32C-001 (18) SIEGFRIED PORTH
A R C H I T E C T
A.I.A.
116 PLEASANT ST.
SUITE 331
EASTHAMPTON , MA 01027
PHONE: 413-529-9434
03/18/13
TO:
LOUIS HASBROUCK
BUILDING COMMISSIONER
212 MAIN ST.
NORTHAMPTON, MA 01060
I SIEGFRIED PORTH ARCHITECT REQUEST THAT YOU GRANT A MODIFICATION
TO WAIVE THE REQUIREMENT FOR CONTROLLED CONSTRUCTION FOR THE PROJECT
LOCATED AT 150 MAIN ST. "THORNE'S MARKET PLACE", SECOND FLOOR NEXT TO
"IMPISH". BECAUSE THE WORK IS OF A MINOR NATURE, AND WILL NOT AFFECT
HEALTH, ACCESSIBILITY, LIFE SAFETY, SPRINKLER LOCATIONS OR ANY STRUCTURAL
ELEMENTS.
THANK YOU, 4` °q
SIEG RIED P• uY� ? ,c, `o.,, ,,
re7� �s T r'_- F� � ��� •
,/ l
p(aiijsre 9.-((- 6
(A) ;it% MAR k ()/0.5
The Commonwealth of Massachusetts r
Department of Industrial Accidents '
r : .
__- =' Office of Investigations
600 Washington Street .�
Boston,MA 02111
- www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
rj
Name(Business/Organization/Individual): e , 44-clei,„ /�it4,L - —_
Address: I,S ie 1 J/- 6 Yanv,l I'`o._ O Lb 3 3
City/State/Zip: 6 1" t& d tO 3J Phone#: ,fi_- 7y/0
Are you an employer?Check fin appropriate box: Type of project(required):
4. I am a general contractor and I
1.[�I am a employer with 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7. ❑Remodeling
2._0 I am a sole proprietor or partner- These sub-contractors have Th
ship and have no employees 8. 0 Demolition
employees and have workers' 9. Building
working for me in any capacity. Building addition
[No workers'comp.insurance comp.insurance.$,
required.] 5. 0 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
right of exemption per MGL
myself. [No workers' comp. rig p p 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.
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 `
: (\-/k
Policy#or Self-ins.Lic.#: \I VJ( (000;C bU Li 0 / Expiration Date: 1-10 `/e(
■
Job Site Address: k.i) Plait A �T City/State/Zip: �,., „ _ O L®(0
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 certify and•r the pains and pena ties of perjury that the information provided above is true and correct
Si' satire: _4 ..y 110,_ ., _.. ■ Date: I— 3
:
Phone##: "-7 L b
Official use only. Do not write in this area,to be completed by city or town officiaL
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
, 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 C)
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
(2.t� - as Owner of the subject property
hereby authorize __ . ___...':to
act on my behalf, in all matters relative to work authorized by this building permit application.
1 1-1516
Signature of Owner 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 u .-r the ..,ins and •en-Ities of__pea_,____r,_� � .
i If
Print Name ;
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: 1�i t^�`po �— _._.C _ _I&.k e. � _.
License Number
_.�._.. _m.:_._________._____.____.._ _ __.l
A ddress 1J� Expiration Date
�..
ature 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
•
Version 1.7 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 ENSLOSED SPACE)
9.1 Registered Architect: _
Not Applicable ❑
Name(Registrant): ` —
___.. . __.____.__..._.W__________
Registration Number
._.,.______...___._ _J 1
Address . _ ___... .....'
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
i
Signature Telephone Expiration Date
Name Area of Responsibility
i
Address___
Registration Number
I I
Signature Telephone Expiration Date
i
Name � Area of Responsibility *_ ��_..--
_ N .
i
Address __,_.___._� .. _._, _ Registration Number
F
Signature Telephone Expiration Date
Name Area of Responsibility
•
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
k r � a ^_ a�... "73T1 —\ `7 Not Applicable ❑
Company Name:
Responsible In Charge of Construction
k1tn).A: _ .A7-__ : 1as.� �_,__..6...10—3_3_ _Iii____..
Address
jjej-vj ---
Signature Telephone
1
Version1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING J •
Existing Proposed Required by honing ,
This column to. filled in by
Building Department
_
Lot Size . _ _ , � ... _
E
Frontage £_ :______._. , — ._v,
Setbacks Front ! i
Side L:' ` R: 3 L:1 . R:" I a t t
Rear ._
- ' 1
Building Height F""`7
`� � t a
Bldg. Square Footage 1 %1 1, :
1
Open Space Footage , , % , ,
(Lot area minus bldg&paved I l 1 I '
parking)
l i i i _ _ ,
#of Parking Spaces 1 '
Fill:
j ;
(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 Q DONT KNOW 0 YES
IF YES: enter Book ' Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q 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 Q , Date Issued
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: I _._
• .__ ... �__.__...�__. __.�.�...___....
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
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 Q NO Q
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> I§ e."7-.../
CUBIC FEET OF ENCLOSED SPACE 4 S2-----
Interior Alterations {g Existing Wall Signs ❑ Demolition 0 Repairs❑ Additions ❑ Accessory Buildin ❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ L
,st,_____O,,
Brief Description Enter a brief description here. ee
Of Proposed Work:I ,Q vM;C V Lo `V 45 h Eia`f46 '`tir4. 4icri S f vr,..m-e vve (.,howl 1, q.,3)
SECTION 5 USE GROUP AND CONSTRUCTION TYPE
GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B - r ❑
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 ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:j
S Special Use ❑ Specify:€ I
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING.RENOVATIONS,'ADDITIONS AND/OR CHANGE IN USE
_
�
Existing Use Group: ___ Proposed Use Group: = _.__ _ .M.
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)
5
1sr
_- ___... ..-., 1st 3
R
2"d 2nd
.,........_...__.. ...... _ _ _ rd 1
3rd 3
4th `__ 4th
___.___.___ __ 1
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
Version1.7 Commercial Buildin:Permit Ma 15,2000
,.....1
RECEIVED City of Northampton ,fig,ttt-14. 41:14':gr'iAlt.'t-,.rz:--..5si',tiei;;:°;„. t-A.fz,.';'7
MAY 2 0 2013 Building Department
212 main street
Room 100 ;,-,.., -,,,,..-:-tr.:,.'AT',1•411A-N...,;-,:g„zr-r7,7mr ,7,4„,4;-,,v,i,..,,,,. ,.,
Northampton, MA 01060
DEPT OF BUILDING INSPECTIO
NORTHAMPTON,mA 01041:me 13-587-1240 Fax 413-587-1272
-i'*.'1!'Ec''''?Ce*--4;4117#,Ii',,'A ' At14.10■4';`44Art 1=.1:1':**:7,i'*', „::,;-"■,IN
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
Map Lot Unit
\So /V\to'.t tz.) ,3 S' i
A.,
an•tAPON'IP-C4'--) k/'Pc 'n' %gw6-e-..-. i Zone Overlay District
''N fdl G-ars4 S .-5- e s%1/4
i -dm Si:District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
•
2.1 Owner of Record: .
I---7174-At.,
Name(Print)(Print) 11), li ilcfcc,,-... -' Current Mailing Address: —
Signature , _A' ILt...-----;7
il C ,l 7, SC/ “q Z.- 4- HO
Telephone
2.2 Authorized Anent:
gf
L.L.S.,.„ a_..L.fIZsita\?.11.,_&_04„033
Name(Print C7g____<1.4)-pt_r_R_Ik ml.1 E.AoL-i- Current Maitg Address: —. .
SS-1— 2L-11-12
,
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 10 co 0 j (a)Building Permit Fee
2. Electrical ?) –7 (b).Estimated Total Cost of
-AS 6 6 '-' ! Constniction from(6)
3. Plumbing : Building Permit Fee
4. Mechanical(HVAC) ........._
A 1
5. Fire Protection _.._____„......,, ...„...._ .....
6. Total (1 +2+3+4+5) .3 0 10 0 0 Check Number 075s lo s 1 g 0
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2013-1107
APPLICANT/CONTACT PERSON GERALD ARCHAMBAULT
ADDRESS/PHONE 68 AMHERST ST GRANBY (413)552-7410 0
PROPERTY LOCATION 150 MAIN ST-MEAGAN'S TREASURE-SUITE 220&230
MAP 32C PARCEL 001 001 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 / 4506
Fee Paid (P
Typeof Construction: REMOVE NON BEARING WALLS&FRAME NEW DRESSING ROOMS&WINDOW
WALL
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 010788
3 sets of P s/Plot Plan
THE F LOWING 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
•
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.
150 MAIN ST-MEAGAN'S TREASURE-SUITE 220&230 BP-2013-1107
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-001 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-2013-1107
Project# JS-2013-001828
Est.Cost: $30000.00
Fee: $180.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GERALD ARCHAMBAULT 010788
Lot Size(sq. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG
Zoning: CB(100)/ Applicant: GERALD ARCHAMBAULT
AT: 150 MAIN ST - MEAGAN'S TREASURE - SUITE 220 & 230
Applicant Address: Phone: Insurance:
68 AMHERST ST (413) 552-7410() Workers Compensation
GRANBYMA01033 ISSUED ON:5/24/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE NON BEARING WALLS & FRAME NEW
DRESSING ROOMS & WINDOW WALL
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 5/24/2013 0:00:00 $180.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner