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31A-076 (13) Est.Cost Proposed Use And Details °scription Fes Paid Check# JMBER OF PERMITS: 1 FEES PAID: $2,250.00 BALANCE: S.00 04,696.00 RUCT 5(2)STORY DORMITORIES(35,342 ote:pre-CO conditions $14,190.00 1254238 UMBER OF PERMITS: 1 FEES PAID: $14,190.00 BALANCE: S.00 UMBER OF PERMITS: 23 FEES PAID: $169,897.00 BALANCE: S.00 Pave 6 of 6 Permit Listing Report by Permit Number Permit Number Address(Work Location) District Zoning Owner Work Category Permit Type Permit No Online Permit No Permit Status Date Issued Contractor(Phone#) Work Dc Permit Number(BP-2015-0522)TOTALS: ESTIMATED COST: $450,000.00 NI FEES INVOICED: $2,250.00 BP-2015-0539 PARADISE RD(69 URC EU(100 SMITH COLLEGE OFFICE OF New Multi-Family $8,61 PARADISE RD) TREASURER Housing Building C OPEN/ZONING Dec-02-2014 WESTERN BUILDERS INC(413)467-9171 CONSTI SQ FT)n C� Permit Number(BP-2015-0539)TOTALS: ESTIMATED COST: $8,604,696.00 N1 FEES INVOICED: $14,190.00 GRAND TOTALS: ESTIMATED COST: $61,532,037.00 N FEES INVOICED: $169,897.00 GeoTMSO 2015 Des Lauriers Municipal Solutions,Inc. Jablonski DeVriese A r c h i t e c t s 29 Elliot Street Springfield , MA 01 1 05 -------------------------------------------------------------------------------------------- 41 3 747 5285 fax line: 41 3 747 0297 September 9, 2014 WWW_jdarchitects.com A F F I D A V I T To: City of Northampton, MA, Building Inspector Re: Construction Control Affidavit for alterations to Commercial Rental Property located at 264 Elm St, Northampton, MA 01060 In accordance with the Massachusetts State Building Code, 780 CMR, Chapter 1 , Section 1 16.1 , 1 Stephen Jablonski AIA, Massachusetts Architectural Registration Number: 6078 being a registered professional architect hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning the entire project, for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following: 1 . Review shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix B. I shall submit periodically, a progress report together with pertinent comments to the Building Inspector. Upon completion of the work I shall submit a final report and an Affidavit of Completion as to the satisfactory completion and readiness of the project for occupancy. r -�i i✓, psi,: ---� -------------- DANIEL,E ga. AL Stephen Jablonski AIA Notary Publ' . „� LISON F. Notary Public Commonwealth of Massachusetts My Commission Expires April 17,2020 _r The Commonwealth of Massachusetts Department of Industrial Accidents —' Office of Investigations r lx 600 Washing-ton Street W� Boston, MA 02111 Y www.mass.aov/dig Workers' Compensation Insurance Affidavit: Build ers/Con tractors/El ectricians/PIumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. E] I am a general contractor and I employees (full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have g, EJ Demolition working for me in an capacity. employees and have workers' b y p �'• 9. Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.7 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 showingtheir 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 are 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. Sienature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town offeciaL - - - 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 1110 111 Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION I1 -OWNER AUTHORIZATION-TO BE COMPLETED.,.WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, W . .. . ... w.._. _ _._..__ _.... ._ __... as Owner of the subject property hereby authorize act on m eYha. in, all matter I ive to work authorized by this building permit application. Signature o Owner Date as Owner/Authorized Agent hereby declare that the statements and informattn on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of per* ry. ,0.00i "� 7 - ButtT� �Z atw � Print Name Signature wn r Agent Date SECTION 12—CONSTRUCTION:SERVICES 10.1 Licensed Construction Supervisor. Not ApplicabI ❑ Name of License Holder: .......... License N ber Address Expiration 7-1-2-173 6 9 S' n Telephone SECTION 13-WORKERS..'.'.COMPENSATION INSURANCE AFFIDAVIT(M.G L..c.152,§259(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 CONSTRUCTION':SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR;1.16(CONTAINING MORE THAN 35,000 C.F.,OF EKLOSED SPACE) 9.1 Registered Architect: �---------....._.---.. .Not Applicable ❑ Name(Registrant): o•-�- / P �� p� Registration Number Address C3 717 �z Expiration Date Signature > Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility _.----._.....__:..._..... _____. _.....__ _ .._. _...... Address Registration Number i f Signature Telephone Expiration Date 3 Name Area of Responsibility Address _ Registration Number ____.__....._._._. ,__....._w.._. Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number i _.___.,. _. _. _ .. __....__.__.._._._.:.__..._...._....._.__._....._....._....._..._...._...._..._....._......_.._....................._......_ 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 Signature Telephone Version1.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING :_ Existing Proposed Required by Zoning This column to lie filled in by Building Department Lot Size Frontage Setbacks Front Side L R:£ Rearw _� Building Height iY Bldg. Square Footage Open Space Footage _ % (Lot area minus bldg&paved - - #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 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 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❑1 J Brief Description Ente rief description ere. 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 ❑ 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 ❑ 38 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 56 ❑ U Utility El Specify:'....� �.�.... ._ ...__._..�...�.�.._._..w-..__.___._...._.,_._.__. __._._.__.._ _ M Mixed Use ❑ Specify S Special Use ❑ Specify COMPLETE THIS SECTION IF.EXISTING B;UIL-DING.UNDERGOING.::RENOVATIONS:,ADDITIONS AND/OR CHANGE IN USE Existing Use Group Proposed Use Group: _ _ __....,..d._ . . ._.... _..__.. 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 _ 1 5c St 2nd 2nd rd rd 3 4th 4 th Total Area(so Total Proposed New Construction sf) Total Height(ft) _.._. -- -------- - Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone-nformation: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Department.use,only City of Northampton status of Permif ' Building Department Curb Gut/Dnvpy'v' Pem�t: —= 212 Main Street SewerlSephcAvaNabrllty Room 100 WateNWell Aya�labdlfy SEP 1 82014 Northampton,-MA 01060 Two Sets of Structuraf Flans ph ne 13-587-1240 Fax 413-587-1272 Plat/site`Plans Plumbing&tiaa Other Speetfy RUtT, 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 1.1 Property Address: ...... ._.__.......... Map Lot Unit Zone Overlay District Elm St:District CS District SECTION 2-PROPERTY OWN ERSHIPlAUTH'ORIZED AGENT 2.1 Owner of c d: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: l 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 /9 (a)Building Permit Fee . r 2. Electrical U (b)Estimated Total Cost of w/}--,v�r Construction from 6 _..._ _,..._ __.._............. 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) _ . _..._.. __....__ . 5. Fire Protection _ 6. Total=0 +2+3+4+5) Uv Check Number / 6 6o This Section:For Official Use Only Building Permit Number Date Issued ._Signature:_ Building Commissioner/Inspectorof Buildings Date File#BP-2015-0310 APPLICANT/CONTACT PERSON ALL-TEK BUILDERS INC ADDRESS/PHONE 88G INDUSTRY AVE SPRINGFIELD (413)736-0099 Q PROPERTY LOCATION 264 ELM ST-2ND FLR DR COCHRANE MAP 31A PARCEL 076 000 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 O'er Lp Fee Paid Typeof Construction: RENOVATE 2ND FLR DR COCHRANE'S OFFICE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 76435 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) ��'� CO MA�� PQ —tort.(' co N-{-t g(k LFE C) Asa P 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 1 30 Signature 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. ontact Office of Planning&Development for more information. 264 ELM ST-2ND FLR DR COCHRANE BP-2015-0310 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A-076 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-0310 Project# JS-2015-000308 Est. Cost: $129000.00 Fee: $774.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALL-TEK BUILDERS INC 76435 Lot Size(sq. ft.): Owner: DEMAIO AARON A Zoning: URB(100)/ Applicant: ALL-TEK BUILDERS INC AT. 264 ELM ST - 2ND FLR DR COCHRANE Applicant Address: Phone: Insurance: 88G INDUSTRY AVE (413) 736-0099 O WC SPRINGFIELDMA01104 ISSUED ON.913012014 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR DR COCHRANE'S OFFICE 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 Sivature: FeeType: Date Paid: Amount: Building 9/30/2014 0:00:00 $774.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner