30B-041 (2) 1 CI 1 vnom it may concern.
The structure appears to be greater than 35,000 cubic feet and requires controlled
construction, however because the work appears to be in minor in nature and will not affect
health and safety issues we can accept a request for a waiver from controlled construction.
However, the letter needs to come from a contractor.
request that you grant a modification to waive the requirement for control construction
for the project at 309-311 Riverside Drive in Northampton because the work is of 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 the contractor in support of this
request. Thank you for your consideration.
Respectfully,
Aleksey Bazukin
Alebuzz Remodeling
40 King St.
Westfield, MA 01085
413-574-4550 �;
r
=, The Commonwealth ofMassachusetts
Department of Industrial Accidents
Office of Investig,ations ,
600 Washington Street
Boston, MA 02111
%~ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): �Q,k,�Q,y 1 A �_J v1 _
Address: �Q �H,p �4- we-t t'kPitJ'
City/State/Zip: WM44wd 1 01Q&5- Phone#: (113
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
employees (full.and/or part-time).* have hired the sub-contractors 6. F-1 New construction
2.YKJ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
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.t
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their I L Plumbing repairs or additions
3.❑ 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' 13T] 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 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.
Simature: a,71"b)h Date: S
Phone#: qt 3 S'174- 4
O'frcial use only. Do not write in this area, to be completed by city or town offtciaL
- -_. — —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#:
1
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 0
SECTION 11 -OWN ER.AUTHORIZATION-TO!BE COMPLETED: WHEN
OWNERS AGENT OR CONTRACTOR APPLIES"POR BUILDING!PERMIT
...... ............_
. as Owner of the subject property
hereby author e' _.. ._ �. (�a _ .. :� . .,..., �. .. . , ....._, to
a t on my beha ,' II matter ative to work authorized by this building permit application.
re of O 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 penaltiesrof pejl jg.. a
. ............
,..�.. . n..A.. . .. �w. . ...�.. ... �_. ..... .
Print Name
Signature of ner/Agent Date
SECTION 12-CONSTRUCTION:SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder. .._, t
License Number
Address Expiration Date
Signature Telephone
SECTION 13-WORKERS,;.
COMPENSATI,ON INSURANCE AFFIDAVIT(MG 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 CONSTRUGTIO.WSERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL:PURSUANT,TO 780 CMR.1,16(CONTAINING.MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable 17-1
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 I Expiration Date
9.3 General Contractor
Not Applicable ❑
mpany Name:
/Responsible InLharge of Construction
Address—
*a 5'79 It a
Nignatu e Telephone
Versionl.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON=ZONING
Existing Proposed Required by Zoning .
This column to lie filled in by
Building Department
Lot Size _
Frontage
Setbacks Front
Side L'--j R. _.___j LL I-1.11111-` R :..—._.,;
Rear
Building Height
i J
Bldg. Square Footage i`"" %
Open Space Footage
Y .
—— - (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 0 YES 0
AF,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 Page; and/or Document#!
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW C YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
-.....-..w.4w,..,,...�,,.w..,..,,,.„..._.,..,.ei
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 i0 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 O
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
,I
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign El New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description ter 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 7 ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational El 2B 13
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H'High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 11 S Storage ❑ S-1 11 S-2 El 5B ❑
UUtility Specify: '�'_,._..__�... _..�,.__... _........:........_______,,...._...,,___._.._....,�.M __M.,w_.._........,.___._,.....____,.,_
❑
M Mixed Use ❑ Specify:{
S Special Use E-1 Specify: ... ,.
f �s
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(so
5i .................. ...._._._ 1
st
1 ,
2nd _., 2nd
rd
rd 3
. . .; -
4 n ., ___.,._._ , . ....,. _.._.. w 4m
Total Area(s17 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❑ Municipal ❑ On site disposal system E]
Version 1.7 Commercial Building Permit May 15,2000
s� Departure t use,only
Dity of Northampton status af�Pem,Et x '
jUL 2 3 2014 wilding Department curb Cut1D6v.6z'zay Permd
212 Main Street Sewer/..6p c A�allab+lrty
Room 100 WatertWell Ava[labilay �
F
orthampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 f?IottSite 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
This section to be completed by office
.1 Property Address
3 l f �t t/( �Srlfit e tj V e— Map D Lot Unit
Zone Overlay District
t -
-. Elm St.District` C8 District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED=AGENT
2.1 Owner of Record
Na a(Print) Current Mailing Address
Signature Telephone
2.2 Authorized Agent:
/-� c . . �i�a•�.. . - h._._.__ �`� lu S .. Gr/ 1e�lr�l�i� av�e�a
Name(Print) Current Marling AddM ss
-Signature Telephone
LL L
SECTION 3-ESTIMA D CONSTRUCTION.COSTS
Item Estimated Cost(Dollars)to be Official=Use Only
completed by ermit applicant
Building (a)Building Permit Fee
2. Electrical - (b) Estimated Total Cost of
Construction from- 6 _. ... .. ..._ .,. ...
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection _....
6. Total=(1 +2+3+4+5) p Check Number
This;SectionI Foe Official Use Only.
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0095
APPLICANT/CONTACT PERSON ALEKSEY BAZUKIN
ADDRESS/PHONE 40 KING ST WESTFIELD (413)579-4550
PROPERTY LOCATION 311 RIVERSIDE DR
MAP 30B PARCEL 041 001 ZONE URB(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 WOW
Typeof Construction: SHEETROCK&PAINT NORTH APARTMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 103834
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFI�MATION 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
t_,Z_ 11_,o�l — 1 A�
Signature ofT3uilding 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.
311 RIVERSIDE DR BP-2015-0095
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30B -041 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-2015-0095
Project# JS-2015-000160
Est. Cost: $1400.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ALEKSEY BAZUKIN 103834
Lot Size(sa. i't.): 10018.80 Owner: OZCELIK STEVE
Zonin : URB(100) Applicant. ALEKSEY BAZUKIN
AT. 311 RIVERSIDE DR
Applicant Address: Phone: Insurance:
40 KING ST (413) 579-4550
WESTFIELDMA01085 ISSUED ON.712312014 0:00:00
TO PERFORM THE FOLLOWING WORK.SHEETROCK & PAINT NORTH APARTMENT
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 7/23/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner