Loading...
37-018 (8) 722 FLORENCE RD BP-2016-1194 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-018 ' 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-2016-1194 Project# JS-2016-002055 Est. Cost: $4200.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ALEX KOMLEV 103055 Lot Size(sq. ft.): 432550.80 Owner: BIBLE BAPTIST CHURCH THE Zoning: Applicant: ALEX KQMLEV AT. 722 FLORENCE RD Applicant Address: Phone: Insurance: 15 SARAH LANE (413) 586-4739 BELCHERTOWNMA01007 ISSUED ON.•4/21/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 43 SQUARE ROOF POST THIS CARD SO IT IS VISIBLE FROM THF 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 4/21/2016 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1194 I APPLICANT/CONTACT PERSON ALEX KOMLEV ADDRESS/PHONE 15 SARAH LANE BELCHERTOWNI01007(413)586-4739 PROPERTY LOCATION 722 FLORENCE RD MAP 37 PARCEL 018 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Ono 04 Fee Paid Building Permit Filled out Fee Paid Tvneof Construction: STRIP&SHINGLE 43 SQUARE ROQF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildine Plans Included: Owner/Statement or License 103055 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: proved 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 D ti Signature of Build inj 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 thp,strict standards of MGL 40A. Contact Office of Planning& Development for more information. Versionl.7 Commercial Building Permit May 15,2000 ---- Department use only 1212 y of Northampton Status of Permit: _ lding Department Curb Cut/Drivew.ay Permit Main Street Sewer/Septic AvailabilityROOM 100 WaterM/ell Availability ..Mampton, MA01060 Two Sets of Structural Plans of hone, 17-1240 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 . __... .. . . . tZ2 !� �w'iCC Map Lot Unit !" � �'����� Zone Overlay District _ .............. _.._. _...._... _.. .. .._.__ Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ACA c -11- Name(Print) Current Mailing Address: �C�`' c �dt✓l�� 1,0322 Signature � Telephone 2.2 Authorized ent: .......... ............ _........ . ............._ ........ . .._._...... 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 200 (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_Officia-Use-Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date i 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❑ Roofing❑ Change of Use❑ Other Brief Description nter a brief description here. Of Proposed WolLl 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 ❑ 18 1 ❑ B Business ❑ 2A ❑ E Educational ❑ 28 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: j 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 st 2nd 2nd 3rd 3rd ...... ...... _._............__.._........._....__. ._ 4th 4h _.._._.._...._......_..................._............_................ ............................_..: 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❑ i 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 NameArea of Responsibility ... __..... _.__. Address Registration Number Signature Telephone Expiration Date ............................ ............ .............._.. ......._...... ............-........ ._ Name Area of Responsibility Address Registration Number ............ . _... ........ . Signature Telephone Expiration Date .__...... ....-_.... ................... _.. .. _...... _... __...._... ..... _ NameArea of Responsibility _.. Address Registration Number .._......_.......... ..... Signature Telephone I Expiration Date 9.3 General Contractor _ .., Not Applicable ❑ --Company-Name:--- --- _ _ Responsible In Charge of Construction Address Signature Telephone i i i S. NORTHAMPTON ZONIVersionl.7 Commercial Building Permit May 15,2000 NG 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 m...,._. (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 Q YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Pageand/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 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 0 —IF-YES,—describe size,—type and-totafion: 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 2 Northampton Storm Water Management Permit from the DPW is required. 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 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT (e as Owner of the subject property hereby authorize K ��� fl ... . ©� to act on my behalf, in all matters rel ive to work authorized by this building permit application. gnature o ner 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 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder c?/..,/r._ � F. ..._ ..... License Number Address / Expiration Date 386 gnature 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 O No 0 � r The Commonwealth of Massachusetts , Department of Industrial Accidents r Office of Investigations 600 Washington Street T Boston, MA 02111 www.niass.gov/dia Workers' Compensation Insurance Affida-0t: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaiblj Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling !!!l�X�\ 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. ❑ We are a corporation and its 10.7 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no l�.❑ Other employees. [No workers' 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 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. 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 of peJuiy that the information provided above is true and correct. i2nature: Date: 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#: I i AK Construction | I request that you grant a modification to waive the requirement for control construction for the re shingling the roof at 722 Florence RD 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.Thank you for your consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control construction for this project" � Respectfully, A|exKono|ev AK Construction 1SSarah Ln Be|chertnxvn, MAO1OO7