24B-031 Newman Construction
697 Bridge Road
Florence, MA 01062
Commissioner Hasbrouck September 18, 2015
Subject: Request for Waiver
I request that you grant a modification to waive the requirement for control construction for the roofing
at 312 King Street in Northampton because the work is of a 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.All work will be
completed within the prescriptive requirements of 780 CMR.Thank you for your consideration.
"Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project"
Respectfully,
Cyrus Newman
Cyrus Newman
Newman Construction
697 Bridge Road
Florence, MA 01062
jhaposal Page No. of Pages
NEWMAN'S CONSTRUCTION
697 Bridge Rd.
Northampton, MA 01060 1166
413-586-1093
PROPOSAL SUBMITTED TO PHONE DATE
Wt
STREET JOB NAME
CITY.STATE and ZIP CODE JOB LOCATION
Sr{fnw'ai�J
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
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r proPOSC hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
dollars($
Payment to be made as follows:
yM g
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices.Any alteration or deviation from above specifications Signature
involving extra costs will be executed only upon written orders, and will become an extra g
charge over and above the estimate. All agreements contingent upon strikes, accidents ote:This proposal ma e
or delays beyond our control.Owner to carry fire,tornado and other necessary insurance.
Our workers are fully covered by Workman's Compensation Insurance. withdra n b us if not accepted within days.
�1creptancle of Proposal —The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Si ature �f
to do the work as specified. Payment will be made ass outlined above.
Date of Acceptance: f �, 2 ' / Signa ure
L
The Coninionwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
_r r 600 Washina--ton Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
C J'
Name (Business/Organization/Individual): lf&_5�44� �H.s�-,c✓c��,✓
Address: 4 -17 (a`'t •'n L J .
City/State/Zip: d i"-kj Phone #: 5716
Are you an employer?Check the appro rate box: Type of project(required):
1.❑ I am a employer with 4. 7 I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.$I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. F_�Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp.insurance comp. insurance.$
required.]] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑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.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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 isproviding 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.
I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct.
SiLynature: Date: /
Phone#. '5t1T6 ` A®qS
Official use only. Do not write in this area, to be completed by city or town officiaL
City or Town: PermitUcense#
i
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 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
S. '.W.c_.. __. .. ___ _ _ as Owner of the subject property
IF
hereby authorize _._ 4ww ., _..._ __.__._ _
If
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... ..._. ___. _..__.... .......... . ........ .
Print Name ...:.......:. . .
Ix 7//--57
Signature of caner ent Dafe
SECTION 12-CO STRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: .. ..1►. N. ,W r✓�.._q .. ... . .._ .....Q 6. �. L...� .
License Number
Address Expiration Date
Sig u 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 0 No O
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 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable
....... _.::
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 Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In arge of Construction
7s — �^
Address
SigrQtuw, Telephone
i
i
Version 1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONTN—G7
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ..._...,
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 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Regis ry 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 DONT 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 ]N+*vLv,,:,4 w1S
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
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❑ Roofings
Change of Use❑ Other❑
Brief Description 'Enter a brief description here. Cpu f lr- OV10—Of Proposed Work:.
.._ _ _..... ., _.__ . :N.C?.►�� .�?X12.._ .'�. ...��.ht. .._...._._ .,, :._: . . . __ . ..�... ... ... .:.. .
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 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ 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 ❑ 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: 9 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(sf)
1s� _ 1st
2nd 2nd
--... . .._.. ........ . ....._._ ......
3 rd 3rd
4th ...:... 4 m
..
Total Area (sf) Total Proposed New Construction{sf)
_..........__......_.._.........................
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zne o Information: 7.3 Sewage Disposal System:
Public ❑ Private E] Zone Outside Flood Zone[] Municipal ❑ On site disposal system❑
( Versionl.7 Commercial Building Permit May 15,2000
Department use only
X`ty of Northampton Status of Permit:
SEP
4, B �Iding Department Curb Cut/Driverivay Permit
,n lions 12 Main Street Sewer/Septic Availability
Electri ` ,_. ',z,Kr".,n''""0 Room 100 Water/WeII Availability
Northampton, 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
3 0 a .N C >r Map Lot Unit
J Zone Overlay District
_.._._. ....__....... . ........._.__. Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Ch.x ��v
Name Print Current Mailin Address:
Signature Telephone
2.2 Authorized Agent:
_.... _.
i zw rti AIN.
Name(Print) Current Mailing Address
Signature Telephone 6 °I Q
SECTION 3 -ESTI TED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be `� �� Official Use Only
com feted b permit applicant
_.,_. .
1. 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) Check Number 1,91
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0364
APPLICANT/CONTACT PERSON CYRUS NEWMAN
ADDRESS/PHONE 697 Bridge Road NORTHAMPTON01060(413)586-1093
PROPERTY LOCATION 312 KING ST
MAP 24B PARCEL 031 001 ZONE HB000Z
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: SHINGLE ROOF OVER 1 LAYER&ADD RIDGE VENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 064690
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO,PMATION 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
ruiling Delay
tureial 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.
312 KING ST BP-2016-0364
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B-031 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2016-0364
Project# JS-2016-000581
Est. Cost: $13000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CYRUS NEWMAN 064690
Lot Size(sq.ft.): 29707.92 Owner: GRECO MARY M&ANGELA M MCPEEK& SUSAN PICARD&JUDITH
DUGAN
Zoning: HB(100)/ Applicant: CYRUS NEWMAN
AT. 312 KING ST
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093
NORTHAMPTONMA01060 ISSUED ON.912112015 0:00:00
TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER & ADD RIDGE
VENT
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 9/21/2015 0:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner