38-050 DEMO PERMITS (6) BP-2006-1260
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: demolition BUILDING PERMIT
Permit# BP-2006-1260
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(sa. 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.5/25/2026 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMOLITION - BLDG 6
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 $ignature•
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-2006-1260
APPLICANT/CONTACT PERSON S&R CORPORATION
ADDRESS/PHONE 706 BROADWAY ST LOWELL (978)441-2000
PROPERTY LOCATION 1 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
Building Permit Filled out
Fee Paid
Typeof Construction: DEMOLI ION-BLDG 6
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 FOLLOWING ACTION HAS BEEN TAKEN ON TRIS APPLICATION BASED ON
INFO.WqATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDE4t:§
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 'roof 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 ommission
01
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.
f
Versionl.7 Commercial Building Pennit May 15,2000
Department use only
City of Northampton status of permit:
Building Department Curb Cut/Driveway'Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Avallability
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
47 L v: -
1.1 Property Address:
n This section to be completed by office
1 Prince Stree �� ap Lot Unit
Northampton, MA
Building #6 Zone Overlay District
dt.District CB District
SECTION 2-PROPERTY OWN ERSHIP/AUT1 6RIZIiMAGENT
2.1 Owner of Record:
MassDevelopment 1 Prince Street/Haskell Bld
Name(Print) Current Mailing Address:
Sa •^ o /°. e /- ter (41 3 ) 5 87-6 31 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 3
This Section For Official Use Only
Building Permit Number Is
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 ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 36
ElM Mercantile El4 11
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)
1 SI 1 sr
2nd 2nd
3rd 3rd
4`h 4m
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: F7.3ewage Disposal System:
Public Private [— Zone Outside Flood Zone❑ ipal ❑ On site disposal system❑
8. NORTHAMPTON ZONING Version 1.7 Commercial Building Permit May 15,2000
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 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
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on the property? YES U 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 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 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 � ; ►u Ii 11 Cv�
Name Area of Responsibility
53 Southampton Road. Westfield, MA 01 085 51- -7L`3+
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
S&R Corporation, Not Applicable ❑
Company Name:
Thomas Guerette
Responsible In Charge of Construction
706 Broadway St. , Lowell, MA 01854
Address
4k& (978 )441 -20
4�k&9&� - 0 978 )441 -200
Signature Telephone
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 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.
Signatur of Owner Date
I' 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
: CS 061320
License Number
18 Longwood Ave. , Londonderry, NH 03053 3/19/2007
Address Expiration Date
( 603 ) 488-5042
Signature Telephone
I -__F_ I
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: 03/1912007 Tr.no: 11076
Restricted: 00
THOMAS J GUERETTE
18 AVE c /
LONDONDERRY, NH 03053
Commissioner
{
FROM :S&R.CORP. NORTHAMTON FAX NO. :4135841568 Apr. 08 2006 12:22PM P1
A N/Source Company
2025 RvvseveltAve
P,O.Box#=5
Springtlpld,ML aru
Marais 31, 2006
90 CORP
706 BROADWAY ST
LOWELL KA 01954
Dear SU CORP,
The addreas listed belov rat had tho gas pervicele)
dis—nected and 3a now rvady :For demolition.
ADDRESS: i PRINCE ST
TOWN ; NORTHAJIPTON IIA
STATE Massachusetts
Sincerely
Terri Miner
Workforce planning
FROM :S&R. CORP. NORTHAMTON FAX NO. :413$241562 Apr. 82 2006 12:23PM P2
—._. MAR 30 26C E 12; 14 FM FR MASS EL.EC CUST SERtJ 592 7581 TO S 141358415GS
Massachusetts F,lectr%c
kNatiaad Grid company
March 30,2006
S and R Corp
706 Broadway St.
Lowell MA 01854
To Whom It May.Concern,
This is to verify that National Grid has removed the electric service and meter's at 1
Prince St.,Northampton, Massachusetts, for Building Demolition.
rtcerely,
1�J ,
Jim N'ichots
Supervisor
Distribution Dosign
JN/ekp
PO 9os 507
NOrmampton.MA 01061-0507
41$M2,72oo
��' TOTAL ?AGE. r 1 :t
The Commonwealth of Massachusetts
1 Department of Industrial Accidents
ft ho-s k
�a Office of Investigations
600 Washington Street
` r Boston, MA. 02111
Workers' Compensation Insurance Affidavit
Nacre bc,7 em
e /lt73/rTca.l
Job Location.I_ TNG 7�L-, Z".
AeQ2LfZj 'r-;-,,v /7?/! Phone (978)441-2000
❑ 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 employees wor cng on u aog 21
Company Name: S&R Corpora-t-ion
Address 706 Broadway Street
City Lowell, MA 01854 Phone# (978)441-2000
Insurance Company L� j Mr�7i/cc/ Policy#WC 111125 7839OiI/
t
Cj I am a sole proprieto -general coutractor or omeowner(circle one)and have hired the
contractors listed-below who have the following workers'compensation policies:
Company Name n/a
address
city Phone#
Insurance Company Policy#
Failure to secure coverage as required under Section 25A of MGL'1.52 can lead to the imposition of
criminal penalties of fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties
m 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 oflavestigations of the DIA for coverage
verification.
I do hereby certify der the pains and penalties of perjurv*at the information provided above is
true and correct. /
Signature s - -�-o Ter_ �la.�QU.rr Date 5-z_11 ,�,.!Wt1z
Print Namecr�ccs r e �rtr Phone-# (978)441-2000
Official use only do not write in this area to be completed by city or to%%m official
City or Town: Permit/license# Building ocpt
Ucensing Gd.
l_l check if immediate response is required S-Clminen
It—Ith P`
hone x Otho
contact person
pOlhcr
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