32C-119 (4) SACKREY CONSTRUCTION CO.
83 S. MAIN STREET SUNDERLAND, MA 01375
BUILDING DESIGN & CONSTRUCTION 413 665-9995
May 30, 2013
Chuck Miller
Northampton Building Inspections
Northampton, MA 01060
Dear Chuck,
I request that you grant a modification to waive the requirement for controlled construction for the
project at 15 Conz St. (replace drop ceiling) because the work will be minor in nature, will not affect
health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of
control construction is considerable when compared to the cost of the proposed work.Thank you for
your consideration.
Respectfully,
John H.Sackrey
Sackrey Construction Co., LLC
Northampton,MA Property Detail http://www.northamptonassessor.us/noho/commdetail.php?map_no=3...
City of Northampton, MA: Commercial Property Record Card
New Search Property Type Classification Code Reference Card 1 of 2 1 2
Parcel - Location - Zoning- Assessment
Map-Block-Lot: 32C-119-001 Zoning: Assessment:
Location: 15 CONZ S Neigborhood: 304 Land: 198,880
#Living Units: Deed Book: 9345 Building: 134,620
Class: C-031 Deed Page: 239 Total: 333,500
Building Information Building Sketch
Bldg#: 1 40 36
Year Built: 1900
# of Units: 1 2sBR/PB 1 sBR
52 52
Quality Grade: C+ 55 -
# Efficiencies: 0
# 1-Bedroom: 0 25
15 31 17 �—�-
# 2-Bedroom: 0
# 3-Bedroom: 0 23
Covered Parking: 0
27 5
Uncovered Parking: 0 44 E;
Total Unadj RCN: 152,610 2sBR/B z
Total Unadj RCNLD: 231,410
6 32
Grade Factor: 1.08
# Ident Units: 1 15
24
Func/Econ Factor: .5
RNCLD: 115,710 Detail Information:
Attached Improvements Levels Use Ext Walls Heat FAC % Good Unadj ]
'Type Meas-1 Meas-2 Meas-3 # Units - 131 91 7 0 1:
RP5 I 8010 11 11 - 01 27 f Brick Stone HW/Steam 7 0 7;
I- 02 27 Brick Stone HW/Steam 71 01 5;
Land Data Outbuilding Info
Square Foot Type Length Yr Phys Func
Utilities Descr Width Quan
Type SQ Value
or Size Built Cond Util
Feet All
no
Prime Public information
Site 11,870 198,880 --
Other Improvements:
1 of 2 5/28/2013 1:23 PM
The Commonwealth of Massachusetts
/ Department of Industrial Accidents .
` 'fill►= ' Office of Investigations •
- �[t 600 Washinanton Street •
Boston,MA 02111
www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� Please Print Legibly
/
Name (Business/Organi7ation/Individual): S A-C L- P.-4 S� LSD . L.-L.-a--
Address: .53 ■ ,,,+_.Q S5-P^
City/State/Zip: Ssv-t..a:0f 47 Vv Phone.#: (-) i 3 C(c) '' - le 3¶
•
Are you an employer?Check the appropriate box: • Type of project(required): /i
4.. I am a general contractor and I
1. am a employer with 7 g 6. 0 New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor orpariner- listed on the attached sheet. 7. 0 Remodeling.
ship and have.nc.employees These sub=contractors have. g, 0 Demolition
• working for me in any capacity. employees and have workers' 9. 0 Budding addition
[No workers'comp.insurance comp.insurance.#
required.] 5. 0 We are a corporation and its 10:0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.0 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. I h.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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. .ii ,, 1
Insurance Company Name: A _•. - , Vv\ " •
Policy#or Self-ins.Lic.#: Ft.64?12 Expiration Date:- 7---) `f / 1 'f
Job Site Address: , Ca City/State/Zip:' 'LO t #. G(`z l l/Q-44c.
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 c- und-�e pat, ra ,,penalties of perjury that the information provided above is true and correct.
Signature: , - Date: c /2A f l-.)J
Phone#: 9l') - c(6.12- (0-G _'7 7 -
Official use only. Do not write in this area,to be completed by city or town official
+ , ; ; , • , , ' , ,
++ I
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 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, .. ., as Owner of the subject property
hereby authorize .. ..._w. .. .w . .to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1, ---`--- -0' , 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.
Print Name
Signature Owner/Agent ate
SECTION 12-CONSTRUCTION S RVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: ._.30 tdcv.4 \,.,., --rl `---1
License Number
Address Expiration Date
I 4 17' c• >c- ' ( o
Signature 1 Telephone j -e/I Li
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
Version!.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
t
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
i
Signature Telephone Expiration Date
9.3 General Contractor
S N ' ..,., Not Applicable ❑
Company Name:
oar 4
5
>
Responsible In Charge of Construction
Addre
115-cC,3' toC.` f
Signatur Telephone
•
Version1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
t This column to be filled in by
t� Building Department
Lot Size
Frontage
Setbacks Front
Side L:' . R: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 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page, and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES 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,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
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. RQ„6D LA c.a.- Cal L4-L.Le” wt-t A 4>R-i t-Lr —
Of Proposed Work: —r 0 & C rz.(L. L
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 I ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-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 ❑
-
U Utility ❑ Specify:
gym..._
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: i. .. ._..._.. . _. . Proposed 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)
1st 1St
2nd 2nd
3rd
3rd
4m
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 ZoneD Municipal ❑ On site disposal system
Versionl.7 Commercial Building Permit May 15,2000
---- Department use only
RECEIVED City of Northampton Status of Permit:
Building Department Curb Cot/Driveway Permit -
MAY 2 8 2013 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets'of Structural Plans
DEPT.OF BUILDING INSPE T
NORTHAMPTON,MAO one 413-587-1240 Fax 413-587-1272 Piot/Site Plans
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
15 C.e S C. p
Ma Lot Unit
Zone Overlay District
Elm`St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner o ecord:
.
\ Name(Print) �, 7— �rt, y Current Mailing Address:
Signature Telephone t. 7 4" 9 ,- > 1
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature 1 Telephone
SECTION 3- STIMATED CONSTR CTION 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 1 1
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-1153
APPLICANT/CONTACT PERSON SACKREY CONSTRUCTION
ADDRESS/PHONE 83 SOUTH MAIN ST SUNDERLAND (413)665-9995 0
PROPERTY LOCATION 15 CONZ ST
MAP 32C PARCEL 119 001 ZONE NB(96)/URC(4)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ���
Fee Paid
Typeof Construction: REPLACE DROP CEILING W/DRYWALL&INSULATE CEILING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 040714
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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
D- olition Delay
7--/3
• •. e of Bui ding 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.
15 CONZ ST BP-2013-1153
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 119 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-2013-1153
Project# JS-2013-001895
Est. Cost: $3500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SACKREY CONSTRUCTION 040714
Lot Size(sq.ft.): 11848.32 Owner: POWERTENINTWO LLC
Zoning:NB(96)/URC(4)/ Applicant: SACKREY CONSTRUCTION
AT: 15 CONZ ST
Applicant Address: Phone: Insurance:
83 SOUTH MAIN ST (413) 665-9995 () Workers
Compensation
SUNDERLANDMA01375 ISSUED ON:6/7/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE DROP CEILING W/DRYWALL &
INSULATE CEILING
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 6/7/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner