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DEPARTMENT OP I3UILDfNG INSPEC'T'IONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
`YORICER'S COMPENSATTON INSURANCE AFFIDAVIT
L, Pioneer Contractors
(licenser/Permia.ee)
"'Ith a principal place of business/residence at:
hOne�
P_O" Box 1145 >\TnrthamntnIIy MA 0-1061-1 —� 580-54$1
(sum tici ty/statr.�a p)
do hereby certify, under the pains and penalties of perjury, ih?t:
( I am an employer providing the following worker's compensation coverage for my
employees wonting on this job:
Wcc 50059570120C1Z
Accnni ated FmpI nyim-r nsur_an1`g Cri
(I)surance: Company) ---- y
(Policy Number) (a-pim on Darr .
( ) I atn a sole proprietor, general contractor or homeowner (curie one) and have lured
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (F_xpirmion Date)
(Name of Contractor) (Insurance Compauy/Pobcy Number) (E%pifatioa Date)
(Name of Contractor) ansur-aace Compaijy/Poticy Number) (Expimbon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Eq)iration Date)
(atuch additional sheet ifnbxss to include informstion peruiaiag to all ooamcwr�)
( ) I am a sole propri etor and have no one worlting for me.
( ) I am a home owner performing all the work myself.
NOTE:plcase be aware thsi while homcowncra who cmpicy persons to do mind •=ooastruccioa or rzpaa work oa a dwelling of
not mode then thine units is wbich the bomoowacr rrsidcf or oa tbo grounds appudcamad tbacto arc not&,cxraay ooaridaod to be
employes under tho workc`s ocmpcam4c t Act(GL152'a 1(5)),application by a homrz>ava for a Uccwc cc permit may c-,-Kkm o tho
legit'natun of an employer under the Wodccex Compomstioa Act
I undera d dIA a copy of this cutcmcat may be forwarded W the Deperwras of inch&atrial Aocid=&offioo of Irrsuraocn for the
coverage ver&catioa and that failure to scatre covetago under sec uou 25A of MGL 152 an Ind to she kVOSihon of aiminal P—a cs
consisting of a fine of up to S 1,500.00 andlor imprisoamcat of up to one year and civil peu&Wcs in the form of a Stop Work Ord--and a
fine of S 100.00 a day aping mc.
r
Fa dTatmol ux OWY
Permit Number
lviap# _ _Lot#
Si tzrre of Licen_scelPcfmi
Pioneer Contractors
Pi Con,Inc.
Trarmnew
P.O Box 1145
Northampton, MA. 01061
Voice 413-586-5491
Fax 413-527-5099
E-Mail pion eercontracayahoo.com
Cell 413.626.7267
To: Louis Hasbrouck/Bldg. Comm. From: David Claxton
Fax: Pages: 1
Phone: 413.587.1240 Date: 28 July, 2014
Re: Thornes Marketplace CC:
❑ 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
removal of the existing awning&balustrade behind it @ 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 0 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
(Pioneer Contractors
hereby authorize?.--= .----___ _ _- to
act on m behalf, in all matters relative to work authorized by this building permit application.
&.-� �3E '� - -- 28 July, 2014
--------- — – --------------------"�----------,--------- – --_-- ---_– ----- --------- ---
Signature o Owner �-►G�v—CS lAaJ1CC C P u�zS_ L lL Date
David Claxton Pioneer Contractors aseav„er/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_pa_ins and penalties_of perjury.
Print Name n
--I�//,,`_— 28 July, 2014
-------- -- - ----------- ------------------------------------------ ----------------------------------
Signature f Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable O
(David Claxton CS-017890
Name of License Holder L---_---=
License Number
01/19/2 01 6
t -------------------- ----
Address Expiration Date
--- (413) 626-7267
-- ------------------- --
Sign re 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 4 No
Versionl.7 Commercial Building Pemiit 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
------------------ ---------------------------------------------------
-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
-- _ I _
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 O
--------------------------------------------------------
Company Name:
David Claxton
----- ----------- --- ------------------ ----- -- -- -- ----
Responsible In Charge of Construction
P.O. Box 1145 Northampton, MA. 01061
Address _
1(413) 586-549 1
---------- --
------ --- ------------------- ----------------
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: Li__ 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 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
IF YES: enter Book Page' and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 O NO Q
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 El Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description
Of Proposed Work: Remove Awning & Ballustrade Behind
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 I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B El
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:
i
S Special Use ❑ 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):i_ __ _ __ J 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)
__ _ _ _ 1St ;
15t
2nd
2nd
3rd ...... ._.. __
rd ! _._ _.. ..._.
3
4tn
4 th _
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 [r] Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
Departmentuse only
�} City of Northampton Status of Permit
—`=- V Building Department utlnvevay Perrn it,
___T____ -
I I 212 Main Street Sewer%Septic Availability
(� 3 0 Room 100 WaterM(e11Availability
��� Northampton, MA 01060 Two Sets,of Stlluctural Plans
Electric, nc— - ___ 1 p one 413-587-1240 Fax 413-587-1272 Plat/Site Plans
11 roc tr rnspoctions OtherrSpecify` �
�'c' i /` C7060
APPLICATION TO CUSTRUCT, 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
.150 Main Street--Thornes Marketplace
Facade REnovation zone overlay District
_...... .---._____ _____ --_-._ ___ __._ _.._._. __-i 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) , �j M Current Mailing Address:
'(413) 582-9970
Signature _______ _ Telephone
2.2 Authorized Agent:
Pioneer Contractors T.O. box 1145 Northampton, MA. 01061
Name(Print) Current Mailmq Address:
(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 (b) Estimated Total Cost of
1,500.001 Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) j �' Check Number J
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
------------------------------------------------------
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0127
APPLICANT/CONTACT PERSON PIONEER CONTRACTORS
ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491
PROPERTY LOCATION 150 MAIN ST
MAP 32C PARCEL 001 001 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
Tyneof Construction REMOVE AWNING&REPAIR BALLUSTRADE BEHIND
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF O jA `fION PRESENTED:
`
'A 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
em ' ion Delay
4ature 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.
150 MAIN ST BP-2015-0127
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-2015-0127
Project# JS-2015-000226
Est. Cost: $5000.00
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
zoninj4: CB(100)/ Applicant: PIONEER CONTRACTORS
AT. 150 MAIN ST
Applicant Address: Phone: Insurance:
PO Box 1145 (413) 586-5491 Workers Compensation
NORTHAMPTON MAO 1061 ISSUED ON.7131120-14 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE AWNING & REPAIR BALLUSTRADE
BEHIND
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 Deuartment 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 7/31/2014 0:00:00 $55.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner