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32A-138 (9) 4/24/13 City of Northampton Mail-25 Main St 4th-5th floor 25 Main St 4th-5th floor Louis Hasbrouck <Iasbrouck @northamptonma.gov> m.._.��_.. To: Richard Lloyd <rlloyd @kohlconstruction.com> Wed, Apr 24, 2013 at 2:22 PM Richard, I need an architect letter and a code review for the project at 25 Main St. I also need some more information about the new windows; are they replacements or new installs, are they visible from the street or public way, etc, etc (central business district review?). Call me if you ha\A� questions; I'm in and out so if I'm not here, leave a number and time to call and I'll get back to you. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg 212 Main Street Northampton, MA 01060 (413) 587-1240 https:°O9le.con-V mail/ca/u/0/?ui=2&ik=ec5f19a57e&vAev--pt&search=sent&th=13e3d482d8dcdd5b 1/1 KlIx The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly Name(Business/Organization/Individual): Kohl Construction, Inc. Address: 31 Campus Plaza Road, Suite 3 City/State/Zip: Hadley, MA 01035 Phone#: 256-0321 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 10 4. ❑ I 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. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t 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 hive 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Insurance Company Policy#or Self-ins.Lic.#: WMZ 800287201 2010 Expiration Date: 02/10/14 Job Site Address: 25 Main Street City/State/Zip: Northampton, MA,01060 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 cePMM an lties of perjury that the information provided above is true nd correct Signature: Date: � Phone#: 413-25 6-0321 Official use only. Do not write in this area,to be completed by city or town offliciaL 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#: Versionl.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 H 0, c7tJa VP C4i A MIS0k ►ORL? _..._ ,_____.. _....... _...... . .,._. _. _.__. _... .... _..... as Owner of the subject property hereby authorize �� ah4l_ C�IIVS j(ZfJIC. I Ic7t.� flCi �.,...... . .. _._.__... ._._ _.._..._ ,...�.. _ _._�_ , .__... � ...,,..� ......_._. _..__.... .. _}to act on my behalf,in all matters relative to work authorized by this building permit application. Ir�f 1 Signature of Owner Date IiC-E}Aix 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 he pains.and_ enalties of perjury 2.0 Print Na Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder.r2�c-1:t A(Lp l�0 License Number 3 0 �0\A R-r-R AVE NyR V+A(A P-T1.0 p _ _.. w_ __ 1_..__�_ _........ . ._ Address Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affid vit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the bu' ing permit. Signed Affidavit Attached Yes a No 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTUR SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCL SED SPACE) 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number Address ....... Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): i Name Area of Responsibility i Address Registration Number i Signature Telephone Expiration Date . _._... __._ _..._._._ _a... _. _ _ _,..... . .... 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 3 Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor • �NL V� ��' t >�s I�LIC'"!- Not Applicable ❑ Company Name: Responsible In Charge of Construction 3 .CA v,.,,P LA 5 pL-A2:A F-O,AN'-> Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front _....... .. Side L R Rear Building Height � / ;..Bld g Square Footage Open Space Footage _ /a (Lot area minus bldg&paved -- parking) #of Parking Spaces - - Fill: ...._._. ... ._ . ..__....... .. .. .._.... ___ volume&Location A. Has a Sp al Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES 0 IF YES, date issued IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES C) IF YES: enter Book Page' nd/or Document#. B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtain e , Date Issued C. Do any signs exist on the property? YES NO Q IF YES, describe size, type and location: S(�t.�(n� d1J NI►AI1� �• ���, RzS'�AK�,4►S�S D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,jation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit 1qay 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCL06ED SPACE Id Interior Alterations Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description '1 gU�L-b jw-loerz($z- 'P0-rt '(-riatJS AS S�FO�J�I TO A100 1-*W3 Of Proposed Work: S-TA 1,2C,.14SE F5.1 W . Lt rkt Fl.0tl)L- Al J I. VtJ1t-Z,14tJJNIF AS Sf}OWKI SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business Nf C)ly fzz S A i l 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 Ed S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify M Mixed Use ❑ Specify: r S Special Use ❑ Specify COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: „ HESS _._ Proposed Use Group: NO �/ ECJ�SIIJE$$ Existing Hazard Index 780 CMR 34): ,- Proposed Hazard Index 780 CMR SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area pei Floor(sf) 0-b ..... 1st 15� ` 2nd _ 2nd ' 3rd 3rd .. _ m — _ . __ 4N , 4 Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water upply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: Public Private ❑ Zone Outside Flood Zoned Municipal On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Department use only s.. City of Northampton Status f Perrrt► X Building Department Curut/pr►veway Per m►tr Y 212 Main Street Sewer pt►e Agra►a rlrt dal I APR 232013 Room 100 Wliterw—bll AVa►labrlrt Northampton, MA 01060 Two Se s QStrucfuraPlar►$ z DEPT.OF BUILDING INSPECT x NORTHAMPTON MA 01 he 13-587-1240 Fax 413-587-1272 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 MA � 016r a ' Zone Overlay District Elm St District, CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: c :`I'AR- -�R... 3 C�vin P LAS P 47ZA- Re Name(Print) C.t}A VA%SAr C-0*.?, Current Malting Address: O l O 3 S /' �, •032 Signature Telephone 2.2 Authorized Agent: K4'� L. i...04 s�'rzue is O� I IJC, 31 CAVKP AS PLO,,ZJIrM RaA_1t _'r��.I_� 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 Z5 , &0o (a)Building Permit Fee 2. Electrical .0 0 (b)Estimated,rota)Cost of Construction from 6 3. Plumbing t 1, 1 d i'b Building Permit Fee 4. Mechanical(HVAC) p"O - 5. Fire Protection : .. ._.__. _... •6 tt ✓ 6. Total=0 +2+3+4+5) Check Number This Section For Official Use Onl Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-0973 APPLICANT/CONTACT PERSON KOHL CONSTRUCTION ADDRESS/PHONE 31 Campus Plaza Rd HADLEY (413)256-0321 PROPERTY LOCATION 25 MAIN ST ����� MAP 32A PARCEL 138 000 ZONE CB(1001/ C f) e 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: CONSTRUCT INTERIOR PARTITIONS&STAIRCASE]BETWEEN 4TH FLR & MEZZANINE New Construction Non Structural interior renovations Addition to Existing_ Accesso1y Structure Building Plans Included• Owner/Statement or License 96576 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay Signature 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.