17D-012 (51) 03/13/2014 07:48 4137967502 KEVIN OBRIEN PAGE 02
Wo O T RIEN CONSTRUCTION
P.0 Box 80125
Springfield,MA 01138-0125
(413)7348299
Fax(413)796-7502
Charles Miller 3/10/14
City of Northampton
2112 Main Street
Northampton,MA 01060
413-587-1240
WSW 8"nst
I request that you grant a modification to walve the requirement for control
construction for the project at Meadowbrook Apartments,Building 029,in
Northampton 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,
Kevin O'Brien
O'Brien Construction
P.O.BOX 801125
Sprineeid,MA 01138-0125
413-538-1556
MA Lic#049810 Fully Insured MA Reg 4 141140
03/13/2014 07:48 4137967502 KEVIN OBRIEN PAGE 01
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03/05/2014 06:23 4137967502 KEVIN OSRIEN PAGE 02
08 O-9BRIEN CONSTRUCTION
P.0 Box 80125
Springfield,MA 01 138-0125
(413)734-829
Fax(413)796-7502
Meadowbrook Apartments 3/5/14
491 Bridge Road
Northampton,MA 01060
413-584-7590
C
8uildina#29
Stair MplamMM
Remove existing stairs
Install pressure treated supports
Install new stringers 2x12 KD
Install new US risers
Install new 12"5YP step treads 42"w
Remove debris to an on site dumpster provided by Meaduwbrook Apartments
TOTAL $1,175.00
Cost of permit from City of Northampton not included.
Additional labor and/or materials will result in additional costs
THANK-'YOU 111
IMA QF_CONTRACT
Payment In full is required upon completion. — /4
SMNED DATE
SIGNED -�"� (91,
SCI E -3
AM tic#049810 Fully Insured AM Reg#141140
The Commonwealth of Massachusetts
Department of Industrial Accidents
a k• Office of Investigations ,
^ W` 600 Washington Street
t Boston, MA 02111
4..!
www.mass.gov/dig
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ` Please Print Legibly
Name(Business/Organization/Individual): C,/1$ L)c- -7
Address: Po
City/State/Zip: S /_i CL.� MA 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
2.-5„I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
have ave
ship and have no employees These sub-contractors 8. E]Demolition
working for me in any capacity.n• employees and have workers'.
� 9. ❑Building addition
[No workers' comp.insurance comp. insurance.
required.] D. ❑ We are a corporation and its 10.El 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.❑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 thepolicy and job site
information.
Insurance Company Name:' 4M ek I CAIJ 22/2 ; G H
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address:__ t �� /�« t� , (Jyri'7q,,OMP7n., City/State/Zip: 1t�y,QIN,aryl,0 16n IV 4 dl PC C
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Sisnature: Date: �-}3 (o
�
-- - -- j
Phone#:-
FIssuing fficial use only. Do not write in this area, to be completed by city or town official
---- �or Town: _-----__ ------ — ------PermitfLicense#
Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Versionl.7 Commercial Building Permit May 15,2000
J
SECTION 10-;STRUCTURAL:PEER REVIEW(780 CMR 11Q 11.)
Independent Structural Engineering Structural Peer Review Required Yes w No 0
SECTION 11 -OWNER;AUTHORIZATION TO BE COMPLETED WHEN .
OWNERS AGENT OR CONTRACTOR`APPLiEs FOR:$UILDING PERMIT .'
_.._.w_. __._.... as Owner of the subject property
hereby authorize _.....
._.--
act on my behalf, in all matters relative to work authorized by this building permit application.
_,
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 under the pams.and penalties_of oe�ury ._ _
Print Name
Sign tune of Owner/Agent - Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor_: Not Applicable ❑ _
p�9j/o
Name of License Holder
License Number
Address Expiration Date
Signatu a Telephone
SECTION 13.-WORKER S!:COIVIPENSATIONINSURANCE AFFIDAVIT(M G L c 1527§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 0
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS-AN.D STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT.TO 780 CMR 1.16(CONTAINING MORE THAN C
35;000 .F..OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
j
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
re
f 6� -eo
Address Registration Number
Signature/ Telephone Expiration Date
1
Name Area of Responsibility
Address R�istration Number
s ! -..----.---
Signature Telephone Expiration Date
Name Area of Responsibility
f(
Address Registration Number
i
Signature Telephone I Expiration Date
-.... ___._.. .....__ .-_. _.._-.-_._.__-..___.._.._ ._ __-._.__........._... ..._._._._`
Name T . Area of Responsibility
3
Address Registration Number
i �
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
..
s
Signature Telephone
0.
Version1.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON,-ZONING
Existing Proposed Required by Zoning .
This column to lie filled in by
Building Department
LotSize _.,.....�.�.._._.., __...�F `. � ..� ..��,.,_.._.___..�._,_w..._�.....
Frontage
Setbacks Front
Side L: R: --- LL_ _.J R:=
F------_i
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 0
IF,YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ' Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
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 0 NO
IF YES, describe size, type and location:
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 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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.
Of Proposed Work. -�D�.�C� 1St=YzS S m �� S
e/Z ,74jeS j ,�) �u� Iji� 47 �
�
SECTION 5-USE GROUP AND:CONS:TRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 18 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ - - - - -_
3A ❑
1 Institutional 11 1-1 El 1-2 El ❑ 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:
x
;
S Special Use ❑ Specify:
i
COMPLETE THIS SECTION IF EXISTING BUILDINGUNDERGOINGRENOVATIONS,ADDI-TIONSANDIOR CH ANGE 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
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
st i
ist
2nd _ __. 2nd
3 rd 3rd t
4th—
Total Area (so 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 Zone❑ Municipal ❑ On site disposal system[]
a
Version1.7 Commercial Building.Permit May 15,2000
z Departure t use,onlX
�a: "`s' �
City of Northampton stags�aPe � �� ;
__. ) Y Building Department Curb Cut/Dnvewa} Perm►t6 � �
x ks s x ya
LV��
212 Main Street Sewer/SepficAvatfal ►trty
Room 100 Wate�/�NeH/fivallabllity
,c
ions
140 MA 01060 Two Sets of 5tructu6aCPlans fr
one 4 3-587-1240 Fax 413-587-1272 Plot/Srte PFans `
Other 5pectfjc �' ; ��,�
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
6 R04
� Zone- Distract
I
__.___,w:___„......-�.m._..-•�.,_...,a�.... ..�...-._....._..�::»..-..�--- -'Elm cf. CB District`
SECTION 2-:PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _
3 M tA��`✓R/zvv f� ,4 /on_7��-�TS Li!9/ :. .�2 ,�J r >�� ..�....__..._..___
Name(Print) Current Mailing Address_: __
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 ermit applicant
1. Building (a):'Building;Permit Fee
2. Electrical (b),'Estimated Total.;Costdf
i Gonstfuction from- 6
3. Plumbing i Building Perm.it:Fee
4. Mechanical(HVAC) _. _"_ • _"_ _"� _ '__
5. Fire Protection ' ' :._...:_�......�...._....___._�__.._..�._...._,
_-6. Total=(1 +2+3+4+5) Check Number
This Section For:Official Use Only.-
Building Permit Number Date
Issued
- -- -Signature:_ -
Building Commissioner/Inspector.of Buildings Date
File#BP-2014-0932
APPLICANT/CONTACT PERSON KEVIN D O'BRIEN
ADDRESS/PHONE 66 GRALIA DR SPRINGFIELD (413)538-1556
PROPERTY LOCATION 491 BRIDGE RD-BLDG 29
MAP 17D PARCEL 012 001 ZONE URB(100)/WP(28)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE RISERS&STEP ON LOWER STAIRS
New Construction
Non Structural interior renovations
Addition to Existiniz
Accessory Structure
Building Plans Included:
Owner/Statement or License 49810
3 sets of Plans/Plot Plan 6K,�572,x- i`s ae MegSY
THE FOLLO ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I TION 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
Demo ' lay
Si&Wmi o uil icia 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.
491 BRIDGE RD-BLDG 29 BP-2014-0932
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.Block: 17D-012 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-2014-0932
Project# JS-2014-001610
Est.Cost: $1175.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin KEVIN D O'BRIEN 49810
Lot Size(sq. ft.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP
Zoning:URB(100)/WP(28)/ Applicant: KEVIN D O'BRIEN
AT. 491 BRIDGE RD - BLDG 29
Applicant Address: Phone: Insurance:
66 GRALIA DR (413) 538-1556 WC
SPRINGFIELDMA01128 ISSUED ON:311412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE RISERS & STEP ON LOWER STAIRS
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 3/14/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner