24B-034 (4) 324 KING ST BP-2016-1056
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24B-034 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRA&ING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2016-1056
Project# JS-2016-001795
Est. Cost: $54000.00
Fee: $378.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: YOUNG ROOFING CO INC 011878
Lot Size(sq. ft.): 87991.20 Owner: BLUEBONNET LLC
Zoning: HB(100)/ Applicant. YOUNGROOFING CO INC
AT. 324 KING ST
Applicant Address: Phone: Insurance:
P O Box 60056 (413) 584-1367 WC
FLORENCEMA01062 ISSUED ON.3/4/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.REPLACE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P. V. 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 $iznature:
FeeType: Date Paid: Amount-,
Building 3/4/2016 0:00:00 $378.00
212 Main Street, Phone(413),587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1056
APPLICANT/CONTACT PERSON YOUNG ROOFING CO INC
ADDRESS/PHONE P O Box 60056 FLORENCE01062(413)584-1367
PROPERTY LOCATION 324 KING ST
MAP 24B PARCEL 034 001 ZONE HB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATIQN CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid Y 16
Building Permit Filled out
Fee Paid
Typeof Construction: REPLACE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 011878
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INVO TION 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
DexAQlitio a
Signature of Bui ding O fici 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.
Version 1.7 Commercial Building Permit May 15,2000
Department use only
Ya: Ci y of Northampton Status of Permit:
B "Iding Department Curb Cut/Driveway Permit -
2016 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability,
oEP1 ;,. . : ,.;, ;,,, p_�,�e, oLilampton, MA 01060 Two Sets of Structural Plans
"" ` 'f"'` Q 7-1240 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
Map Lot Unit
/ Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
i'tCo' 3,�Lq KI o)r 3k
Name(Print) Current Mailing Addre s:
J (� q13 - -�y-
Signature SG- ,C l-e'( � ` Telephone � 3
2.2 Authorized Agent:
kJ16a'd en :
iCJ16a'd %XqW'E
Name(Print) J ✓ Current Mailing Address:
Signature l p
Tele hone
SECTION 3-ESTIMATED CO RUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building - ,� l (a) Building Permit Fee
coc C�-
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) ;> �,1(J Check Number 3
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versiont.7 CommerFial 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[] RoofingX1 Change of Use❑} Other❑
Brief Description Enter a brief description here. Q'—u
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 ❑ 1B ❑
B Business 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ I-1 ❑ I-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)
1st 1St
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 O DON'T KNOW ® YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW YES O
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW ® YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES it NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 CommerFial 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(CO TAINING 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 N me: Ll
Responsible In Char a of Cons ructio
Address
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 Requir d Yes O No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED 1 WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 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.
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.
11,(�)(U
Print Name
Signature of ner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: �y Not Applicable
r7❑
Name of License Holder: � )C�I"J
f License Number
urel&� �JC`(so; 5)1"4
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
The Commonwe lth of Massachusetts
Department of ndustrial Accidents
Office of nvestigations
a l Congress Street,Suite 100
Boston,AIA 02114-2017
www.mass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: (GCI',`::_iE% f loLeTe Wp- 1
City/State/Zip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.® 1 am a employer with 13 4. ® I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.® 1 am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling
ship and have no employees These sub-contractors have g, ® 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 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] + c. 152, §1(4),and we have no
employees. [No workers' 13.0 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 providing workers'compensation insurance for my employees. Below is the policy and job site
information. c
Insurance Company Name: �Jl L'v��
Policy#or Self-ins. Lic. #: 00RoC,G QC*M TIA Expiration Date: I 17
Job Site Address: �l l 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 and r the p4ins and penalties of perjury that the information provided above is true and correct.
Si nature: ��'� Date: 3 I
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.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
young Roofing Co., Tn,.
Date: February 19,2016
OFFICE
144 Texas Rd. To: Bluebonnet Diner 324 King St. Northampton, MA. 01060
Northampton,MA.
01060
Mailing Address job Location: Banquet Room & Rear 12'x 39' storage roof.
PO.Box 60056 g
Florence,MA.01062
PHONE Specifications:
413-584-1367
413-586-9167
cell phone 1. Remove the existing membrane insulation tar and gravel, and insulation down to the decking.
413-531-9821 2. Apply 1/8 inch per foot tapered polyisocyanurate insulation 1.5 inch at the low point. Average R
FAX value 20.15. (Install 3" insulation to the rear entrance.)
413-585-0226
EMAIL 3• Install all necessarywood nailer,
byoung0crockers-m I ° c? 6
dyoungO.crockercom 4. Apply Carlisle's gauge reinforced mechanically attached roofing system.
Contr.Supervisors 5. Flash all walls, edges, and roof penetrations with an approved Carlisle detail.
Lic No.-011878 6. Fabricate and install .032 gauge white aluminum edge metal locked to a kicker strip.
7. Fabricate and install 9 new scupper boxes,
8. Install 3"x4" pipe to one new scupper box and 4" ABS pipe across the lawn.
9. Remove all our roofing debris and dispose of in a legal land fill.
10. Obtain a building permit.
11. Upon completion of the work Carlisle will inspect the job an issue the owner a Fifteen (15) year
Golden Seal Total System warranty. --- -All materials guaranteed to be as specified.Any alterations or deviation 01,373
AUTHORIZED SIGNATURE: �- i
4G' PRESIDENT
from above specifications involving extra cost will be executed only upon
RICHARDYO'
written orders,and will become an extra charge over and above the
estimate.All agreements contingent upon strikes,accidents or delays Acceptance of Proposal-The above specifications and
beyond our control. Owner to carry fire and other necessary insurance. conditions are sa'sfactory and are hereby accepted.You are
All accounts not paid within 30 days are subject to a late charge of I authorized do t work specified. Payment will be made as
1/2%per month on the unpaid balance. In the event that legal action is outlined a ove.
instituted to collect any sums due under this agreement,the undersigned
agrees to pay all cost incurred including reasonable attorney's fees. SIGNATURE '
DATE NCE—F"
�y�
Metcalfe ASSOCI 'ateS ARCHITECTVRE
142 Main St. Northampton, MA, 01060 Tristram W. Metcalfe III, Ma. Reg. 5393
Phone number> 413 586 5775
Cell number> 413 695 8200
Email >twm3cn.com
NCARB,NYS,MA,CT,NH
'. registrations
WMAIA
AIA
February 29,2016
To: Louis Hasbrouck,
Building Commissioner City of Northampton
Puchalski Municipal Building,
212 Main Street,Northampton,MA 01060
RE: Renovations to roof at;
Bluebonnet Diner
324 King St..Northampton,Ma 01060
Loc: Banquet room &rear storage room roof 39ft x 12ft
Dear Louis,
This is a Certification of compliance with code concerning the above project.
Project Description applies as per code in IEBC 2012:
I request that you grant a modification to waive the requirementfor control construction for
the project at Bluebonnet Diner,324 King St.,Northampton,Ma 01060 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.
Thank you for your consideration.
Attached are the Specifications by Young Roofing Co., Inc.
Titled; To;Bluebonnet Diner
324 King St.,Northampton,Ma 01060
Attached specifications are by Young Roofing
If you have any questions please reply. APC
�.-
w
14. me �e'.X"'
Sincerely, ;, ,
r MG�lJ';
C J�
Tris Metcalfe, f � `'� r ��a
Ma Reg Archt#5393 `�,�;� ry Of