38C-077 (6) 8 EASTHAMPTON RD BP-2016-1220
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C-077 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: vinyl siding 13UILDING PERMIT
Permit# BP-2016-1220
Project# JS-2016-002102
Est. Cost: $8000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEVEN BOULANGER 86013
Lot Size(sq. ft.): 27442.80 Owner: M&S HOLDINGS LTD PARTNERSHIP
toning GI(95)/WP(59)/SC(5)/ Applicant: M & S HOLDINGS LTD PARTNERSHIP
AT. 8 EASTHAMPTON RD
Applicant Address: Phone: Insurance:
8 EASTHAMPTON RD
NORTHAMPTONMA01060 ISSUED ON.4/21/2916 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING
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 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-2016-1220
APPLICANT/CONTACT PERSON M& S HOLDINGS LTD PARTNERSHIP
ADDRESS/PHONE 8 EASTHAMPTON RD NORTHAMPTON01060
PROPERTY LOCATION 8 EASTHAMPTON RD
MAP 38C PARCEL 077 001 ZONE GI(95)/WP(59)/SC(5)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid dM wrt
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL VINYL SIDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO �ION PRESENTED:
A� 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
of ' n elay
y
Sig ure of Building O ficial 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 Building Permit May 15,2000
Northampton
CifY oto
BuildinLin
epartment
rr r
212 Street
LtT4,
� Rom 100 �.North m on, MA 01060. , -1 40 Fax413-587-1272 Cr2SL" "rln0}060RTNAh4. f�,N,M� -
'd� Kn ra ifs ��i
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
NLS dicer Zone Overlay District
Elm St.District CB District:.
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r � �,s�-� �•.� _trot _._..
Name(Print) Current Mailing Address:
y��� ala
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. Bui �� { (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 d
This Section For Official Use Only
Building Permit Number [Fate
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❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other
Brief Description �Entera brief description here.
Of Proposed Work: �V t, \
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 Hi h 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: s
.. ..........
_.... .... ..... .. m _ . �m __ ...,
M Mixed UseE] Specify:
S Special UseElSpecify: 1
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: �` .�� _._ s _ _.. p:
Use Proposed Prop Grou
. ...
p ) ........... .
Existing Hazard Index 780 CMR 34):;1_111111- ,.. _ .�..... .... 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(so
St
1si �_..._..._....
W
. _ _.__ � .., nd €
2nd` y �� 2 . ..�.. .._
__. 3rd
3rd
_,.. ....._ . ._ _ ._
4th 4th
_._._..,.,,.._....,. ___. .._.._. . .._. ._..a
Total Area(so 5 b0 Total roposed New Constructions
( _.
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
S. NORTHAMPTON ZONING Version1.7 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
:
4
Y
Side Ui, R:• L R:
Rear �.
Building Height
Bldg.Square Footage °to (
Open Space Footage %
{Lot area minus bldg&paved i3 6
parking)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0 YES 0
IF YES: enter Book ; Page; and/or Document#' a
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 Obtained , Date Issued:
C. Do any signs exist on the property? YESNO 0
IF YES, describe size, type and location:
c+
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 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 IA
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial',Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERA ICES-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):
r
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
_
Name Area of Responsibility
.___
------_-. --._._._ _.__ ..._...,.�.._. _ ..._.. ..
Address __ Registration Number
� q
Signature Telephone Expiration Date
............ .. _..........__..... .
F
Name Area of Responsibility
.....___. . . __-. .....
i
L............_____., ___.._....W.. _. .. _.....
Address Registration Number
.._ ------------ �.
�.,.................
Signature Telephone Expiration Date
Name Area of Responsibility
r-
Address Registration Number
...... ............
Signature Telephone I Expiration Date
9.3 General Contractor
Not Applicable
CompanyName:
a
..__ _ __ _. .. ______. ______._____.� � _ _ _�__ _. - - 08"6013
Responsible In Charge of Construction
Address
{
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 0 No
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
m—._
as Owner of the subject property
hereby authorize i....m. .m._........ _..__ ......._. .... _... 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.
Sig @41 the_pams,a-nd penalties,of perlury
Print Name
s
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable (�
j
Name of License Holder:
License Numb r
i
Address Expiration D to
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
The Commonwealth of'Massachusetts
Department of IndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
J Boston,MA 021.14-2017
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrici4ns/Plumbers
Applicant Information PleaselPrint Legibly
Name(Business/Organization/Individual): (Y'%
Address:
City/State/Zip: Phone#: �1 3i�J i 5 csy
Are you an employer?Check the appropriate box: Type of project(required):
I.❑ I am a employer with` 4. ❑ I am a general contractor and I
�emplayees (full and/or part-time).
have hired the sub-contractors 6. New construction
2.2 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
wor tng for me in any capacity. employees and have workers'
[No workers' comp. insurance camp.insurance.
$ 9. ❑Building,;addition
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LE]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 Other � U 1
employees. [No workers' 13.P
comp.insurance required.]
*Any applicant that checks box#I 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,
tContractors 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'camp,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 a 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 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 tete Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: r _ C ( L�wa r -.. c'v .4._ E --"r`�r 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#:
City of Northampton 212 :.Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the cgnstruction
activity governed by this Building Permit shall be disposed of in ''a properly
licensed solid waste disposal facility, as defined by MGL c 111, ;S 150A.
Address of the work:
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant
-A- vs---t
Date Signature of Permit Applicant