32C-165 Initial Construction Control Document
!t To be submitted with the building permit application by a
7.2 `. �� Registered Design Professional
1 ►f ,' for work per the 8'h edition of the
Massachusetts State Building Code, 780 CMR,Section 107
Project Title: �T/�// Date: /1 457
Property Address: _�/1�t /�/ fe/ /Lw. i%A IL."(
Project: Check one or both as applicable: 0 New construction )(Existing Construction
Project description: / _ doi AM:'
I,6_ ;: A' a, MA Registration Number:£'4 Expiration date:V ,am a
registere• design professional, and I have prepared or directly supervi th preparation of all p s,
computations and specifications concerning:
To(Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [ ] Electrical [ ] Other
for the above named project and that to the best of my knowledge,information, and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress r-•• r.. u 3.)together with pertinent
comments, in a form acceptable to the building official. Ep AR
Upon completion of the work,I shall submit to the building offi 4.1 � }Con.r, milik• •ntrol Document'.
Enter in the space to the right a"wet"or / t No
o. •y=
electronic signature and seal: / +- ' 'dM771I
Phone number: 1{3-�2/�'y� �T Email:
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06_11_2013
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
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Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
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Title Telephone No.(business) Telephone No. (cell) e-mail address P CO-u..1
If applicable,the property owner hereby authorizes
JrXeG0i#V,//'illtZ4- .• !,ire O/ 4- / //27(J 4 67DCC)
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here U and skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
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Na e e:• trant) Telephone No. e-mail address _ Re ' tration Numb-r
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Street Address City/Town State Zip Discipline xpir. +'on sate
10.2 General Contractor
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Company Name F_x Da=it i fr.j-C e., 04cti 'qr.-(e1
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Name of Person Responsible for Construction License No. and Type if Applicable
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Street Address City/Town State Zip
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Telephone No.(business) Telephone No.(cell) e-mail address
SECTION II:WORKERS'COMPENSATIOI+ INSURANCE AFFIDAVIT(M.G L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ .6-5; 000, c 0
1.Building $ S S 00o` CJ U - Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $ 22/�
4.Mechanical (HVAC) $ Note:Minimum fee=$.J'!v (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 6 1 6•-L.:,, v U (contact municipality)and write check number here 6"�
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
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Please print and sign name Title Telephone No. Date
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Street Address City/Town State Zip
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Municipal Inspector to fill out this section upon application approv• /,,� ,_
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NOV 18 2013
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❑cct ic. t';,.S,I r . 3 ti?n: I;i :) i,tivna
" '``A 01'''0 The Commonwealth of Massachusetts
∎ct fi Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: J Building Official:
SECTION 1:LOCATION(Please indicate Block#��and_Lot#pfor locations for which a street address is not available)
/Z0:4 , 11% 2r • /ICJ t i '/�pl0 VrON f7r77C) L
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair. Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ NQ'
Is an Independent Structural Engineering Peer Review require.? Yes 0 No�X
Brief Description of ro.osed Work: !I .-���- �Ur
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,'ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): - L Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 aa90
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2 .Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Factory F-1 ❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ., IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:A trench,will not be Licensed Disposal SitPublic TA Check if outside Flood Zone Indicate municipaIX lr
e
.
Private❑ or indentify Zone: or on site system❑ re permit i l trench or specify:
perrmit s enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed Yes❑ or N Yes❑ No
/ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:__ Use Group(s):4 L Type of Construction: Occupant Load per Floor:/ 'O 0
Does the building contain an Sprinkler System?: Special Stipulations: --'7
125A PLEASANT ST BP-2014-0628
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 165 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
Penniit# BP-2014-0628
Project# JS-2014-001066
Est.Cost: $55000.00
Fee: $330.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVID FORTIER 008026
Lot Size(sq.ft.): 105415.20 Owner: HARMONIC ROCK
Zoning: CB(100)/ Applicant: DAVID FORTIER
AT: 125A PLEASANT ST
Applicant Address: Phone: Insurance:
32 Laurel St (413) 586-8965 WC
NORTHAMPTONMA01060 ISSUED ON:11/19/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REROOF PLATFORM ROOFS
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 11/19/2013 0:00:00 $330.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner