39A-023 (2) Louis Hasbrouck <U -- /3
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
Dear Sir,
I request you grant a modification to waive the requirement for controlled construction,for the project
located at 441 Pleasant St., known as Community Enterprises Inc., because the work is of a minor
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 to install a full lite 3' x 6'8" tempered glass door.
Respectfu I
Micha- 'L. Harrington
acs sties Director
Community Enterprises Inc.
CSL#102948
Phone:413-575-8345
A
J
•
1
rCq v
r
e � � .-
J
ti Z , _
�,,rro
Sv�d1S d
A
kil ;\ \. 4
o
-Oo 1 L -
...k
2
6.
"6 .: VilitY,
o
Z.� 1 -
4:1,. ''') \n
I;
p
•
', The Commonwealth ofMassachusetts
e.,.,�: Department of Industrial Accidents
t?. ,
Office of Investigations
,
l2
t, �,v-*7. , 600 Washington Street
`r. - Boston, MA 02111 •
_-- www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I 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
AI am a sole proprietor or_partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
g Y P h'• 9. Building addition
[No workers' comp. insurance comp. insurance. ❑
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11.❑Plumbing repairs or additions
3.❑ I am a homeowner doing all work
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.❑ 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:.
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
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/o 'ne-year impri ,nment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day a....:•.st the violato Be advised that a co py of this statement may be forwarded to the Office of
Investigations of the D • ,or/it surance • erage verification.
I do hereby cert,,, 'n,: II •pains +- - senalties of perjury that the information provided above is true and correct.
Signature: L. Date:
Phone#:
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#:
Version1.7 Commercial Building Permit May 15,2000
J
SECTION 10-,STRUCTURAL PEER REVIIEW(780.CMR::110 11),.
Independent Structural Engineering Structural Peer Review Required • Yes 0 No 0
SECTION 11 -OWNER:AUTHORIZATION TORE,COMPLETED WHEN.
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, N -,,.__._G ___.�/�(�.L5 aC` ' as Owner of the subject property
(-4 •\ f\ l 4 l'� 4 S
hereby auth tee ___ _ C� �
to
act on my •-,al in alio.tters relative to work authorized by this building permit application.
LA Al i v t iMou od e 6J-161012( _ 'ac) -13 .
Sign. - of• ner 1 . Date
I, . _ __ --C tL r—` ___t
l !41-- ,as Owner/Authorized
Agent hereby declare that the state ents and infor ation on the foregoing application are true and accurate,to the best of my knowledge
and belief. /
Signed under the pains an. ,'al' s •f.er
i
,
Print Name / _.. _.._.. _
3�
:Signature of Owner/Agent ` Date 9---,)-0 TL3 _..,.__
SECTION 12-CONSTRUCTION:S' ; CES
10.1 Licensed Construction Supervisor: .
4(C( -.._ Not Applicable ❑____
-'Name of License Holder.l ..���_ � #
License Number
.__..a(C: "6 7 Iii. Z—d . ...., --- __I .._... ..1._..m5':_1..5..__ .__..._.. _. ..
Address t1,7-1.(., ery Al Expiration Date
,
Signature Telephone
SECTION 1/WO' : RS'`',C() PENSATION INSURANCE AFFIDAVIT(M G L c 152 §25C(6))
. Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide thisraffidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
Version1.7 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 EIJSLOSED SPACE)
9.1 Registered Architect:
TM - _ __ ._ , Not Applicable ❑
Name(Registrant): I
1 Registration Number
Address i
Expiration Date
Signature Telephone
9:2 Registered Professional Engineer(s):
_ 1
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
_ _. . _ __ _ S _._._._._._.._..
Address • Registration Number _
Signature � Telephone� Expiration Date
y i 3
.
Name Area of Responsibility
,
Address Registration Number
Signature Telephone Expiration Date
1
Name _ Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
.. ..__._ jlit"LL.. 04-6 ( - . ._ .............._ .. .b I Not Applicable ❑
Company Name:CO J n/� G
Responsible In Charge of Construction
_.__._ 'T/''`C .._. .___..... ..._. ..... _.._.......-w__.....____..........___..r._
i
_Address-- to /mil AM 4iJ et _ sr.
/'o/LTA . P10N (AA, 0 6U 41(3 ` 34
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING 4 f
Existing Proposed Required by Zoning
This column to fie filled in by
Building Department
LotSize ---.._.. .�..._��.._. ! .......,.... _. ! -..._�. .__.a.M...._._..__.. ,
Frontage i...___ ._... ___._.___. — ,.
Setbacks Front ._. , ___._1 __. .
Side L:7---1 R.1__._,1 L:%,_w.. R:1r_... a i 3._..._._._
r—
_
...� = I
Rear `-
Building Height E" "1 ET-1 },.
Bldg. Square Footage _. _ I__..... %° ._._-_._' I,___._1
Open Space Footage A % �_ u ,---
(Lot area minus bldg&paved J L... i L
parking)
#of Parking Spaces !
Fill: 4 ,€._
3 1
(volume&Location) ,__,.._.—_.____.—_ __.__._..._ __. _......_...._._._
•
A. Has a Special Permit/Variance/Finding eve een issued for/on the site?
. NO Q DONT KNOW YES Q
c.
:IF.YES, date issued: 4
IF YES: Was the permit recorded at the Regis of Deeds?
NO Q DONT KNOW YES Q
IF YES: enter Book Page it?and/or Document
B. Does the site contain a brook, body of water or wetlands? NO ONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued: E
C. Do any signs exist on the property? YES
(Fr NO Q
1 t iµ ,5/Pe
IF YES, describe size, type and location: � X1�r- r= ��. pr
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading, exca on, 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.
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. ,)r/-L (, 3 `y G g/I �vf�'-t_t WY 4A'^MYJV„wM Of Proposed Work:i ,A .��
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 - r ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ - 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B I ❑
U Utility ❑ Specify:
i
M Mixed Use Specify: 1
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): ___ _ w _, _,_r_ __ ,_., Proposed Hazard Index 780 CMR 34): L._ __r„__._._____,_ .
SECTION.6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE.USE ONLY
Floor Area per Floor(sf)
15t ....... ... . .._.._.... _....__._.. ..__._ _.., 1st
nd __° ,.�...—_.,._.,..__ ____ , 2nd
2 3
3rd 3`d ..
....._.._..._._..,_.._.....,M._. th i.„........ ..
4th 4
Total Area(sf) J Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft ;_:
7.Water Supply(M.G.L.c.40,§54) 7.1 F1ood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone❑ Municipal ❑ On site disposal system
_.,
7.. .., _ ,
R .. ,
. , . Version Commercial Building Permit May 15,2000
L.
Vfi' 44210APeOtttrl6tit 1400;601Y,Icier4,„ ;?;Wi;:;.:.-
"44,4o..04.44,444;x-cnvi4m,ofeAw:m*Ftt.ws,i,vikoo.w:40,4'7.:v. ,,,.
1 ! City of Northampton ;stauts,I.ofRerriuti,vneiwpiat,,,,,t4*, 44e0-0,L4rfti.„14,,,r,
Building Department
212 Main Street
..... j '
aPT OF E3L );,-;: jr,ot
NORTHAMPTO,N.tiv;01060 'LS ____,' Room 100
Northampton, MA 01060 i4 14W
,..5,.,:i :1141:igvi7,4,y:,,,,,-,
cutbizeltiprivew4Y-iFtPerilltiy_41,4A, -,d,trifte:**,;t4;P:1
;24,p.zsivom.44.4,4:401;,*,:ttt-amvp-4,:mowevotk.N,A.,tifmnIf
' ;aP*riqq002.001.faNittia,4*.ttN,,,..0„,,,,A,0,x-44....,:ggR,,,,,a,,, ,,,,,,
,,....,,,,,kt,094,-raj6,Vz.- W,...''A:Vq-,. .,514, ,:<',',;:.
‘11/-at..eilkitfpltAvairabliity0Mem,kM:19441.-4-- -, ..
.egukP441, , ,,, ,.v,,..v,, ,::4.,. .,vt,:VVF
'14/PIrS4ts0S,tiuttinfOrPlat4Vihz.A.k4, 40003,7A:,:. :4,-.. .4.:k
...
phdhe 413-587-1240 Fax 413-587-1272
Other SPatifNin4=4' .?:=7:-. P.;4.',IN,:::;, 1; :i.,i.-2-A .NA.-6:',-Y':t:'(;
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
q il t pi A- -A-Air -7-: Map Lot Unit
put,4-r 4 A--A4 PTO rt) evt.A. Zone::.
f 1 .i Overlay District
.
-L......,,............._..........._:.............. ........___. - ___........,..,...........--.:......--i:.;•-Eim..$t."...DiStriCf. , .:' CB District
:. . . :. . .: .. . ..,—... ..... :.:
SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT '-':'...:
2.1 Owner of Record: it'
372E . 1
Name(rint) A — Current Mailing Address:
( Aitaili- - 1_, j
r a la(60 t—T°41\ .(4- 4 .... _........
Signature f,/ AT ----____
Telephone tft — —7 4T-G—a-
2.2 Authorized A.- /
41 Al
'--------------' 114(((Ott-- t•11A/V11--/-e, ,I..__2
Name(Print) .' # - - - - Current Mailing Address' Aj.50/0 CTIO/U
1
Adig ' A' „------0:01-E:,______._..;
Signature 1 Telephone If f 3 -S-7 -
SECTION'a....ES •.. ED.0• S'7-UCTION COSTS: . ':-:
AlIF •
Item Estimated Cost(Dollars)to be ;.•,::: .:..•:; ......:.. OfficiakUse.Only ..
completed by permit applicant :. . .-. ..... . • .. •• . - -
1. Building ; '.°610 az) 1 (a)Building Permit Fee
f!. i
2. Electrical ; (b)Estimated Total Cost of
Pi Pr
c onstructionfrom(6)
' -
3. Plumbing '.-------- -----------1 ''Ehiildirig,Permit.Fee
.................,_17....„._ ,....„...._____„......,....._
4. Mechanical(HVAC) ,....,....,„__ .......___
5. Fire Protection N . ....„„..._i
" -
6. Total=(1 +2+3+4+5)
Check Number 1140X Set\55.
This Section:For:Official Use Only' ..
Building Permit Number . Date,
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-0205
APPLICANT/CONTACT PERSON MICHAEL L HARRINGTON
ADDRESS/PHONE P 0 BOX 393 NORTHAMPTON , (413)575-8345
PROPERTY LOCATION 441 PLEASANT ST
MAP 39A PARCEL 023 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Heal_ rt Fee Paid �J J
Typeof Construction: INSTALL 2ND FLR TEMPERED GLASS DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 102948
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I NF 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
1; • ' ' n Delay
3
Sign. re 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.
441 PLEASANT ST BP-2014-0205
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A-023 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-2014-0205
Project# JS-2014-000341
Est. Cost: $500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MICHAEL L HARRINGTON 102948
Lot Size(sq. ft.): 21344.40 Owner: COMMUNITY ENTERPRISES INC
Zoning: GB(100)/ Applicant: MICHAEL L HARRINGTON
AT: 441 PLEASANT ST
Applicant Address: Phone: Insurance:
P 0 BOX 393 (413) 575-8345
NORTHAMPTON ,MA01061 ISSUED ON:8/21/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2ND FLR TEMPERED GLASS DOOR
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 8/21/2013 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner