Zone Information: 7.3 Sewag rsposal System: Public Private ❑ Zone _____ Outside Flood Zone Municipal On site disposal system Versionl.7 Commercial Building Permit May 15, 2000 Department use,onl C i Cit of Northampton S ta tu s o f Permi l Building Department C urb Cut/Dnveway P ' :.' DE 212 Main Street S /SepticAvaS[ablalty 5 2012 Room 100 Weter/Well A:valrability - DI P OFS - y J Northampton, MA 01060 Two Sets of StructuraFPlans NO MO A , ofvne 13 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans r‘ Other S eci ` ' p 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 This section to be completed by office 1.1 Property Address: t - t ( ) t - Rc e C a 56 �' ., ,... M Lot Unit it, 1 ee c.0 E l 6 . Zone Overlay District �i���ec�� Cr tC 2 (� -___- Elm St. District' CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: _ F t 6e5 /c // c�5 0 .__.._ 0 oK 6 oo i 6 j lore 4 c � -t 4 Name (Print) Current Address: /1/3 Mailing - 3 '/ y _ -__._ _ Signatur' t MTelephone 2.2 A Med •• Name Print l , (— (& C�� / _ � c; 4 -C ' Current Mailing_ M Address_ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building f7 ` J - 6906 (a) Building Permit Fee ` , 2. Electrical — (b) Estimated Total Cost of l , J OC 0 Construction from (6) 3. Plumbing , Building Permit: Fee 4. Mechanical (HVAC) �re Protection] ,c 000 6. Total = (1 + 2 + 3 + 4 + 5) 3 [ C)Q Check Number J� /5 (. 5 This Section For Official Use Only Building Permit Number Dater issued Signature: Building Commissioner /Inspector of Buildings Date _ .5tt _ � ' TRC-10't COS � �Cki 5 5E X a te'= 1C > S ��e ��t � t �N�nr � Elf— i 1 le t -1- Fe L : 5 S 5 t= • 5 = o 6 2 - `) — 1 °S -- i Y 9 . C File # BP- 2013 -0633 APPLICANT /CONTACT PERSON AQUADRO & CERRUTI INC ADDRESS/PHONE P 0 Box 656 NORTHAMPTON (413) 584 -4022 PROPERTY LOCATION 16 BARDWELL ST MAP 17C PARCEL 135 001 ZONE SI(71)/URB(29)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid q f 5 `r� ' 5 Typeof Construction: CONSTRUCT SHED ROOF ADDITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062358 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9RMATION PRESENTED: o'` 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. 16 BARDWELL ST BP- 2013 -0633 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 135 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ADDITION BUILDING PERMIT Permit # BP- 2013 -0633 Project # JS- 2013- 000684 Est. Cost: $53000.00 Fee: $157.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: AQUADRO & CERRUTI INC 062358 Lot Size(sq. ft.): 56192.40 Owner: FLORENCE CASKET COMPANY Zoning: SI(71)/URB(29)/ Applicant: AQUADRO & CERRUTI INC AT: 16 BARDWELL ST Applicant Address: Phone: Insurance: P 0 Box 656 (413) 584 -4022 Workers Compensation N O RTHAM PTO N MA01061 ISSUED ON:12/11/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: CONSTRUCT SHED ROOF ADDITION 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 12/11/2012 0:00:00 $157.50 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner