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23A-055 Fitzgerald Realty Corporation Fitzgeraldproperties123 @gmail.com Dear Building Department, I request that you grant a modification to waive the requirement for control construction for the project at 45-47 Maple St, in Florence 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. Thank you for your consideration. Respectfully, Harold Fitz:erald AP/ • raid Realty Co •r. e 37 Mary Jane Lane Florence, MA 01062 P.O. BOX 60445 • FLORENCE, MA 01062 • T:413-586-2529 • F:413-586-0256 The Commonwealth of Massachusetts Department of Industrial Accidents `;,i Office of Investigations 11,1 1 ., 600 Washington Street Boston, MA 02111: } www.mass.gov/dig 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.❑V] 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 2.❑ I am a sole proprietor or_partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub contractors have 8. ❑Demolition working for me in any ca p aci ty employees and have workers'. 9. Building addition [No workers' comp.insurance comp.insurance. ❑Building required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. officers have their Plumbing repairs or additions ❑ I am a homeowner doing all work ave exerc eir 11.❑ 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.❑ 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.#:�1 � �'E i' c?2.R!5- = X34 Expiration Date: /0 -- /g- --a ,l C� Job Site Address 73 7 l(.4 V��'� � Vl City/State/Zip: > ,c J� r � ,p/p Attach a copy of the workers' cdmpensation 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 1-' l . _. Date: / — & or s 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 SECTION 10-STRUCTURAL PEER REVIEW(780,CMR 110.11) . w 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 ,as Owner of the subject property hereby authorize act on my behalf, in all matters relative to work authorized by this building permit application. _µ___ ____ Signature of Owner .. �YnMF1w .•�WH Date I, __.-. __ _ ___. __ _ __..M 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 penaltieSMof,perlury. „ .,,-. _... _m. i Print Name ,._....__ i Signature of Owner/Agent Date SECTION 12-CONSTRUCTION:SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder.'.._1 �..__,.. ' ., 6 .._. _...__... License Number I Address v7 7 i / ,44,00� _ c Expiration Date -N s �.-_ c?-, —IS- — (9--0 LC- Signa e ( Telephone SECTION 13- ORKERS'`CO 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 this affidavit 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 EI LOSED SPACE) 9.1 Registered Architect: ._ * ? Not Applicable ❑ Name(Registrant): _._. _ ._ M Registration Number Address i .__ _..., .._ ,..__........: Expiration Date __ _.___i Signature Telephone 9.2 Registered Professional Engineer(s): [ i Name • Area of Responsibility _.._.__.r __._.__..__..____..,. _M_. �. _ __ _ ______1 ._ __._._ __..._....___._.._....._.__......_....._.._.___.._.... t Address Registration Number Signature Telephone Expiration Date I j Name Area of Responsibility Ie Address • Registration Number i Signature Telephone Expiration Date ��a�� �� __._..__ . _,-.... -.... .„....,....»................,...,..... .,.vs»....r.w.,+....« ,....,,.....,..........r..........� ..w.w,«+,.wo.......n.....+,n.r.+.ry......w..wn�,.....w..�.«..n...w ..«n-r...........n.«_.....dw+` ..y.�.-..,,w- ....._.�. __.m.....a..«.,.,.. .,..._.. Name. Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name .,_ __ Area of Responsibility Address Registration Number 9 _.,. ._ _.... . 1.m. „ Signature Telephone Expiration Date 9.3 General Contractor • Not Applicable ❑ Company Name: _ _ _ _ i Responsible In Charge of Construction �� � __.._._._... _�_��� ._._......___,,.,.... _.Address _ _ I t Signature Telephone • ^ ^ Vozsion1.7C000mooial Building Permit May 15,2000 & - - ^ '�-r-��-�7���� '� ' Existing ' � Proposed� . . Required by Zoning , _ Building Department Lot Size — ' _ I ; ----- -------� __� _� Frontage L�___-�__��__ __� �___-_ ____= L_____- Setbacks Front � _7 ' ' -� F-'-� ` �___/ F---l� � � r---� �i�� ��� ' aL-_-� �i _� }�L___) �___: L___� ( l ! / ' 7 ^ -� Rear c__-_� " ' Building Height ----� F---1 �---, "=a" [ �_] ___� Bldg. Square Footage [-_-� 96 r--- � } �---' - % . -� (Lot area minus um^&nu,� ; _-]' i __� L = r_ j - �--� parking) l. | - -� �__ 1 ` ' . ^' �__� | ^ #of�a6do�3pucnx ' -� - Fill: ' � _ (volume&cu�nvn . A. Has nSpeci Permit/Variance/Finding ever been �suedfor/on the site? ' NO e DON7KNOV 0 YES 0 � ] date��/�� issued: I - � IF YES: Was the permit recorded at the Registry of Deeds? p' ^' NO 0 DONT KNOW 0 YES and/or Document# IF YES: enter Book B. Does the site contain a brook, body of water or wetlands? NO (2( DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obta ned from the Conservation Commission? Needs tobeobtaned Obtained �-\ Issued:obtained �_w��� Ob~a~ v�� , Date v~�^/ C. Do any dgnsedstnn the prope� ��property? YES �_/ NO � �y IF YES, describe size, type and location: ��~'~ D. Are there any proposed changes tooradd �nnsof�Qns intended for the prope�y? YES � l NO �^� ---- �—� IF YES, describe size, type and location: E. Will the c natrucdnn activity disturb(clearing,grading, or tilling)over 1 acre orisb part nfa common plan that will disturb over 1 acre? YES `^�� l NO K*`~�� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Almimplit ' 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 C9' Change of Use❑ Other❑ Brief Description `Enter a�br1ief description here. Of Proposed Work: !rv► Y �3 /....- 5If/■-e -2-(Ad"FL G4` /� "4� re Dr h SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ID 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 ❑ I Institutional ❑ I-1 ❑ I-2 ❑ 1-3 ❑ 38 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 0 S-2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: .....a.� .., ......_..._ ..... ._._._ ,. . ._.___._......__.,.-.............__,..._.... COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS ADDITIONS AND/OR CHANGE IN USE Existing Use Group: ._ __.__.:__w.�. ,._.._______ _ I Proposed Use Group: ! __.,_....-__. ___ , _ _....___�_._. ? Existing Hazard Index 780 CMR 34): :.,___ ._�__ .._,_ __ Proposed Hazard Index 780 CMR 34):1____________,_ __ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY, Floor Area per Floor(sf) ._. -,..w._.....,., 2nd w. 2nd i 3rd _..__:. . 3`� ... __ _. 4th _____ ._._.:_,_._._. .._...._...., € 4th ... Total Area s ( f) Total Proposed New Construction(sfl 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 0 Zone „.,,.,___,,,= Outside Flood Zone[] Municipal ❑ On site disposal system El • Versionl.7 Commercial Building.Permit Ma 15,2000 { CU i I. orthampton t BUIM i ± Department 1 NOV 2013 2: aln Street e i *iiiNp' z Deppat ni e t sea,O�nl e 4.o- ,'status cf it i � � 0 ' A ar , ri fib. i, ap w2c}v Y s w,�3 s i.,k Z ° q Curb CutfDnveVy Permtt n >A I A is ,a SewerlSept»Aaifabtly M ` ' ' {, 4, � .K k } 8 i Ro.m 100 UateNUekayatfability Electnc Plamb,ng &G Oi-t + •n MA 01060 Twal Sets of StructiiratlPlans Nortreuh�tu..-MAI r : - -,0 Fax 413-587-1272 'PlotfSite Prans _ 1. ;. 4 :Other Specify } s tx.q, 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 /�7�p� i r �� ' ! Zone Overlay District Z L G" ETmSt:District CB District SECTION 2-'PROPERTY OWNERSHIP/AUTHORIZED AGENT . 2.1 Owner of Record: j1 , r? ,' ,,r,..,4 -41 ._ M _ .._,a ... __ __. . _..... �:... t v ;'rint I - Current Mailing Addres _s i ndi . ...i/ / ���/ /0,% i Telephone .. . i 1E ' __....... .._«..._...»....,�_.......+.......»....-........mss - ...�...� ......«.._,»........,.-................»..,_ 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 n D) (a)Building Permit.Fee 2. Electrical ;-----'------"7 (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 \ )tI . ( This Section!For,Official Use Only Building Permit Number Date -Issued Signature: Building Commissioner/Inspector_of Buildings Date r File#BP-2014-0589 APPLICANT/CONTACT PERSON RUILI MA ADDRESS/PHONE 37 MARY JANE LANE FLORENCE (413)586-2529 PROPERTY LOCATION 33 MAPLE ST MAP 23A PARCEL 055 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 41/ Fee Paid Typeof Construction: REPAIR 2ND FLR REAR PORCH ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070307 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ION PRESENTED: pproved 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 Molopay Signature of B. ding fficial Da e 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. 33 MAPLE ST BP-2014-0589 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-055 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2014-0589 Project# JS-2014-000989 Est.Cost: $500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RUILI MA 070307 Lot Size(sq. ft.): 32190.84 Owner: FITZGERALD REALTY CORPORATION Zoning: URB(100)/ Applicant: RUILI MA AT: 33 MAPLE ST Applicant Address: Phone: Insurance: 37 MARY JANE LANE (413) 586-2529 WC FLORENCEMA01062 ISSUED ON:11/12/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPAIR 2ND FLR REAR PORCH ROOF 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 11/12/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner