32C-166 (29) Code Review Thomas Douglas Architects Inc
196 Pleasant St Toilet rm 196 Pleasant St.
Northampton,MA Northampton, MA
413-585-0641
8o6 Accessibility
CMR 521
Valuation of Project:
• This project's construction costs are: $6,730
• The assessed value of the building is: $721,18o
• The cost of the project is less than i% of the assessed valuation of the
building.
3.3.1 b. If the work costs$loo,000 or more, then the work being performed is required
to comply with 521 CMR. In addition, an accessible public entrance and an accessible
toilet room shall be provided.
3.3.2 If the work performed, including the exempted work, amounts to 30% or more
of the full and fair cash value of the building, the entire building is required to comply
with 521 CMR.
3.3.3 Alterations by a tenant do not trigger the requirements of 3.3.1B and 3.3.2 for
other tenants.
This project's construction costs are less than 30% of the assessed value of the
building and less than $1oo,000.
The proposed toilet room will be built to accessible standards.
End of Document
3 of 3
Code Review Thomas Douglas Architects Inc
196 Pleasant St Toilet rm 196 Pleasant St.
Northampton,MA Northampton, MA
413-585-0641
Work Area Method Calculations
The existing space is:
Basement: o
First story: 2,982 square feet
Second fl: 2,927
Third fl: 2,927
Attic fl: 2,062
Total building area: io,898
The new work area is 65 square feet
The work area is less than i% of the aggregate area of the building.
704 Fire Protection:
704.2, 912.21 Automatic sprinkler systems
Automatic sprinkler systems are installed throughout the building.
Level 2 work requirements:
The reconfiguration of space, the addition or elimination of any door or
window, the reconfiguration or extension of any system, or the installation
of any additional equipment.
This Project will have 1 new 65 sq. ft toilet room.
701.3 Compliance
There are no proposed doors or windows.
New electrical equipment must comply with section 708
Minimum ceiling height of newly created habitable and occupied spaces shall be 7
feet..
705 Means of Egress
This Project will not affect the existing egress elements.
705.7 Means of Egress lighting
This Project will not affect the existing egress devices.
705.7 Exit Signs
This Project will not affect the existing egress devices.
711 and 607 Energy Conservation:
None of the existing exterior walls or the roof are being altered, so no new
insulation is required.
2 of 3
Code Review Thomas Douglas Architects Inc
196 Pleasant St Toilet rm 196 Pleasant St.
Northampton,MA Northampton, MA
413-585-0641
CODE REVIEW July 28, 2014
196 Pleasant St
Northampton, MA
Applicable Building Code: MA 78o CMR Eighth Addition
IBC, IEBC International EXISTING Building Code, 2009
ZONING DISTRICT: CB
PROPOSED RENOVATIONS:
PROJECT DESCRIPTION:
• Install 1 new toilet room.
• This room will be adjacent to a 922 square foot employee-only storage and
office area. Other adjacent areas on this floor are storage and mechanical.
Use Groups
• B
• There is no change of use
• Existing separation of uses within the overall building: none required
• The current level of safety or sanitation will NOT be reduced and the
portions altered shall conform to the requirements of the IBC, including
interior finishes, interior floor finishes, and interior trim.
Construction Type
• 4
Sprinkler System
• The building is fully sprinkled. The system will be modified for the new
space.
704.4 Fire alarm and detection:
• There is a fire alarm system in the space with pull stations. The system will
not need to be modified.
I of 3
��
��� Initial Construction Control Document
Tobe submitted with the building permit application hvu
Registered Design Professional
�«vvorkpurtbc8 m edition ofthe
Massachusetts State Building Code, 780CMR, Section l07.6.2
Project Title: Date:______
Property Address: rthampton, MA
Project: Check one or both am applicable: ; New uoumUocduoL�xiatiu&Construction
Project description: Install a new toilet room in the attic of the building
[ as Douqlas K4A Registration Number: Expiration date: am
registered design professional, and hereby certify that l have prepared mdirectly supervised the preparation of all design
plans,computations and specifications concerning:
Entire Project [ ] &robitoo800| [ ] Structural [ ] Moobuuicu|
Fire Protection [ ] Electrical [ ] 0rbor
for the above named project and that such plans,computations and specifications meet the applicable provisions ofthe
Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee)shall perform the necessary professional services and be present on the
construction site oou regular and periodic basis to:
). Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
cuornauko iu accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, l shall submit ficld/nro8reoxreports(see item 3.)together with pertinent
comments,inuf000 acceptable k/the building official.
Upon completion of the work,l shall submit to the building official u 'Final Construction Control Duoomcot'
Enter in the space to the right a"wet"or
electronic signature and seal:
Phone number: 413-585-0641 F%W douqlasgidouglasarch
N OF
Building Official Use Only
Building Official Name: Pen-nit No.:--- Date:
Trial Version l0092V|z
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the.foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 7-2010 Fax# 617-727-7749
www.mass.gov/dia
The Commonwealth of Massachusetts
f r_1 _
Department of Industrial Accidents
I: Office of Investigations
�. 1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print I.,e�jibly
Name (Business/Organization/Individual): VC. L 4Grf 50�
Address: '3 N e w t tc, C i 4� pRR �4 ►
City/State/Zip: (Pre f-N A C 1 cl M4 Phone #: 5 2 2 __3165
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F-1 I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.19 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have ge F-1 Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance.*
required.] 5. F� We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. No workers' com right of exemption per MGL
y [ p• 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 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.
lContractors 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 thepolicy 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.
Ido hereby certify under thepains andpenalties of erjury that the information provided above is true and correct.
Signature: Date�-- / 2 l
Phone#: � 7 �1)S 0(o 4
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#:
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 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1 Thomas Douglas 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„penury.
Print Name
la-iov�o�s o U r �
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
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
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:
Thomas Douglas Not Applicable
Name(Registrant):
8944
Thomas Douglas Registration Number
_.. 08/31/2014
Address
(413) 585-0641 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 ❑
Company Name:
Responsible In Charge of Construction
Address
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 NO CHANGES
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 Q DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW Q YES
IF YES: enter Book Page, and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 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 NO
IF YES, describe size, type and location: EXISTING
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
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 kv
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 R 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: ', tr✓ 4 - Ih Nv-, Ibti�t�
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 High 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 Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: B Proposed Use Group: B
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 si
15 _ 2,982',
2nd
2^d 2,927
d 2,927; 3 rd
4m 65
4m 1,815;
Total Area(sf) 10,898 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 Zoned Municipal ❑ On site disposal system❑
I Version 1.7 Commercial Building Permit May 15,2000
Dep ritnsnt use only
Citybf Northampton Stafcbfl�i w
Bulldi�ng Department �ti �Qr ewayPerrtrt
—' 2.1-2 Main Street err
Room 100 Wterlell Avall
Northampton, MA 01060 Twat of Stticturai Pig
phone 413-587-1240 Fax 413-587-1272 PiotfSlte Plans_
Other Specrfy
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
'196 Peasant St Map Lot Unit
:Northampton,MA
Attic Floor Zone Overlay District
Elm St District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
;Thomas Douglas 196 Peasant Street,Northampton,MA
Name(Print) Current Mailing Address:
-- (413) 585-0641
Signature " Telephone
2.2 Authorized Agent:
same as above see above
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building $2,000.00 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
$1,000.00 Construction from 6
3. Plumbing $2,730.00' Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection $1 000.00
6. Total=0 +2+3.+4+5) ;y "130, tX7 I Check Number 5
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date"
File#BP-2015-0133
APPLICANT/CONTACT PERSON Thomas Douglas
ADDRESS/PHONE 196 PLEASANT ST NORTHAMPTON (413)585-0641
PROPERTY LOCATION 196 PLEASANT ST
MAP 32C PARCEL 166 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Typeof Construction:_INSTALL 4TH FLR TOILET-ACCESSIBLE STANDARDS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildiny,Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
Demolition Delay
E
� 7/1l
Signs re 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.
196 PLEASANT ST BP-2015-0133
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C- 166 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-2015-0133
Project# JS-2015-000238
Est.Cost: $6760.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 5401.44 Owner: Thomas Douglas
zoning: CB(100)/ Applicant: Thomas Douglas
AT. 196 PLEASANT ST
Applicant Address: Phone: Insurance:
196 PLEASANT ST (413) 585-0641
NORTHAMPTON MAO 1060 ISSUED ON:81812014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 4TH FLR TOILET - ACCESSIBLE
STANDARDS
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 8/8/2014 0:00:00 $55.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner