25A-043 Pepin Roofing & Siding Co.
52 Cottage St. Rear
Easthampton, Ma. 01027
413 527 3640
H.I.C. 107104
7/21/14
1 request that you grant a modification to waive the requirement for control
construction for the project at 68 Bradford St. 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. ((I have provided a stamped letter
from a registered design professional in support of this request.)) Thank you for your
consideration.
Respectfully,
Paul J. Miller
Pepin Roofing & Siding Co.
52 Cottage St. rear
Easthampton, Ma. 01027
SIEGFRIED PORTH
A R C H I T E C T
A.I.A.
116 PLEASANT ST.
SUITE 331
EASTHAMPTON , MA 01027
PHONE: 413-529-9434
07/21/14
TO:
LOUIS HASBROUCK
BUILDING COMMISSIONER
212 MAIN ST.
NORTHAMPTON, MA 01060
1 SIEGFRIED PORTH ARCHITECT REQUEST THAT YOU GRANT A MODIFICATION
TO WAIVE THE REQUIREMENT FOR CONTROLLED CONSTRUCTION FOR THE PROJECT
LOCATED AT 68 BRADFORD ST. NORTHAMPTON,MA. BECAUSE THE WORK IS OF A
MINOR NATURE, AND WILL NOT AFFECT HEALTH,ACCESSIBILITY, LIFE SAFETY, OR ANY
STRUCTURAL ELEMENTS.
EDARc
THA �kkED p0
SIE E� I
-N
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: to Y 6 S�•
The debris will be transported by: S�l
The debris will be received by:
Building permit number:
Name of Permit Applicant J��P -�. ��° �1
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
—
Department of1fidustrialAccidents
7i '
--, — Office of Investigations ,
`' F 600 Washington Street x
Boston, MA 02111
~� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information / Please Print Legibly
Name (Business/Organization/Individual): -
Address: „1 Cc>L1 )t' l� �c«r , os � �. -,�✓.e�.� rA e, Cpl 0„97
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
have hired the sub-contractors 6• ❑New construction
employees(full and/or part-time).* Remodeling
2. I am a sole proprietor or partner- listed on the attached sheet. ❑
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers' 9 ❑Building addition
[No workers' comp. insurance comp. insurance.$
required.]
5 10.❑Electrical repairs or additions
. ❑ We are a corporation and its
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.KRoof repairs
insurance required.]t c. 152, §1(4), and we have no 13 ❑ Other
employees. [No workers'.
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.Lic.#: 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.
a /✓ � .7��- Date•
St nature t1
Phone J�4
Official use only. Do not write in this area,to be completed by city or town offcciaL
-- -
--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-STRUCTURAL,PEER REVIEW(780 CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 -OWNERI AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FORSUILDING PERMIT
I, . ___w.. __.._,...____�.. .. !,as Owner of the subject property
hereby authorize . _.._..___ ,_....._ _. _. .._ .__."to
act on my behalf, in al!jnatto relative to work authorized by this building permit application.
Signature of Owner Date
I, c .. r.°j.��( __._. �! r�vc, , +d• v Goo
•-�,,_,__,�„j(..._...�..�_..__,_._..�..._____.M. ., ,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 penug_e..,�___,.m
Print Name.
:
Signature of O er/Agent Date
SECTION 12-CONSTRUCTION.SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:L r.•) _ i�z_'.1� _...__...___. 4: ._,. _7 .
License Number
. � rte. led J
Address Expiration Date
Signature Telephone
SECTION 13=WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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 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 PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF EN
LOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
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 R�istrationNumber
s_.. _.w, ._____
Signature Telephone Expiration Date _ _
._.....-.... _..
Name
Area of Responsibility
_.�.._�_...,,_._..___�.._.�....:
Address Registration Number
Signature Telephone Expiration Date
_.... w..� .. r�.v. ..__ _.... _ _..w . .. _..
Name Area of Responsibility
Address Registration Number
Signature Telephones I Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
--risk ��' a Z S/� �t'�l./ C'f`.�,r� "„ /� /✓�°. yyt r t�(u'1�,..__
Address---
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON:ZONING
Existing Proposed Required by Zoning
This column t6 Se filled in by
Building Department
Lot Size
Frontage
Setbacks Front /- R:Side L _ R. L
z.......,..�._.., ,.. ..�...,,.....
Rear _.
Building Height
Bldg. Square Footage %
Open Space Footage % _ _--
-- — (Lot area minus bldg&paved l
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 0 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 j Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued
C. Do any signs exist on the property? YES 0 NO 0
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 0
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
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
-4 ❑ A-5 ❑ 1B ❑
B Business Z 2A ❑
E Educational ❑ 2B - I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
- 3A ❑
H High Hazard ❑ _ - --- _. _ -
Institutional ❑ I-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
Specify:
.....
M Mixed Use
S Special Use F-1 Specify:
COMPLETETHIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDI-TIONSAND/OR.'CHANGE IN USE
Existing Use Group __.___.._.__. ._.. _ -_ W_ ___._ __ 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)
q.
St
1st
1
2nd ,
2nd
3rd ....-,.,.,.........._..,......_- 3rd ......�.____'_.._ ._ .....
th
4
4th ---------_.
Total Areas Total Pro osed New Construc'on s
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 E] Municipal ❑ On site disposal system E-]
Versionl.7 Commercial Building.Permit May 15,2000
Departure t usennly
City of Northampton status of Permit v
Building Department euib cut1DfiVeway Fzermrt
AL
J
212 Main Street sewerlSepttcAvalla5rli#y
Room 100 WaterlWel]Ayallabihty
-&p coons
Northampton, MA 01060 Two Sets of StructuaC Plans
I nc' P
R�of°s 4.13-587-1240 Fax 413-587-1272 Plof%S�te Plans
C
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
_.._ _._.
.......... __._._._.
Map Lot Unit
Zone. Overlay District
0
-- - Elm St:District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) 01A n;1,0f1�, Current Mailing Address:
Signature — Telephone
2.2 Authorized Agent:
vl CAL , t s leN/
Name(Print) 7 Current Mailing Address:
f c✓/ 11-/1 c./
Signature - %^� -�y Telephone S'r 7 3/1 1010
SECTION`3 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use:Only
completed by ermit applicant
1. Building (a)"Building Permit Fee
r
2. Electrical (b):Estimated Total;Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection ...,.w___ .. ._..... ._. _. __.....,.._.!
_ 6. Total=0 +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-2015-0069
APPLICANT/CONTACT PERSON PEPIN ROOFING&SIDING CO
ADDRESS/PHONE 52 COTTAGE ST EASTHAMPTON (413)527-3640
PROPERTY LOCATION 68 BRADFORD ST
MAP 25A PARCEL 043 001 ZONE GIO01)/
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: STRIP& SHINGLE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildina Plans Included:
Owner/Statement or License 049074
3 sets of Plans/Plot Plan
THE FOLL ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
olition Delay
of m ficia 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.
68 BRADFORD ST BP-2015-0069
GIs#: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 25A-043 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
CaterY. ROOF BUILDING PERMIT
Permit# BP-2015-0069
Project# JS-2015-000131
Est.Cost: $16500.00
Fee: $99.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PEPIN ROOFING & SIDING CO 049074
Lot Size(sq. ft.): 35937.00 Owner: MAZESKI CHARLES J JR
Zoning: GI(_101) Applicant: PEPIN ROOFING & SIDING CO
AT. 68 BRADFORD ST
Applicant Address: Phone: Insurance:
52 COTTAGE ST (413) 527-3640
EASTHAMPTONMA01027 ISSUED ON.712412014 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF
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 Sienature:
FeeType: Date Paid: Amount:
Building 7/24/2014 0:00:00 $99.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner