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32C-001 (24)
a asaxchnsrtta' DEPARTMENT OF BUILDD,,'C INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ;4 ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, Pioneer Contractors (licens=Jpermitt.ee) 1,1,qth a principal place of business/residence at: P-0- Box 1 1 4 5 Northampton MA 01061 (phone«) -5 5 4--a (stir�t/ci t)'/statr.�ri p) do hereby certify, under the pains and penalties of perjury, that: ( I am an employer providing the follow ng worker's compensation coverage for my employees worldrlg on this job: Wcc 500595701 20C1Z oe o /Iy° Asnr i a fled F'm131nyerG Tnsur xiv Co --- ----- .--- T (Insivana; Company) (Policy Numlzer) (Ex-pi-ration Date. L ( ) I am a sole proprietor, general contractor or homeoNvner (circie one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Lnsu uc-- Company/Potiey Number) (E>Tirntion Date) (Name of Contractor) ansu ance Company/Policy Number) (E1•pitadon Date) (Name of Contractor) (Insurance Compaoy/Policy Nwnbu) (F-\pirauoa Date) (Name of Contractor) (Insurance Compaay/Policy Number) (E.ypimtion Date) (etiarh additic"shcd ifnoc, v to ioctudc infonustion pcttaining wall oocdr ors ) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowncn who employ per%.am to do ma: rrt coasuuct.ioa or repair work as a dwcl.tins of not afore than thmo units is which d--.c homoawacrresides or oa the grounds appucteaea<thacto arc aot 6'mOmay ooandaed to be cmployaa undcr tho Ymcker`a oempeasatioa Act(GL152,ss 1(5)),application by a homcoavcr for a Uccuzc or pamil maY oidcacc the Iegaf cuts of an employes under the Workoes Compoowdioa Act I undcr%umd that x copy of this rnacmcui may bo focwurded to tho Dcpumxai of Iodustxial A.id--ce ofboo of lraurwm for tho coverage vaificstion and dut failtae to&=u=covccuga uoder soctioa 25A of MGL 152 can Icad to the imPos—of aimiaal pcnaltics ooasi.s¢ng of a fine of up to S 1.500.00 anNor impriso�of up to one year and civil penalties in the form of a Stop Work Otdc and a fino 0(5100.00 a day agaiaA Mc. FPcrmit dgzuttnrn ii use only �p Number � — Lot# Si cure of LiccnscelPermi e Pioneer Contractors Transmittal Pi Con,Inc. P.O Box 1145 Northampton, MA. 01061 Voice 413-586-5491 Fax 413-527-5099 E-Mail pioneercontrac(&Vahoo.com Cell 413.626.7267 To: Louis Hasbrouck/Bldg. Comm. From: David Claxton Fax: Pages: 1 Phone: 413.587.1240 Date: 14 July,2014 Re: Thormes Marketplace CC: 0 Urgent X For Review ❑Please Comment ❑Please Reply ❑Please Recycle • Comments: I request that you grant a modification to waive the requirement for control construction for the repairs to the third floor ceiling project @ Thornes Marketplace, 150 Main St. 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 David Claxton Pioneer Contractors 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 No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Thornes Marketplace LLC as Owner of the subject property hereby authorize Pioneer Contractors to act on my behalf, in all matters relative to work authorized by this building permit application. J&,,r A �/� ��y �42`)R�—�r c�Fs- ` �+ 0611412014 ("'C.� 1�R4�{2�IZ�C't��S Signature of Owner Date David Claxton-Pioneer Contractors 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 perjury. fl� Print Name 1p-- 06/14/2014 Signature o wner/A ent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: David Claxton CS-017890 License Number 01/19/2016 Address Expiration Date (413) 626-7267 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(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 Q No Versionl.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 ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable El Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 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 Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA. 01061 Address (413) 586-5491 Signature Telephone Version 1.7 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: L: R: 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 O DONT KNOW O YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO @ DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained ® , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O 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 ® NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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 0 Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Repair&re-attach exisitng ceiling. Of Proposed Work: 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 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 213 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 ❑ 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 0 Specify: S Special Use ❑ I Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE 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(sf) 1 St 1 St 2nd 2nd 3rd 3rd 4 4"' m Total Area(sf) 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[Z] Municipal ✓❑ On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 Department use only __I V/ I City of Northampton Status of Permit JLL 15 2014 Building Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability Room 100 WaterM/ell Availability _Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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 150 Main Street--Thornes Marketplace Map Lot Unit Yoga Sanctuary--3rd Floor Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Thornes Marketplace LLC 150 Main St.,Northampton,MA. 01060 Name(Print)v Cs�y 1-` f&—4- Current Mailing Address: /�/�} ��kt- 7 '3X (413) 582-9970 Signature 5 � L-� Telephone 2.2 Authorized Anent: Pioneer Contractors P.O. box 1145 Northampton, MA. 01061 Name(Print) Current Mailing Address: 4em 7 (413) 586-5491 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $3,500.00 (a)Building Permit Fee 2. Electrical $500.00 (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) $800.00 s 5. Fire Protection 6. Total=(1 +2+3+4+5) ck Che Number This Section For Official Use Only Building Permit Number Date Issued Signatur . Builds missioner/Inspector of Buildings Date 150 MAIN ST-3RD FLR YOGA SANCTUARY BP-2015-0071 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-001 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-2015-0071 Project# JS-2015-000133 Est. Cost: $4800.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PIONEER CONTRACTORS 017890 Lot Size(sq. ft.): 16683.48 Owner: THORNES MARKETPLACE LLC C/O HPMG Zoning: CB(IOO)/ Applicant: PIONEER CONTRACTORS AT. 150 MAIN ST - 3RD FLR YOGA SANCTUARY Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAMPTON MAO 1061 ISSUED ON.712212014 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR & RE-ATTACH EXISTING CEILING 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 7/22/2014 0:00:00 $55.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner