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38A-009 m x_ 0 GZ) 1 O z00 0 M 0 - m m m ril 73 —I co 6 0 6" 1'-6" 2-8 m � •• O > m - I mx i • cn °' c 5O O -0 5 � zo r -1 m (,) W z � m > w � � o 000 J < —I X 11111111111 5 Z w N • mZx ! e ‘ - -< 0 ° �- , G J_ � Co ;� a L7 c O _ -i m N * zm * c m Z m CO r0 *- o -ri • 0 0 m -< < z E Z X cn O ° 0co > X Z - X1 0 Z 0 m 0 i > 0 N m � > � zm 0 rn o0 m � 0 m 94, , 4-� z 42" n xi Om 'few C - c Z O oz,� m �-1 z o1 D —s ate ►. fi PILASTER SECTION DES BY DW RTL 1 NE F N.BY RTL T SCALE.._ 3/4• 1'0" . 4 I DATE 03/22/13 FOUNDATION REPAIR l �� �.�� ' E PROJECT NO 13032 REV Structural&Civil Engineering STUART WARNER rleet@wildblue.net DWG.N0. TEL/FAX: 978-544-8000 ST-1 P.O.B. 881 WENDELL MA 01379 TEL 66 PRINCE ST., NORTHAMPTON, MA / ,e - n *x City of Northampton Massachusetts � , � s., ',,r r-- w K =i DNPARTNNNT or BUILDING INSPNCTIONSr , ` " 212 Nein street • Municipal !wilding )a, • t - Northampton, NA 01080 �iiw ► 1��'� INSPECTOR Louis Hasbrouck Fax:413-587-1272 Chuck Miller Building Commissioner Phone: 413-587-1240 Assistant Commissioner SECONDARY CONSTRUCTION CONTROL DOCUMENT (For professional EnglnoorslArchitects responsible for a portion of a controlled project) Project Tide: / Date: Project Location: b g 10►"/hc a St: Map: Parcel: Zone: Scope of Project: �o-L•� cl�lt-1p�a�j�. T In accordance with the Eighth edition Massachusetts State Building Code,780 CMR Section 107.6: i, ©lO e?7 l ,e C-f Mass. Registration# 2 .S7.? / being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Fire Protection [ ]Architectural DO 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 work, I shall submit to the building official a final report as to the satisfactory Completion of the above mentioned work. tw or ai,ass c ROBERT T. Signature and Se I of Registe Professional l. LEFT c 1;;. STRUCTURAL €: 38942 �Qf015TE � • 25' Day of Ae, / 20 62 ,3 FSSrrp .N' (seal) The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,VO CQ14/S.+r vc÷e IV e_ Address. Cz,.s City/State/Zip:j€jjt?rf 7 ilt//ff 0/C0)-- Phone #: //,3 CYfre 4,0 3 Are you an employer? Check thea propriate box: Type of project(required): 1.Eye' am a employer with 43 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees 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 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' com right of exemption per MGL y comp. 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: 4 Policy#or Self-ins. Lic. #: 4 fee(' ` aI 3 /4.)a_. Expiration Date: ` / LO/y Job Site Address: 6' City/State/Zip:A0/ %P/f/ 91 Q Attach a co py of the workers' compensation policy declaration page(showing the policy number and expiration i on 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 u •the pai i nd penalties of perjury that the information provided above is true and correct. `) Signature: hit, / Date: 1°r3 Phone#: j ©FD3 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#: 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 NoA) SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, ,S—T- , as Owner of the subject property hereby authorize J O LV't4-L P P jt)D ryQi •:_C to act on my behalf, in all matters relative to work authorized by this building permit application. �yj�/ Si nature of Owner Date I, ,b17 AJ r° L l7 I 1°a G ,as Owner/ thorize 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. Print Na > Signa_Ire of Owner/ nt Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: L D • ct. rJV U - 0 3 5.€7/6. License umber Address \ l E ratio Date G 7" ` ,/3 - 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 t e b ilding permit. Signed Affidavit Attached Yes No 0 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 ❑ Name(Registrant): Registration Number Address 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 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 �2&jo c 5kc • Not Applicable ❑ Company Name: Responsible In Charge of Construction Address , I ,111 . y73- yy-oifl3 Signature Telephone Version1.7 Commercial Building Permit May 15,200O 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 0 � ---�-------'--' ------------------------------'------------�-� i | Name(F�y�v���____.__��--- ------------- --------------------- -----' -----� | —Registration mum ber - ' Address i-- -- -- Expiration Date Signature Telephone 92 Registered Professional Engineer(s): ------------------'---1 [- /-' - --- / | / Name Area of Responsibility ----- - -} Address i-------'---� -Registration Numjer - ! � /'- ' - ' 2��)-��---- Signatu - Tmu�nmnm �w��uwnDate ---------------------------'---'----�-------'--�-'----1 �----'----'----------- - - ' L-_-___.____-____-_--__'' Name Area of[--'----------------'------- -----'--- �- '------------ - ----1 / - _Responsibility----�--- --' '-' - --1 Address Registration Number Signature Telephone . Expk��nQa� �-- �-------------------'----- --'----------� ---- ---------------'--'7 Name ���R�p�u�� | � -- -- - ----------- -- � ---------------_- -. � � Address Registration Number r-- ---------� [--'-- -- ----- -- ---- --- -� 1 __-__-______� Signature Telephone Expiration Date - -- ' - ' ' - - - ------------'--- - r-- '--- -- - - ' ` Name Area of Responsibility �' -�---- - ----------- ---------�----- ----------- ------- r---- -- --------- -- ' - -' � __' Address Registration Number |--- --------') r----� ----------� - - Signature Telephone Expiration Date 9.3 General Contractor i -- � - - ' - --------------------'--------� --- ^ U _ /n_ ,4110^~rI`010 -TX)(° • | Not Applicable 0 Company Name ,Ds Of-6D '�^ -Te,pi _T'uJC ^ Responsible r`|�"Charge of Construction ?)- �w k 101 Address - _ - - 51/3-5-71-19,03- � G�nm�, - A Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING'' !,D c 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 Fill: (volume&Location) A. Has a Special Permit/Variance/Findin• ever been issued for/on the site? NO Q DON'T KNOW 411i YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 16 YES Q IF YES: enter Book , Page', and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO 16 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO X5 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,e avation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q 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 Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs%Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Lc'Sh4-,( -h(C'O rouKa(cc .'o--1 13"T7 d2 F-3-1 F- P'°' /°I44/ Of Proposed Work: '? R-e 11!!eil-i R le' 1 4 F F FOu..(vTt`o, s:II 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 ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential igi R-1 ❑ R-2 Pa R-3 ❑ 5A ❑ S Storage ❑ S-i ❑ S-2 ❑ 5B I Er U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: Ni 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 /V o C I.H4v9 tS BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1St 1St 2nd 2nd 3rd 3rd 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[3 Version 1.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: MM — , 2013 Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability OF BU LDINO 1N EGZ Room 100 WaterlWell Availability DEpNORTNANPTON Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 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 W R,iu c E Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5-rv� 2 Gv 2.-/)* . s",g0Llvei-D. /vl°��tfi/Ll Name(Print) Current Mailing Address: Fo Signature �� L' Telephone 2.2 Authorized Agent: D004-C.0 J. et_, ,t( ,3%)<52 (6�i�9�v /'f if'/1070(2v)- Name(Print) Current Mailing Address 7/3-- -7//r ��- Signature Telephone SECTION 3-ESTIM ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 01000. 2. Electrical (b)Estimated Total Cost of off ` Construction from(6) 3. Plumbing d70© Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) r 000' Check Number /6-4,0 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1030 APPLICANT/CONTACT PERSON TEAGNO CONSTRUCTION INC ADDRESS/PHONE 228 TRIANGLE ST AMHERST (413)549-0803 PROPERTY LOCATION 68 PRINCE ST MAP 38A PARCEL 009 001 ZONE URB(130)/RR(1)I THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /�0 3 1''�'J Fee Paid (�(/ J Typeof Construction: REPAIR FOUNDATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 82248 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 e' S- 2—43 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. 68 PRINCE ST BP-2013-1030 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38A-009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: FOUNDATION BUILDING PERMIT Permit# BP-2013-1030 Project# JS-2013-001703 Est. Cost: Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TEAGNO CONSTRUCTION INC 82248 Lot Size(sq. ft.): 16552.80 Owner: WARNER STUART Zoning:URB(130)/RR(1)/ Applicant: TEAGNO CONSTRUCTION INC AT: 68 PRINCE ST Applicant Address: Phone: Insurance: 228 TRIANGLE ST (413) 549-0803 Workers Compensation AMHERSTMA01002 ISSUED ON:5/1/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR FOUNDATION 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 5/1/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner