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D --f -O Z m a o m 0 m1 d tr � n = 3a c• cn O�' m° N -p Do 0 rt r °o z 0 m o D p m 03 -n X o n Q a -s CD m m m Q = a r �'+, CA) .Zm1 = a � — N m r+ 20 N n� C/) Z m 0 � � U) y _ ai ai w w o m co m m N N N N CD z ® C- N -1 X ;a ?1 ;a 0 o "-D Q. rnm _ _ o z z O jo O A Q m x � m a °o o N K c = Q c -s u m O 3 a � ° � rL 3 -r z Z 'N+ o (D OL°0 C OA ofD � 3 m tr p o wvo fD D Z lD H ' � ^J �p n fD CD i, CD co m @ w v a o '' m 6 m O o o n o � oo CD p �' j m o rn m vwi � m m vi n� 3 m N h� o - m O o v -4 m a� m = w m to Q cQ rD n u m s �. a) n If O m N g_ m 3 to p Q a N - m w ' D cn .cam x o �- A � m ci ` ao ° m J.C. PRATT BUILDERS CONST. LIC. #061401 • REG. # 115419 I request a modification to waive the requirement for control construction for the project at 69 State Street - Replacement Windows - because the work is of a minor nature. We are not changing footprint of structure, will not affect health, accessibility, life and fire safety, or performing any structural work. The cost of control construction is considerable when compared to the cost of proposed work. Respectfully, �- J.C. Pratt Builders 43 Montgomery Road Southampton, MA 01073 (413) 568-4246 43 Montgomery Road • Southampton,MA 01073 Phone: (413)i@&4W ., The Commonwealth of Massachusetts Department of Industrial Accidents _- Office of Investigations I- . .r 600 Washington Street Boston, MA 02111 www.mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers 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.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling _ 2.-►SQ I am a sole proprietor or partner- _ _- -- - These sub-contractors'have ship and have no employees 8. ❑Demolition working or me in an capacity. employees and have workers' g Y P t3'• $ 9. F-1 Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions �.❑ I am a homeowner doing all work ❑ 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' 1 3.❑ Other ,.,2L 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.Lie.#: Expiration Date: Job Site Address: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: lix - -- 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#: Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-;51 RUCT.URAL:PEER REVIEW(780 CMR 110 11i) _....: Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION 11 -OWNER:,AUTHQRIZATIQN TOBE COMPLETEQ.WNEN OWNERS AGENT OR CONTRACTOR APPLIES FOR:>BUILDING.PERMIT r_. _ w __— __..._a. _o-....._:•,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 7 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 pains and penalties of perur�!• ,, __� _ �_ -. Print Name 1 Signature of Owner/Agent - Date SECTION 12-CONSTRUCTION-SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: — License Number Address Expiration Date SignatureU Telephone SECTION 13=WORKERS'COMPENSATION INSURANCE AFFIQAVIT(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 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL P.URSUANT TO 780 CMR1.16(CONTAINING MORE THAN 35,000 C.F.OF EI LOSED SPACE) 9.1 Registered Architect: �— Not Applicable ❑ Name(Registrant): i 3 Registration Number Address Expiration Date- Signature Telephone 9.2 Registered Professional Engineer(s): I Name Area of Responsibility _.. __....__. ...._._._..._._........--..________ _..�__.__. _ __. _ _ ___.__._._.__._ ._........_... I Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility ............_.._...__._......__.. Address � _....,. R�qistration Number Signature Telephone Expiration Date 1 { Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i _ _..... .._._...... __.._._._.... ------_ Name Area of Responsibility I Address Registration Number 3 3 E t , Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction �_. 3.. .!'114� � .__ --Address Signature Telephone T Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING :;, Existing Proposed Required by Zoning . This column tore filled in by Building Department LotSize _�.,...._.._..__.�....,.,.....� _..�.. �. �.�....__._._�....__..._. Frontage Setbacks Front Side L: R• --- ! L•= R:? '� _ -e 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 _ -._.. ....__. IF YES: enter Book Page; and/or Document B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW C) 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, exca ion, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 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 L.:ESS THAN 35,.00q w 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[K Brief Description Enter a brief description here. ^,S4.4!/ OF qY �� -.u�. � Of Proposed Work:1 c0a25 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 ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H-Hi h Hazard ❑ 3A ❑ 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 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S eci p S Special Use ❑ Specify: �.. •. ..._. ._......_.____..�. .,.w. ����-�...__•^- ��� � COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONSAND/OR:CHANGE IN USE Existing Use Group _ _ Proposed Use Group. Existing Hazard Index 780 CMR 34):'_, �,µ_..._ 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 1 St 2nd 2nd ......_.........._.. ....._............__. '-'-.—_.-__.._-- 3 3rd rd 4th _..._..._..._-__.___ —._.. 4t' ._.._ .___..._.___.._......._ _..____._.......... ..-.__.__...___.•_._ Total Area(so Total Proposed New Construction s Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Di posai System: Public [ Private ❑ Zone' Outside Flood Zone❑ Municipal On site disposal system❑ v Version1.7 Commercial Buildin Permit May 15 2000 i �" Departrrte t use,onE� 11 r MAY City of Northampton Status pf Perrot z� � Building Department Curb r✓uf/Dfl�eway Permtt,f r � 212 Main Street Sewer/5eptlAvatlabtlify}� 3 a inspections Room 100 W6tdNWQ11 aval[abi5 a `—"-' Northampton, MA 01060 Twa Sets of 5tructura�Plansx phone 413-587-1240 Fax 413-587-1272 Elot/Site Prars Other Speclfjr ` �t � �� 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 :This section to be completed>byoffice 1.1 Property Address: Map Lot Unit Zone;: Overlay District ' El St District'' CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature p l.�✓JV-'-' 1.�//wry Tele hone 2.2 Authorized Agent: _ Name(Print) Current Mailing Addr�s , Signature � Telephone SECTION 3-ESTIMATED C0NSTRUCTIONICOSTS: Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building'Permit Fee 2. Electrical (b)Estimated Total,Cost.of ) ! O,C-00, Construction from- 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This.Section For Official Use Only.' Building Permit Number Date :Issued Signature:__ Building Commissioner/Inspectorof Buildings Date N t(j File#BP-2014-1204 APPLICANT/CONTACT PERSON J C PRATT BUILDERS Sf CT I# ADDRESS/PHONE 43 MONTGOMERY RD SOUTHAMPTON (413)568-4246 Q PROPERTY LOCATION 69 STATE ST MAP 31B PARCEL 258 001 ZONE CB(100)/ 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: INSTALL 49 REPLACEMENT WINDOWS New Construction Non Structural interior renovations Addition to Existing Accessory Structure - Building Plans Included• Owner/Statement or License 061401 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON l� 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 L 1 � 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. 69 STATE ST BP-2014-1204 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B -258 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:window replaced BUILDING PERMIT Permit# BP-2014-1204 Project# JS-2014-002035 Est. Cost: $40000.00 Fee: $240.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J C PRATT BUILDERS 061401 Lot Size(sq. ft.): 8276.40 Owner: SERIO COSIMO A&CLAIRE A LEBORIO J&MARY G SERIO Zoning: CB(100)/ Applicant: J C PRATT BUILDERS AT. 69 STATE ST Applicant Address: Phone: Insurance: 43 MONTGOMERY RD (413) 568-4246 (� SOUTHAMPTONMA01073 ISSUED ON.•512812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 49 REPLACEMENT WINDOWS 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: FeeTyne: Date Paid: Amount: Building 5/28/2014 0:00:00 $240.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner