32A-260 (5) Parsons mouse
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June 11,2015
Proposed Work on Parsons House,58 Bridge St.:
- Dig full-depth basement and bulkhead(see drawing[BI).
- Replace 24'of rotting sill and lower 4' of post
- Augment original joists with 2x10's, 16"on center(see drawing[C]).
- The original floor has been removed to allow the archaeology to take place;
- It will be reinstalled with a new 3/4" 1x10 shiplap subfloor.
- All exterior cladding that has been removed to perform the repairs shall be replaced
using new materials to match the original.
- All interior finish that has been removed to perform the repairs shall be replaced
using new materials to match the original.
- All disturbed grading shall be regraded.
"`•; The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investia ations
600 Washington Street
rr m a
f Boston, MA 02111 -
www.mass.gov/dig
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): -
Address: 1
City/State/Zip: Phone #: Sf
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 4. 0 I am a general contractor and I
6. F-1 New construction
employees (full and/or part-time).* have hired the sub-contractors
2 I am a sole proprietor or partner- listed on the attached sheet. 7. `Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition.
working for me in any capacity. employees and have workers' 9 0 Building addition
[No workers' comp. insurance comp. insurance.$
5. 7 We are a corporation and its 10.0 Electrical repairs or additions
required.]
3.❑ I a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.7 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 provtdirxg 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: City7State/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 c tify u r ze ains and penalties of perjury that the information provided above is true and correct.
Signature: L Date: Z
Phone#: e
Of 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#:
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW.(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR'r PERMIT
....n.. __._'. A _. __
I, as Owner of the subject property
hereby authorize i 1S___.. 1..""Qn -�'�C.? . .___. .._ ._:.. .r_...._.�.� ..a_
act on my half, in all matters reI 've tow rk authorized by this building permit application
Signature of 0=61 Date
I, �.1r1 __..!_l/► s.7 ..._._ _.._._ ..____. _._.__ ,..._.... ... .. ......__..; 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_underthe pains and Penalties oferlury
Print Na
Signature wner nt Date
SECTION 12-CONSTRUCTION:SERVICES -
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: � r,�..� `V !..L`. .'�.c _,. .. _GS o$4,t 5 Z-
License Number
Address Expir ion Date
Si Telephone 4
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 0
Version 1.7 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;1116(CONTAINING MORE THAN 35,000 C.F.OF EKLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
.._.._......._._ _ ............ . ............
Registration Number
Address
Expiration Date
Signature Telephone Y
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
_� w._.
Name Area of Responsibility
Address Registration Number
. ......... .._�-__._. __...._-.
Signature Telephone I Expiration Date
9.3 General Contractor
N�.._5 _ �/✓� L ._._. �.2!G/�c. r- _... _,_._..._ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
_.
Address
Signat Telephone
Version 1.7 Commercial Building Permit May 15,2000
S. NORTHAMPTON:ZONING '.
Existing Proposed Required by Zoning
This column tofe filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
Rear ?
Building Height ......._.' ---
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 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 .47% DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:WY✓
C. Do any signs exist on the property? YES 46r� NO
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
_ 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 Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15,2000 '
s
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE "
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs4n 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
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 ❑ 113 ❑
B Business ❑ 2A ❑
t
E Educational ❑ 2B I ❑
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:
COMPLETETHIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE:IN USE
_ _..
Existing Use Group: __.. . _...._...._ __. _._._..__ __ _. .m . , _ Proposed Use Group: :_.._ .._ __..._ w. .__,,_.._ .------.._
Existing Hazard Index 780 CMR 34): _,_. ,_; _ ___ _.... m Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFICE USE ONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(so
_ _,..._...._ _.._.... _ ..__�..... _ St
1st
__..,.._. _._ 2nd
2nd
rd
rd 3
4th .� .�..�.�.�_...�...
a
.. _.,:r.......... ..........._._. ....,,....M:....,.._.._
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 Information: 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 Perms#
Building Department Ci.irb CuUDnveway Perms
212 Main Street Sewer/Se.pficAvatfa[ility
Room 100 Wat6M.eli Availability
,SUN ! 2 I AI', - `
Northampton, MA 01060 Tuvo Sets of StructuralPlans
El ctric, F . .,
phone 13-587-1240 Fax 413-587-1272 Plot/Site Plans
-;ions OtherSpecify.
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
.^P } ,,.�d c�� Map Lot Unit
� � �^ 1 � Zone Overlay District
- - Elm'St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2_1 Owner record ' r!L NO r�l0.P/Vi
Name(Print) Current Mailing Address
Nan C11 fie- �r
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address
Signature Telephone
SECTION 3 ESTIMATED CONSTRUGTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building f 5 0O b (a)Building`Permit Fee
2. Electrical
00 (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) (o OQ 0 Check Number
This Section Foe Official Use Only
Building Permit Number Date
Issued
-Signature:_
Building Commissioner/Inspector.of Buildings Date
File#BP-2015-1286
APPLICANT/CONTACT PERSON KRIS THOMSON
ADDRESS/PHONE 362 KENNEDY RD LEEDS01053 (413)549-1027 Q
PROPERTY LOCATION 58 BRIDGE ST
MAP 32A PARCEL 260 001 ZONE URC(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:_STRUCTURAL REPAIRS&NEW BASEMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 084152
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
Dem lit' a
i
i�s'-sue
Signat mg O f icia 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.
58 BRIDGE ST BP-2015-1286
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma:Block: 32A-260 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-2015-1286
Project# JS-2015-002369
Est.Cost: $66000.00
Fee: $396.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KRIS THOMSON 084152
Lot Size(sq.ft.): 21344.40 Owner: NORTHAMPTON HISTORICAL SOCIETY
Zoning URC(100)/ Applicant: KRIS THOMSON
AT. 58 BRIDGE ST
Applicant Address: Phone: Insurance:
362 KENNEDY RD (413) 549-1027 O
LEEDSMA01053 ISSUED ON.611612015 0:00:00
TO PERFORM THE FOLLOWING WORK.STRUCTURAL REPAIRS & NEW BASEMENT
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 Sienature:
FeeType: Date Paid: Amount:
Building 6/16/2015 0:00:00 $396.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner