23A-308 (2) Initial Construction Control Document
To be submitted with the building permit application by a
lRegistered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
_
Project Title: �C t.1 �.�
_�,rdt� / "�`'1C1�1 c�-�� � Date:
Property Address; Y_,12!SLAZ
Project: Check one or both as applicable: New construction '`Existing Construction
Project description:
Registration Number: Expiration date: ,am a
registered design professiona4 and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
Architectural j ] Structural ] Mechanical
Fire Protection j ] Electrical j ] Other
for the above named project and that to the best of my knowledge,information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code,(780 C.MR),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 on a regular and periodic basis to:
I. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties fir 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.
Nothing in this document relieves the contractor of its responsibilivy regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'.
Enter in the space to the right a"wet"or VI
electronic signature and seal:
If
Phone number: Entail
Buildin .3�a
Building Official Name: Permit No.: Dete:
Version 06 11 2413
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Business/Organization Name: _ ( .-
Address: �[0 ( V 1 ,� o 0 b
City/State/Zip: Phone#: ` ✓v ��
Are you an employer?Check the appropriate box: Business Type(required):
1.❑ I am a employer with employees(full and/ 5. ❑Retail
or part-time).* 6.IffRestaurant/Bar/Eating Establishment
2.X I am a sole proprietor or partnership and have no 7• ❑Office and/or Sales(incl. real estate,auto,etc.)
employees working for me in any capacity. F Uv')[No workers' comp. insurance required] $• ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have IOX.Manufacturing
no employees. [No workers'comp. insurance required]* 11.❑Health Care
4.F1 We are a non-profit organization,staffed by volunteers,
with no employees. [No workers' comp. insurance req.] 12.ZOther
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check box#1.
I am an employer that is providing workers'compensation insurgV employees. Below is the policy information.
Insurance Company Name:
Insurer's Address:
City/State/Zip:
Policy#or Self-ins.Lic.# Expiration Date:
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 D for insurance coverage verification.
I do hereby c i un er the pains and pe Z es erjur that the information provided ab ve is true and correct.
4j l5�
Si natur . Date:
Phone#:
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.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
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
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT - F
a 't
s Owner of the subject property
%;
, 1
hereby authorize 1 Vtsfr' G E to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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 penalties of perjury.
I Pri N m
i natu 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 36,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
El
116 Pleasant Street, Ste. 331, Easthampon,MA. 01027 Not Applicable
Name(Registrant): w `�
116 Pleasant Street, Ste. 331, Easthampon, MA. 01027 Registration Number
Address v � '
413 529-9434 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 0
Company Name:
Responsible In Charge of Construction
Address _
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size -3�"' �.'�-�"7J_ � �f C4 �„
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height L
Bldg.Square Footage 0 1_ % j„ :
Open Space Footage t�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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book Page and/or Document#;
B. Does the site contain a brook, body of water or wetlands? NO kV DON'T KNOW 0 YES
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO
IF YES, describe size, type and location: Don't know yet.
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
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 Interior Finishing work, addition of 2 ADA compliant restrooms and electrical updates.
Of Proposed Work: 7 y 6 —&'Uz���
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 ❑ 16 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ( ❑
F Factory [z] F-1 ❑ F-2 ✓❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑✓ S-1 IZI S-2 ❑ 513 ❑
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: F-1 Proposed Use Group: F-2;A-2;M;S1 & S2
Existing Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 2,3,&4
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
1St _ 2,120 151 2,120'
2nd 2nd
3m
3`d
4m
4th
Total Area(so 2,120 Total Proposed New Construction (so
2,120
Total Height(ft) 30,21r. � /?I
Total Height ft J
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 [Z] On site disposal system❑
1,
Version 1.7 Commercial Building Permit May 15,2000
..� �� Depertr►lent,use only
L Z 4 20i - , City of Northampton status of Permit:
Building Department Curb Cut/Driveway Permit
lectric, Piumbin 212 Main Street Sewer/Septic Availability
Nortnampto joso�ion8 Room 100
, MA 0 water Mell Aveitability
orthampton, MA 01060 Two Sets of Structural"Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site 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
1.1 Property Address: This section to be completed by office
36 Main Street Map Lot Unit
-Florence,Massachusetts 01062
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Florence Sewing Building,Inc. 5 Middle Street, Florence Massachusetts 01062
Name(Print) l?AOZ CY fu 0—' 7-/it! Current Mailing Address:
Signature Telephone ,-/// Y -T
2.2 Authorized Aaent:
Yy °.
Name(Print) Current Mailing Address:
U 1Q- .f--
Signatur • Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building / hrl� (a) Building Permit Fee
2. Electrical � (b)Estimated Total Cost of
Construction from 6
3. Plumbing _ Building Permit Fee
4. Mechanical(HVAC) O VV�/
5. Fire Protection
6. Total=(1 +2+3+4+5) U Check Number f, c
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-1020
APPLICANT/CONTACT PERSON
ADDRESS/PHONE 5 MIDDLE ST FLORENCE01062
PROPERTY LOCATION 36 MAIN ST-BREWERY n ` �`"
MAP 23A PARCEL 308 001 ZONE GB(100)/ L LA A N 6 f U d �'
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out d69
Fee Paid
Typeof Construction: BREWERY BUILDOUT, FINISH WORK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
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)
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
A—
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. Contact Office of
Planning& Development for more information.
36 MAIN ST- BREWERY BP-2015-1020
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-308 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-2015-1020
Project# JS-2015-001716
Est. Cost: $11300.00
Fee: $8.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. 1): 37461.60 Owner: Brew Practitioners, LLC.
Zoning: GB(100) Applicant: Brew Practitioners, LLC.
AT: 36 MAIN ST - BREWERY
Applicant Address: Phone: Insurance:
33 Hockanum Road
HADLEYMA01035 ISSUED ON:412412015 0:00:00
TO PERFORM THE FOLLOWING WORK:BREWERY BUILDOUT, FINISH WORK
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 Siznature:
FeeType: Date Paid: Amount:
Building 4/24/2015 0:00:00 $8.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner