38-050 DEMO PERMITS (4) 0114-1" �.� .:�� BP-2006-1263
GIs#: COMMONWEALTH OF MASSACHUSETTS
°' ��► CITY OF NORTHAMPTON
Lot: -001
Permit: BUIIOj
Category: demolition BUILDING PERMIT
Permit# BP-2006-1263
Project# JS-2006-1865
Est.Cost:
Fee: $15.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: S & R CORPORATION 061320
Lot Size(sq.ft.): 226512.00 Owner. HOSPITAL DEVELOPMENT LLC
Zoning:PV Applicant. S & R CORPORATION
AT. 1 PRINCE ST
Applicant Address: Phone: Insurance:
706 BROADWAY ST (978) 441-2000 WC
LOWELLMA01854 ISSUED ON:512512OP6 0.00.00
TO PERFORM THE FOLLOWING WORK:DEMOLITION - BLDG 13
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:
Drivevky 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 $i2nature:
FeeType: Date Paid: Amount,
Building 5/25/2006 0:00:00 $15.00773
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2006-1263
APPLICANT/CONTACT PERSON S&R CORPORATION
ADDRESS/PHONE 706 BROADWAY ST LOWELL (978)441-2000
PROPERTY LOCATION I PRINCE ST
MAP 38A PARCEL 050 001 ZONE PV
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out iaap
Fee Paid
Typeof Construction: DEMOLITION-BLDG 13
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 061320
3 sets of Plans/Plot Plan
THE FLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INY99MATION 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 DeedsTroof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health i Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit fro;mElm Street ssion
Z
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.
Versionl.7 Commercial Buildin Permit May 15,2000
Department use only
City of Northampton �taf0 rmit:
Building Department Crtr , i'eway Permit -
212 Main Street , Sewer/ p Availability
Room 100 AlSter yallability
Northampton, MA 01060 TwoS is of Structural Plans
phone 413-587-1240 Fax 413=587-1272 t, �e Pla .
fr 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
1 Prince Street Map Lot Unit
Northampton, MA
Building #13 Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
MassDevelopment 1 Prince St. /Haskell Build
Name(Print) l/ _ Current Mailing Address:
(41 3 ) 587-631 4
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by 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= 0 +2+3+4 +5) Check Number
This Section For Official Use Only
Building Permit Number / Date
/
/ l G 3 Issued
Signature:
Building Commissioner/Inspector of Buildings Date
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 P Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. Complete demolition of building
Of Proposed Work: including foundations
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 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:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: 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)
15 1 St
2nd 2nd
3rd 3rd
4th 4th
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 Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[-]
Version 1.7 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
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 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 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 0
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:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 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
IF YES,then a Northampton/Storm Water Management Permit from the DPW is required.
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):
Tighe & Bond Engineers �ev,C'
Name Area of Responsibility
53 Southampton Road. Westfield, MA 01085 3'i4-, s4
Address Registration Number
—� 1113-sda-16oO 3G�c.�
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
S&R Corporation, Not Applicable ❑
Company Name:
Thomas Guerette
Responsible In Charge of Construction
706 Broadway St. , Lowell, MA 01854
Address
n �Gli�26 (978 )441 -200
192m—Signature Telephone
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 Q No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
S' ature of Owner Date
1, 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
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Thomas Guerette C S 061320
License Number
18 Longwood Ave. , Londonderry, NH 03053 3/19/2007
Address Expiration Date
` ( 603 ) 488-5042
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 0 No 0
BOARD OF BUILDING/REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 061320
Birthdate: 03/19/1967
., Expires: 03/19/2007 Tr.no: 11076
Restricted: 00
THOMAS J GUERETTE
18 LONGWOD AVE
LONDONDERRY. NH 03053
Commissioner
FROM :S&R.CORP. NORTHAMTON FAX NO. :4135841568 Apr. 08 2006 12:22PM P1
l � Gw
A NiSourm GvrnDany
2025 Roosevelt Ave
P,0.Box#2025
Springlield,MA 01102
Harch 31, 2006
588 CORP
706 BROADWAY 5T
LOWELL KA 01954
Dear S&R CORP,
The address® listed belov hag had the gas Wervioel6)
disconnected and 3a nov ready ;Far demolition.
ADDRESS: i PRINCE ST
TOWN NORTHAMPTON IKA
STATE Ma®eaohueets
nSincerely
Terri Miner
Workforce planning
FROM M :S&R.CORP. NORTHAMTON FAX NO. :4135841568 Apr. 08 2006 12:23PP1 P2
MAR 30 260E 12; 14 FM FR MASS ELEC OUST SERU 532 7631 TO 914135641566
Massa�11 eljusetts Electric
A;N869"ai and Company
March 30,2006
S and R Corp
706 Broadway St.
-Lowell MA 01854
To Whom it May.Concern,
This is to verify that National Grid has removed the electric service aid meter's at 1
-Prince St.,Northampton, Massachusetts, for Building Demolition.
'nticerely,
` twJ
Jim Nichols
Supervisor
Distribution Design
JN/ekp
PO 5Qx$07
PJannampton.MA 010M-0507
413.882.7200
+' TOTAL ?AGE. Oi r
f
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA. 02111
Workers' Compensation Insurance Affidavit
Name bcL;7-em NvSP:r�I
Job Location,1,
r
City_ iUi�,n Jy� ��„V, � Phone (978)441-2000
d I am a homeowner performing all work myself.
(� I am a sole proprietor and have no one working in any capacity.
I am an employer providing workers'compensation for my emp oyees wor ung on this Ia
Company Name. S&R Corporation
Address 706 Broadway Street
City Lowell, MA 01854 Phone# (9-78)441-2000
Insurance Company �7•t/a Policy#WC 1111.25 7 833�o j J/
CJ I am a sole proprieto general contractor or omeowner(circle one)and have hired the
contractors listed below who have the following workers'compensation policies:
Company Name rt/a
address
city Phone#
Insurance Company Policy#
Failure to secure coverage as required under Section 25A of MGL152 can lead to the imposition of
criminal penalties of•a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties
ui the form of a STOP WORK ORDER and a fine of$100.00 per day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage
verification.
I do hereby certifyrapder the pains an�yenalties of perjur,v*at the information provided above is
true and correct.
Signature � .�`7r� P,u seL: ian�t;er Date Sl/f��t�C�
Print Name T�it/7cCS . � Phone-# (978)441-2000
Official use only do not write in this area to be completed by city or town official
City or Town: Permit/license# Building]9d_
Ucettsincheck if immediate response is required Scicetrnt(Wtht
Contact person hone C Other
•
MERICAN
ENVII�Q
m-,Jizl'-.�,,'.,;;,,C�
N State, Hosptai
North Hampton, MA
Buildmos 13
A� Mf
Pi-i-w! Dafisng AE-(-; has perfarrned a visual mspecn,-.tr, f,ir
i it"'S Six ind -;gric .11 1 fad o 1, -tS c�,,ta n i
d rteen The T Bond. survey �,-Jearlv st,3* S "fal !heff...
te
e;lthehe r of � buOdings Or Fnday May 2006 AFC a j S C-)(
and deterrnmed that there are 11u visible asbqstos containing materials eithii
!Ihirieep at to s tIrre Tne mspecttc,)-) was conducted byMr Michael Mc(,,aff rey Ai 3'i , r44
tufMP-f assistance ,�.r if you have any questions please contaci rn, 37-
y off -