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38B-009 (2)
__ , I ! : I _ _ r : : : • • I , ; 1 1 �I' 1 ■ : : 1 . _ I • ! - _ i ! 1 I '..•.: . ..'1'' . ill,,, i IL i 1 i',. i," fl;;, illi, , ',,'',; ';' ' !, • [ 4-1.7-1 '''' i , . I• Q I 1 j I I • •C I 1 ;•i : _ ! -_ •_I • I_._ , y - 1 1 : : , I j 1 1 j I ... !I ' I I ' - •.. • • j I . 1 , I i I i • r , I ; j I - I _ r I i I ,I _ ._ - . ._.. _. . -f •_- r - - - i__.. _. - .._. - i I : • • If: . , , I • • I 1.. 1 I I I 1 : 1 I 1 I i I �I 1 • 1 I ______ 1 I k r f , I_ F ._ 1 ., __. • ..... _ _ ._ , .. . I • 1 yl L o • I 1 I • I I 1 I I 1' } I._ , i II : I II , I I•I ; •• •' I ', s ' �' ! 1 I • I : , , _ 1 I I - f 1 1 ri I I 1 I I I i , j I • • • P P r m � rl"ie9° tin Saba' (1r-t°�a}" jC= ,e. b z �jF y. fit Qi ° ay� ' ue� x s e �� 9 HO DOUGLAS l R m o a a Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 10/10/13 RE: 136 West Street, Suite 01, Northampton, MA Dear Mr. Hasbrouck I am writing to kindly request that you grant a modification to waive the requirement for control construction for the above referenced project at 136 West Street, Suite 01, for Steve Czupryna of Aldenville Construction, who has prepared the project scope of work. I have toured the project with the project manager and believe 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. Please except this stamped letter as consent that we allow for Aldenville Construction to oversee the construction and implementation of this project. Thank you for your consideration. Respectfully, .000.':.cis'‘..7:10 AN. wry. Tom Douglas / gb. t'l . ii'-',,\ Thomas Douglas Architects gl art%. 196 Pleasant Street '- , Northampton, MA 01060 r, , , •F' irk° 196 Pleasant Street.Northampton,MA 01060 I 413 S85.06412 j tdouglasarch tects.com • CS-080726 • .s s)+, STEVEN T C2RYNAaa 178 WHEA'T'T A.ND AVE CHTC©PEE$1A 01020 : 1112912013 DRIVER'S LICENSE 155 9a.END :!HUli3ER _ 03-16-2013 NONE S A 0 } 11-29-^017 -29-'964. s cuss ti REST :5 sex M; RGT 6.00 D NONE u e S7EVEN 7 178 WHEA7iAND AVE (/ •- - CHICOPEE,MA 01020-1761 DD 93.18.2013 Rev 07-15-2009 The Commonwealth of Massachusetts •--�- Department of Industrial Accidents 1 117-. . —. Office of Investigations =Tao! i> » ..... 600 Washington Street . � Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): s-6✓�.,,, 7- z.,JP/1'l Address: / 7 1 W/ rc44 2 .4i/.. ti/o/76 lei /4' 0 r a"2e..) City/State/Zip: Phone#: Are you an employer?Check the appropriate bo . Type of project(required): 1.❑ I am a employer with 4. Pir 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. Rkemodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.I required.] 5. ❑ We are a corporation and its 10.❑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' 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. 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. 65 1,/C — situce7,Nc 2-.7,4/S. ao Soars i445 Insurance Company Name;Wtbd - ,41 C 3.0 5 cc'. a/�/� We 79S6G99 Policy#or Self-ins.Lic.#: 4J r P 93 9 a ~/ Expiration Date: 7(AC ►y /'a €.4-7.6.3% /1b4erreeN wi"b y irks Job Site Address: /3G w 6s r Amva A.A.o wPIZ.✓ ,A- 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/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 certi u er the pai enalties of perjury that the information provided above is tr e an correct. Signature: �� Date: ` /d /3 Phone#: V/3-v21lG<-1'S Of 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 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 Not Applicable ❑ Company Name: PA Responsible In Charge of Construction 17 8 1.0HFA, ►rf> A/4 Mcb f'EE ow 0/4)2_0 Address _ Signature Telephone 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 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, J ) ,as Owner of the subject property hereby authorize J"I E Jt4 T 2 Z PiZL/ to act on my behalf, in atters r to thorized by this building permit application. /Signature of Owner � Date I, '/�� 5 l� �- , 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. t L)�(. Print Nam P.755-'}3 Signature ner/Agent SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: A J r atiAr 1 c g /vo 43,07 ‘, License Number 7 8 f E r9,9 c io w `i/99 h 3 Address Expiration Date � %3-e?9 - Sa/ S nature 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 No Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning ,i! /� �0 C 64 This column to be filled in by OV �{-y 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/Finding ever been issued for/on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW a YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO R DONT KNOW 0 YES Q 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 ec NO 0 IF YES, describe size, type and location: ti, ' Otis 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 Gy 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 Le 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. Ball-O tiu_'TO S'U T dCc -A) Nom' 6,21`D Of Proposed Work: OF'FIC F 5 TO C...P,SAIM QE+ --F1 Oa , ,-a.+. `ou-- +ccrcit&J E c T:-- EPL-rgCE. OL-ER- EXtS It O2*C.E. .0 O SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑ ,�,f A-4 ❑ A-5 ❑ 1B ❑ B Business Lkr 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 l ❑ U Utility ❑ Specify: 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: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) Aj/ /049- 1st 1st 2nd 2nd 3 3`d `d 4th 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water S ply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage posal System: Public Private ❑ Zone Outside Flood Zone Municipal Or On site disposal system _ .mad Version1.7 Commercial Building Permit May 15,2000 �� ` , v�� Department use only EC - -1, City of Northampton Status of Permit: �11 Building Department Curb Cut/Driveway Permit ICP‘ I 1 \ 0 212 Main Street Sewer/Septic Availability t)C _�t ons Room 100 Water/Well Availability P��, ,'= 5 orthampton, MA 01060 Two Sets of Structural Plans ectniortr -rV' ' p one 413-587-1240 Fax 413-587-1272 Plot/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 1 36 / ,G T j Map Lot Unit NOW(�c m c voR3 '(71 © Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: / AbgH PIdt P 1/2-T1,5/,5C s ie ? ' , ? / `7 '� 1 /= /* ''--'A 6/ f !/ Name(Print) Current Mailing Address: '{t 3 c d-- ) 2 b Signature Telephone 2.2 Authorized Agent: /Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 61 `00 (a)Building Permit Fee 2. Electrical nn�� (b)Estimated Total Cost of v3r 00 Construction from(6) 1 ( , CXD,CiO 3. Plumbing a`l gcn 1O() Building Permit Fee 4. Mechanical(HVAC) �y�-' 5. Fire Protection Li r 7-7` ` OD 6. Total=(1 +2+3+4+5) (6f , . on Check Number Ø q9, 10 This Section For Official Use Only Building Permit Number Date Issued Signature: r / 110111 idelf'— ' AWr' / —7° -' Building C. missioner/Inspector of Buildings Date 136 WEST ST-SUITE 01 BP-2014-0439 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-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:renovation BUILDING PERMIT Permit# BP-2014-0439 Project# JS-2014-000762 Est. Cost: $16600.00 Fee:$99.60 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEVEN CZUPRYNA DBA ALDENVILLE WINDOW 080726 Lot Size(sq. ft.): 56497.32 Owner: NORTHAMPTON PROPERTIES INC Zoning: SI(100)/ Applicant: STEVEN CZUPRYNA DBA ALDENVILLE WINDOW AT: 136 WEST ST - SUITE 01 Applicant Address: Phone: Insurance: 178 WHEATLAND AVE (413) 246-8801 CH I COPEEMA01020 ISSUED ON:10/11/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:SUITE 01 - DIVIDE OFFICE & ADD KITCHENETTE 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 10/11/2013 0:00:00 $99.60 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner